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Some Antipsychotic Drugs Reduce Insulin Sensitivity in Children

http://www.medscape.com/viewarticle/703831?src=mpnews&spon=12&uac=89474MT
American Psychiatric Association 162nd Annual Meeting: Abstract NR5-030. Presented May 19, 2009.

APA 2009: Atypical Antipsychotics Linked to Rapid, Adverse Metabolic Changes in Children
Caroline Cassels
--atypical antipsychotics in children-->improvement in behavior: decr aggression, irrit, disruption
--but also assoc with rapid adverse metabolic changes
--12 weeks of initial tx-->significant mean incr in adiposity, % body fat, decr in insulin sensitivity
--also linked to significant incr in BMI percentile and fasting plasma TG's
--preliminary results from Metabolic Effects of Antipsychotics in Children (MEAC) study
--presented 162nd APA Annual Meeting
--5-year study funded by the National Institute of Mental Health (NIMH)
--directed by John Newcomer, MD, Washington University School of Medicine
--kids studied were 6-18 yrs with Aberrant Behavior Checklist (ABC) irritability subscale scores >18
--randomized to 12 weeks of open-label treatment with olanzapine (Zyprexa, Lilly), risperidone (Risperdal, Janssen), or aripiprazole (Abilify, Otsuko/Bristol-Myers Squibb)
--used 18 as cutoff on ABC subscale because same cutoff was used in other studies
--many of these kids have been suspended from school or near to being hospitalized
--pop enrolled had not been helped by other approaches (which other approaches?)
--kids screened for Dxs assoc with aggression and irritability, incl: depression, ADHD
--if kids found to have these Dxs they were referred back to primary care doc for usual tx
--population was treatment naive
--randomized to 1 or 3 study meds
--monitored weekly to detect metabolic change
--primary end points: DEXA of body composition, MRI of abdomen, insulin sensitivity with stable isotopomer tracing during hyperinsulinemic-euglycemic clamp conditions
--"According to Dr. Nicol, MEAC is 1 of the first studies to look at a treatment-naive pediatric population and is the only study in children taking antipsychotics to date that is using gold-standard measures of adiposity and insulin sensitivity."
--preliminary results for first 57 kids: 12 weeks of initial antipsychotic tx assoc w/
1) significant mean increases from baseline in DEXA total fat (2.74 kg) and
2) DEXA total percent body fat (2.97%),
3) associated mean decrease in whole-body insulin sensitivity
--BMI percentile increased 14.8 points
--fasting plasma triglycerides mean increased by 18.1 mg/dL
--marked reductions in the ABC irritability score, with a mean drop of 15.37 points
--Lawrence Maayan, MD, at Nathan S. Kline Institute for Psychiatric Research at New York University,
already knew that "these agents cause weight gain, especially with risperidone and olanzapine"
--he is looking forward to knowing the differences between the 3 drugs studied re: metab effects
--"Certainly there are good data out there showing that olanzapine is most likely to cause weight gain in susceptible individuals; risperidone seems to be somewhere in the middle, although it appears it is more likely to cause weight gain in kids; and the picture for aripiprazole is not clear."
Tags: adhd, depression, diabetes, insulin, obesity, parenting, pharmaceuticals, psych
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