New Predictors May Determine Metabolic Risk in Kids on Atypicals

In the first study, which included more than 300 children with mental health disorders, those who were treated with SGAs had a 30-fold higher risk of having metabolic syndrome than their counterparts who did not receive such medications. Of those treated with the drugs, a large waist circumference was a more sensitive test than a high body mass index in identifying who had metabolic syndrome.

In the second study, it included more than 200 child psychiatric inpatients, those carrying a specific gene variant were almost 6 times more likely to develop metabolic syndrome after taking SGAs than children without the variant.

Coauthor Constadina Panagiotopoulos, MD, assistant professor in the Department of Pediatrics at the University of British Columbia stated that, "There are a lot of prescriptions happening, with many of them for off-label indications in children." "So anything we can do to understand and mitigate long-term risk is really important." Dr. Panagiotopoulos added that waist circumference is a simple screening tool in this patient population and should become part of metabolic monitoring protocols.

"Clinicians need to be aware of the risks of [SGAs] and should carefully balance that against the benefits of these medications. And if they're going to continue prescribing these medications, they need to incorporate monitoring as a standard clinical practice," she said.

"Metabolic monitoring has been relatively low in adults and even lower in kids in tertiary care institutions. But we found that a child carrying weight around their middle is a risk factor for other metabolic complications and is a measurement that needs to be used."

According to the investigators, prescriptions of atypical antipsychotics for children have risen in North America over the last decade by 6- to 10-fold.

"Despite limited approvals by the Food and Drug Administration for children, these medications are used to treat a wide variety of diagnoses and symptoms in a population with still growing and developing physiology," they write.

Several previous studies have suggested a link between these medications and various metabolic side effects in adults, including increased risk for cardiovascular disease. They have also been linked to rapid weight gain and increased incident diabetes in children.

In a second study, Dr. Panagiotopoulos and colleagues sought to determine whether children with the methylenetetrahydrofolate reductase (MTHFR) C677T variant were at increased risk for developing metabolic syndrome when taking SGAs.

The specific variant was chosen because of past research showing a link between it and metabolic syndrome in adults with schizophrenia, and between it and cardiovascular disease in adults even with no psychiatric illness. And the results showed that 15% of the children treated with SGAs had metabolic syndrome vs 2% of the SGA-naive children (OR, 8.113; P < .05).

"This is the first report of an underlying biological factor predisposing children to complications associated with SGA medication use. However, we need to do more research before this can be translated into clinical practice," said Dr. Panagiotopoulos.

Can J Psychiatry. 2012;57:34-44. Transl Psychiatry. Published online January 24, 2012