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Second generation antipsychotics (SGAs) for non-psychotic disorders in children and adolescents: a review of the randomized controlled studies.
Eur Neuropsychopharmacol. 2011 Aug; 21(8):600-20.EN

Abstract

In children and adolescents the Second Generation Antipsychotics (SGAs) represent the class of psychotropic drugs whose use has grown more significantly in recent years: they are primarily used for treatment of patients with disruptive behavior disorders, mood disorders and pervasive developmental disorders or mental retardation. In order to compare the efficacy and tolerability of antipsychotics against placebo or each other, a systematic Medline/PubMed search for randomized, double blind studies on SGA in patients younger than 18 years of age at enrollment, was conducted. Papers on schizophrenia, discussed in another article of this specific issue, were excluded by the efficacy analysis. A set of standard efficacy and safety indices, such as treatment effect sizes (ES), the Numbers Needed to Treat (NNT) and Numbers Needed to Harm (NNH), was used to compare medications. 32 studies analyzing efficacy and/or tolerability of SGAs in children and adolescents with bipolar, autistic or disruptive behavior disorders, and Tourette syndrome were identified. SGAs efficacy on mania, extreme mood variability, irritability, aggression and disruptive behavior appears to be greater than for psychotic symptoms in schizophrenia: average NNT was 2-5, whereas for schizophrenia it varies between 3 for risperidone and 10 for olanzapine, quetiapine, and aripiprazole. As for schizophrenia, different SGAs show a similar efficacy for specific non-psychotic disorders, but they significantly differ in their safety profile. In randomized studies, adverse effects were usually relatively minor, easily predictable and manageable, whereas long-term open-label studies have indicated that some adverse event, such as the metabolic effects, may be severe and potentially life threatening on the long-term. Taken together, these findings suggest that the choice of a specific treatment should be guided primarily by the safety profile of specific antipsychotics, considering specific risk factors (i.e. obesity and BMI, family history of diabetes or cardiovascular disorder, etc) for the single patient.

Authors+Show Affiliations

Centre for Pharmacological Therapy in Child & Adolescent Neuropsychiatry, Department of Neuroscience "B.B. Brodie", University of Cagliari, Italy. azuddas@unica.itNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

21550212

Citation

Zuddas, Alessandro, et al. "Second Generation Antipsychotics (SGAs) for Non-psychotic Disorders in Children and Adolescents: a Review of the Randomized Controlled Studies." European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology, vol. 21, no. 8, 2011, pp. 600-20.
Zuddas A, Zanni R, Usala T. Second generation antipsychotics (SGAs) for non-psychotic disorders in children and adolescents: a review of the randomized controlled studies. Eur Neuropsychopharmacol. 2011;21(8):600-20.
Zuddas, A., Zanni, R., & Usala, T. (2011). Second generation antipsychotics (SGAs) for non-psychotic disorders in children and adolescents: a review of the randomized controlled studies. European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology, 21(8), 600-20. https://doi.org/10.1016/j.euroneuro.2011.04.001
Zuddas A, Zanni R, Usala T. Second Generation Antipsychotics (SGAs) for Non-psychotic Disorders in Children and Adolescents: a Review of the Randomized Controlled Studies. Eur Neuropsychopharmacol. 2011;21(8):600-20. PubMed PMID: 21550212.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Second generation antipsychotics (SGAs) for non-psychotic disorders in children and adolescents: a review of the randomized controlled studies. AU - Zuddas,Alessandro, AU - Zanni,Roberta, AU - Usala,Tatiana, Y1 - 2011/05/06/ PY - 2010/09/21/received PY - 2011/03/29/revised PY - 2011/04/03/accepted PY - 2011/5/10/entrez PY - 2011/5/10/pubmed PY - 2011/12/13/medline SP - 600 EP - 20 JF - European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology JO - Eur Neuropsychopharmacol VL - 21 IS - 8 N2 - In children and adolescents the Second Generation Antipsychotics (SGAs) represent the class of psychotropic drugs whose use has grown more significantly in recent years: they are primarily used for treatment of patients with disruptive behavior disorders, mood disorders and pervasive developmental disorders or mental retardation. In order to compare the efficacy and tolerability of antipsychotics against placebo or each other, a systematic Medline/PubMed search for randomized, double blind studies on SGA in patients younger than 18 years of age at enrollment, was conducted. Papers on schizophrenia, discussed in another article of this specific issue, were excluded by the efficacy analysis. A set of standard efficacy and safety indices, such as treatment effect sizes (ES), the Numbers Needed to Treat (NNT) and Numbers Needed to Harm (NNH), was used to compare medications. 32 studies analyzing efficacy and/or tolerability of SGAs in children and adolescents with bipolar, autistic or disruptive behavior disorders, and Tourette syndrome were identified. SGAs efficacy on mania, extreme mood variability, irritability, aggression and disruptive behavior appears to be greater than for psychotic symptoms in schizophrenia: average NNT was 2-5, whereas for schizophrenia it varies between 3 for risperidone and 10 for olanzapine, quetiapine, and aripiprazole. As for schizophrenia, different SGAs show a similar efficacy for specific non-psychotic disorders, but they significantly differ in their safety profile. In randomized studies, adverse effects were usually relatively minor, easily predictable and manageable, whereas long-term open-label studies have indicated that some adverse event, such as the metabolic effects, may be severe and potentially life threatening on the long-term. Taken together, these findings suggest that the choice of a specific treatment should be guided primarily by the safety profile of specific antipsychotics, considering specific risk factors (i.e. obesity and BMI, family history of diabetes or cardiovascular disorder, etc) for the single patient. SN - 1873-7862 UR - https://www.unboundmedicine.com/medline/citation/21550212/Second_generation_antipsychotics__SGAs__for_non_psychotic_disorders_in_children_and_adolescents:_a_review_of_the_randomized_controlled_studies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0924-977X(11)00070-8 DB - PRIME DP - Unbound Medicine ER -