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Neuromotor Adverse Effects in 342 Youth During 12 Weeks of Naturalistic Treatment With 5 Second-Generation Antipsychotics.
J Am Acad Child Adolesc Psychiatry. 2015 Sep; 54(9):718-727.e3.JA

Abstract

OBJECTIVE

Second-generation antipsychotic (SGA) effects in youth were monitored to quantify extrapyramidal side effects (EPS) and to identify risk profiles for treatment-emergent EPS.

METHOD

Data were analyzed for the nonrandomized, prospective Second-generation Antipsychotic Treatment Indications, Effectiveness and Tolerability in Youth (SATIETY) inception cohort study. EPS were assessed at baseline and 4, 8, and 12 weeks after naturalistic SGA initiation for schizophrenia, mood, disruptive behavior, and autism spectrum disorders using the Simpson-Angus Scale (SAS), Barnes Akathisia Scale, Abnormal Involuntary Movement Scale (AIMS), and Treatment Emergent Side Effect Scale. Drug-induced parkinsonism was defined by incident mean SAS score >0.33, anticholinergic initiation, or increasing total SAS score ≥2 in patients with baseline EPS.

RESULTS

In 342 youth aged 13.6 ± 3.5 years (male = 58.2%, antipsychotic-naive = 65.8%), 15.2% developed drug-induced parkinsonism. Raw SGA-grouped drug-induced parkinsonism rates were as follows: quetiapine = 1.5%, olanzapine = 13.8%, risperidone = 16.1%, ziprasidone = 20.0%, and aripiprazole = 27.3%. SGA type, dose, higher age, and lower baseline functioning were jointly associated with drug-induced parkinsonism (R(2) = 0.18; p < .0001). Controlling for these factors, drug-induced parkinsonism rates were significantly lower only for quetiapine and olanzapine. Subjectively reported EPS (5%), EPS-related treatment discontinuation (3.3%), and anticholinergic initiation (3%) were infrequent. Anticholinergic initiation was most frequent with risperidone (10.2%; p = .0004). Treatment-emergent dyskinesia ranged from 4.5% (aripiprazole) to 15.5% (olanzapine). SGA type, younger age, white race/ethnicity, and baseline AIMS were jointly associated with treatment-emergent dyskinesia (R(2) = 0.31; p < .0001). Controlling for these factors, treatment-emergent dyskinesia rates differed among SGA subgroups, with higher rates with olanzapine and ziprasidone. At baseline, psychostimulant use was associated with dyskinesia, and number of psychotropic comedications was associated with subjective EPS.

CONCLUSION

In youth, SGA-related EPS rates did not generally exceed those reported in adults, with particularly low rates with quetiapine and olanzapine.

Authors+Show Affiliations

The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY; Charité Berlin, Berlin.The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY; Feinstein Institute for Medical Research, Manhasset, NY.The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY.New York Methodist Hospital, Brooklyn, NY.The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY.The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY.The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY; Feinstein Institute for Medical Research, Manhasset, NY; Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, NY.The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY; Feinstein Institute for Medical Research, Manhasset, NY.The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY; Feinstein Institute for Medical Research, Manhasset, NY; Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, NY. Electronic address: ccorrell@nshs.edu.

Pub Type(s)

Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26299293

Citation

Carbon, Maren, et al. "Neuromotor Adverse Effects in 342 Youth During 12 Weeks of Naturalistic Treatment With 5 Second-Generation Antipsychotics." Journal of the American Academy of Child and Adolescent Psychiatry, vol. 54, no. 9, 2015, pp. 718-727.e3.
Carbon M, Kapoor S, Sheridan E, et al. Neuromotor Adverse Effects in 342 Youth During 12 Weeks of Naturalistic Treatment With 5 Second-Generation Antipsychotics. J Am Acad Child Adolesc Psychiatry. 2015;54(9):718-727.e3.
Carbon, M., Kapoor, S., Sheridan, E., Al-Jadiri, A., Azzo, S., Sarkaria, T., Kane, J. M., Saito, E., & Correll, C. U. (2015). Neuromotor Adverse Effects in 342 Youth During 12 Weeks of Naturalistic Treatment With 5 Second-Generation Antipsychotics. Journal of the American Academy of Child and Adolescent Psychiatry, 54(9), 718-e3. https://doi.org/10.1016/j.jaac.2015.06.015
Carbon M, et al. Neuromotor Adverse Effects in 342 Youth During 12 Weeks of Naturalistic Treatment With 5 Second-Generation Antipsychotics. J Am Acad Child Adolesc Psychiatry. 2015;54(9):718-727.e3. PubMed PMID: 26299293.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neuromotor Adverse Effects in 342 Youth During 12 Weeks of Naturalistic Treatment With 5 Second-Generation Antipsychotics. AU - Carbon,Maren, AU - Kapoor,Sandeep, AU - Sheridan,Eva, AU - Al-Jadiri,Aseel, AU - Azzo,Sally, AU - Sarkaria,Tania, AU - Kane,John M, AU - Saito,Ema, AU - Correll,Christoph U, Y1 - 2015/07/07/ PY - 2015/02/09/received PY - 2015/06/23/revised PY - 2015/06/30/accepted PY - 2015/8/25/entrez PY - 2015/8/25/pubmed PY - 2016/11/2/medline KW - dyskinesia KW - extrapyramidal KW - parkinsonism KW - second-generation antipsychotic KW - youth SP - 718 EP - 727.e3 JF - Journal of the American Academy of Child and Adolescent Psychiatry JO - J Am Acad Child Adolesc Psychiatry VL - 54 IS - 9 N2 - OBJECTIVE: Second-generation antipsychotic (SGA) effects in youth were monitored to quantify extrapyramidal side effects (EPS) and to identify risk profiles for treatment-emergent EPS. METHOD: Data were analyzed for the nonrandomized, prospective Second-generation Antipsychotic Treatment Indications, Effectiveness and Tolerability in Youth (SATIETY) inception cohort study. EPS were assessed at baseline and 4, 8, and 12 weeks after naturalistic SGA initiation for schizophrenia, mood, disruptive behavior, and autism spectrum disorders using the Simpson-Angus Scale (SAS), Barnes Akathisia Scale, Abnormal Involuntary Movement Scale (AIMS), and Treatment Emergent Side Effect Scale. Drug-induced parkinsonism was defined by incident mean SAS score >0.33, anticholinergic initiation, or increasing total SAS score ≥2 in patients with baseline EPS. RESULTS: In 342 youth aged 13.6 ± 3.5 years (male = 58.2%, antipsychotic-naive = 65.8%), 15.2% developed drug-induced parkinsonism. Raw SGA-grouped drug-induced parkinsonism rates were as follows: quetiapine = 1.5%, olanzapine = 13.8%, risperidone = 16.1%, ziprasidone = 20.0%, and aripiprazole = 27.3%. SGA type, dose, higher age, and lower baseline functioning were jointly associated with drug-induced parkinsonism (R(2) = 0.18; p < .0001). Controlling for these factors, drug-induced parkinsonism rates were significantly lower only for quetiapine and olanzapine. Subjectively reported EPS (5%), EPS-related treatment discontinuation (3.3%), and anticholinergic initiation (3%) were infrequent. Anticholinergic initiation was most frequent with risperidone (10.2%; p = .0004). Treatment-emergent dyskinesia ranged from 4.5% (aripiprazole) to 15.5% (olanzapine). SGA type, younger age, white race/ethnicity, and baseline AIMS were jointly associated with treatment-emergent dyskinesia (R(2) = 0.31; p < .0001). Controlling for these factors, treatment-emergent dyskinesia rates differed among SGA subgroups, with higher rates with olanzapine and ziprasidone. At baseline, psychostimulant use was associated with dyskinesia, and number of psychotropic comedications was associated with subjective EPS. CONCLUSION: In youth, SGA-related EPS rates did not generally exceed those reported in adults, with particularly low rates with quetiapine and olanzapine. SN - 1527-5418 UR - https://www.unboundmedicine.com/medline/citation/26299293/Neuromotor_Adverse_Effects_in_342_Youth_During_12_Weeks_of_Naturalistic_Treatment_With_5_Second_Generation_Antipsychotics_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-8567(15)00398-6 DB - PRIME DP - Unbound Medicine ER -