Experts Call for Better General Medical Care of Young People on Antipsychotics

An NIMH-funded study of metabolic effects of antipsychotics in children demonstrated that antipsychotic-induced increases in adiposity were associated with adverse changes in insulin sensitivity measured for adipose and hepatic tissue.

This finding is from the Metabolic Effects of Antipsychotics in Children study (MEAC) and was presented by John Newcomer, M.D., executive vice dean and professor of clinical biomedical science at Florida Atlantic University, at APA's 2015 annual meeting in Toronto today. The study was discussed in the symposium “It’s About Time! Improving Physical Health Outcomes in Young People Prescribed Antipsychotic Medications.”

In the study, antipsychotic-naive youth ages 6 to 18 with clinically significant aggression/irritability in the setting of one or more DSM-IV disruptive behavior disorders were randomized to 12 weeks of treatment with aripiprazole, olanzapine, or risperidone. During 12 weeks of exposure, differential effects of treatment were observed on measures of adiposity and other endpoints.

Although irritability/aggression subscale scores improved, after 12 weeks there were significant antipsychotic-induced increases in adiposity leading to changes in insulin sensitivity. “Clinicians and health care systems can beneficially modify patient risk through use of monitoring and interventions, including appropriate referrals and use of medications with lower potential for adverse metabolic effects,” Newcomer said.

He was joined in the symposium by Jackie Curtis, M.D., clinical director of Youth Mental Health at South Eastern Sydney Local Health District in Australia. She described results from an ongoing study showing that a multidisciplinary approach may be able to reduce antipsychotic-induced weight gain in youth. The study involved 28 young people, ages 15 to 25, with first episode psychosis who were randomly enrolled into the Keeping the Body in Mind Program (BMP), an intervention program that offers weekly individualized dietetic monitoring and education, a prescription for exercise with a trainer, and group education.

Sixteen youth received BMP, while the remaining youth served as controls. After 12 weeks, the results showed that those enrolled in BMP had a weight gain of 1.8 kilograms compared with 7.8 kilograms in the control group. Change in waist circumference was seven times greater in the control group than the intervention group. Blood pressure, lipids, and glucose did not differ among the group. The researchers concluded that multidisciplinary early lifestyle interventions may be beneficial in reducing antipsychotic-induced weight gain and may be an important means of maintaining or achieving physical health in patients with psychosis.