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The Burden of Antipsychotic-Induced Weight Gain and Metabolic Syndrome in Children

Antipsychotic medications are critical to child and adolescent psychiatry, from the stabilization of psychotic disorders like schizophrenia, bipolar disorder, and psychotic depression to behavioral treatment of autism spectrum disorder, tic disorders, and pediatric aggression. While effective, these...

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Autores principales: Libowitz, Mark R., Nurmi, Erika L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994286/
https://www.ncbi.nlm.nih.gov/pubmed/33776816
http://dx.doi.org/10.3389/fpsyt.2021.623681
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author Libowitz, Mark R.
Nurmi, Erika L.
author_facet Libowitz, Mark R.
Nurmi, Erika L.
author_sort Libowitz, Mark R.
collection PubMed
description Antipsychotic medications are critical to child and adolescent psychiatry, from the stabilization of psychotic disorders like schizophrenia, bipolar disorder, and psychotic depression to behavioral treatment of autism spectrum disorder, tic disorders, and pediatric aggression. While effective, these medications carry serious risk of adverse events—most commonly, weight gain and cardiometabolic abnormalities. Negative metabolic consequences affect up to 60% of patients and present a major obstacle to long-term treatment. Since antipsychotics are often chronically prescribed beginning in childhood, cardiometabolic risk accumulates. An increased susceptibility to antipsychotic-induced weight gain (AIWG) has been repeatedly documented in children, particularly rapid weight gain. Associated cardiometabolic abnormalities include central obesity, insulin resistance, dyslipidemia, and systemic inflammation. Lifestyle interventions and medications such as metformin have been proposed to reduce risk but remain limited in efficacy. Furthermore, antipsychotic medications touted to be weight-neutral in adults can cause substantial weight gain in children. A better understanding of the biological underpinnings of AIWG could inform targeted and potentially more fruitful treatments; however, little is known about the underlying mechanism. As yet, modest genetic studies have nominated a few risk genes that explain only a small percentage of the risk. Recent investigations have begun to explore novel potential mechanisms of AIWG, including a role for gut microbiota and microbial metabolites. This article reviews the problem of AIWG and AP metabolic side effects in pediatric populations, proposed mechanisms underlying this serious side effect, and strategies to mitigate adverse impact. We suggest future directions for research efforts that may advance the field and lead to improved clinical interventions.
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spelling pubmed-79942862021-03-27 The Burden of Antipsychotic-Induced Weight Gain and Metabolic Syndrome in Children Libowitz, Mark R. Nurmi, Erika L. Front Psychiatry Psychiatry Antipsychotic medications are critical to child and adolescent psychiatry, from the stabilization of psychotic disorders like schizophrenia, bipolar disorder, and psychotic depression to behavioral treatment of autism spectrum disorder, tic disorders, and pediatric aggression. While effective, these medications carry serious risk of adverse events—most commonly, weight gain and cardiometabolic abnormalities. Negative metabolic consequences affect up to 60% of patients and present a major obstacle to long-term treatment. Since antipsychotics are often chronically prescribed beginning in childhood, cardiometabolic risk accumulates. An increased susceptibility to antipsychotic-induced weight gain (AIWG) has been repeatedly documented in children, particularly rapid weight gain. Associated cardiometabolic abnormalities include central obesity, insulin resistance, dyslipidemia, and systemic inflammation. Lifestyle interventions and medications such as metformin have been proposed to reduce risk but remain limited in efficacy. Furthermore, antipsychotic medications touted to be weight-neutral in adults can cause substantial weight gain in children. A better understanding of the biological underpinnings of AIWG could inform targeted and potentially more fruitful treatments; however, little is known about the underlying mechanism. As yet, modest genetic studies have nominated a few risk genes that explain only a small percentage of the risk. Recent investigations have begun to explore novel potential mechanisms of AIWG, including a role for gut microbiota and microbial metabolites. This article reviews the problem of AIWG and AP metabolic side effects in pediatric populations, proposed mechanisms underlying this serious side effect, and strategies to mitigate adverse impact. We suggest future directions for research efforts that may advance the field and lead to improved clinical interventions. Frontiers Media S.A. 2021-03-12 /pmc/articles/PMC7994286/ /pubmed/33776816 http://dx.doi.org/10.3389/fpsyt.2021.623681 Text en Copyright © 2021 Libowitz and Nurmi. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Libowitz, Mark R.
Nurmi, Erika L.
The Burden of Antipsychotic-Induced Weight Gain and Metabolic Syndrome in Children
title The Burden of Antipsychotic-Induced Weight Gain and Metabolic Syndrome in Children
title_full The Burden of Antipsychotic-Induced Weight Gain and Metabolic Syndrome in Children
title_fullStr The Burden of Antipsychotic-Induced Weight Gain and Metabolic Syndrome in Children
title_full_unstemmed The Burden of Antipsychotic-Induced Weight Gain and Metabolic Syndrome in Children
title_short The Burden of Antipsychotic-Induced Weight Gain and Metabolic Syndrome in Children
title_sort burden of antipsychotic-induced weight gain and metabolic syndrome in children
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994286/
https://www.ncbi.nlm.nih.gov/pubmed/33776816
http://dx.doi.org/10.3389/fpsyt.2021.623681
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