[The metabolic syndrome and antipsychotics in children and adolescents]

Significant weight gain is a well known side-effect of atypical (second generation) antipsychotics. In recent years there is a growing body of evidence that atypical antipsychotics may cause metabolic syndrome which includes: increased waist circumference, lipid and glucose metabolism changes, and in some cases - elevation of blood pressure. During the last decade there has been a substantial increase in the use of atypical antipsychotics among children and adolescents, mainly due to lower rates of extrapyramidal side-effects, but also due to increased diagnosis of schizophrenia and bipolar disorder in youth, and the widespread use of atypical antipsychotics in disruptive behavior disorders. The definition of the metabolic syndrome in youth derives from the adult definition, but it is not universally accepted in pediatrics. The main difficulty lies in establishing the normal values of height and weight during the different stages of growth in childhood and adolescence. The long term implications of the metabolic syndrome diagnosed in young ages are yet to be studied, as are treatment and preventive options. A literature review of recent studies indicates that youth are more susceptible to adverse metabolic side-effects of atypical antipsychotics compared to adults. These side-effects also occur during treatment with lower doses as in disruptive behavioral disorders. Monitoring these metabolic parameters among adults treated with antipsychotics is lacking, and even more so in children and adolescents. Since youth treated with atypical antipsychotics are likely to be treated for long periods of time, it is crucial to diagnose, treat, and prevent those side-effects.