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Published on: November 21, 2013
Neurological Adverse Effects of Antipsychotic Medication in Children and Young People
Frank M C Besag1,2,3, Michael J Vasey4, Chris Hollis5,6,7
1East London NHS Foundation Trust, 9 Rush Court, Bedford, MK40 3JT, UK. fbesag@aol.com.
Insights
Children and young people (CYP) taking antipsychotics face neurological adverse effects (NAEs), including sedation and movement disorders. More research is needed to understand NAE risks and management in this vulnerable population.
Area of Science:
- Pharmacology
- Pediatric Neurology
- Psychiatry
Background:
- Neurological adverse effects (NAEs) are a significant concern in patients using antipsychotic medications.
- Children and young people (CYP) may exhibit increased susceptibility to NAEs, yet research specific to this demographic is limited.
Purpose of the Study:
- To review the existing literature on NAEs in CYP, focusing on data from randomized placebo-controlled trials.
- To highlight the prevalence, types, and potential risk factors of NAEs in pediatric populations undergoing antipsychotic treatment.
Main Methods:
- Systematic review of published literature on NAEs in CYP.
- Emphasis on data derived from randomized placebo-controlled trials.
- Analysis of reported NAEs including sedation, movement disorders, seizure threshold changes, and neuroleptic malignant syndrome.
Main Results:
- Sedative effects and movement disorders like akathisia, dystonia, and parkinsonism are common in CYP, though often show minimal changes in short-term studies.
- Tardive dyskinesia seems less frequent in CYP than adults, but data is scarce.
- Antipsychotics like clozapine may lower seizure threshold, with unclear vulnerability in CYP; neuroleptic malignant syndrome is rare but serious.
Conclusions:
- Current data on NAEs in CYP is limited, with many risk factors and management strategies extrapolated from adult studies.
- Further research, particularly self-controlled studies using large prospective databases, is crucial to clarify NAE incidence and risk factors in CYP.
- There is a need for evidence-based guidelines tailored to the pediatric population regarding antipsychotic-induced NAEs.
Abstract:
Neurological adverse effects (NAEs) are commonly reported in individuals treated with antipsychotic medications. Children and young people (CYP) may be particularly susceptible to these effects, but few studies have focused on the risk of NAEs in this population. This review provides an overview of the published literature on NAEs in CYP with an emphasis on data from randomised placebo-controlled trials. Most antipsychotics are associated with sedative effects that may impair daily functioning. Akathisia, dystonia and parkinsonism are commonly reported in CYP, although rating scale assessments typically show minimal changes from baseline in short-term randomised studies. Tardive dyskinesia appears to be less common in CYP than in adults, but data are limited. Some antipsychotics, in particular clozapine, are associated with a reduced seizure threshold, but it is unclear whether CYP may be more vulnerable than adults and available studies are subject to various confounding factors. Neuroleptic malignant syndrome, a rare and potentially fatal adverse drug reaction, has been reported in CYP treated with both first-generation and second-generation antipsychotics. Data on risk factors and management strategies for NAEs are largely from studies in adults and may not be relevant to CYP. Future studies should aim to resolve some of the current uncertainties. In particular, within-subject "self-controlled" studies using prospectively collected data from large databases would help to clarify the incidence and risk factors, in particular for less common NAEs, while controlling for possible confounders.
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