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Serum ferritin critical threshold fluctuations predict antipsychotic treatment discontinuation in pediatric Tic

Linxia Li1, Xianjin Yao1, Jianing Dou1

  • 1Department of Neurology, Hangzhou Children's Hospital, Hangzhou, China.

Frontiers in Pediatrics
|July 6, 2026
PubMed

Insights

Dynamic fluctuations in serum ferritin levels below 30 ng/mL predict antipsychotic treatment discontinuation in children with tic disorders. Monitoring ferritin may help identify high-risk patients for early intervention.

Area of Science:

  • Pediatric Neurology
  • Psychopharmacology
  • Nutritional Psychiatry

Background:

  • Serum ferritin levels are crucial for various biological processes, and their fluctuations may impact treatment outcomes.
  • Antipsychotic medications are used to manage tic disorders in children, but treatment discontinuation is common.
  • Understanding predictors of treatment discontinuation is vital for optimizing care in pediatric tic disorders.

Purpose of the Study:

  • To investigate if dynamic fluctuations in serum ferritin (SF) below 30 ng/mL independently predict antipsychotic treatment discontinuation in children with tic disorders.
  • To assess whether the type of antipsychotic (typical vs. atypical) modifies the association between SF fluctuations and treatment outcomes.
  • To evaluate the relationship between SF fluctuation patterns and the rate of tic symptom improvement.

Main Methods:

  • A retrospective cohort study of 228 children (aged 6-16) with DSM-5 diagnosed tic disorders receiving first-line antipsychotics.
  • Participants were stratified into high-fluctuation (coefficient of variation [CV] ≥25% with ≥1 value <30 ng/mL) and low-fluctuation groups.
  • Cox regression models were used to analyze treatment discontinuation, adjusted for demographic, clinical, nutritional, and socioeconomic factors.

Main Results:

  • High ferritin fluctuation was associated with significantly higher discontinuation rates (60.3% vs. 24.0%) and predicted a >2-fold increased risk of discontinuation (adjusted HR=2.11).
  • Lack of efficacy was a more frequent reason for discontinuation in the high-fluctuation group.
  • High fluctuation was also linked to slower tic symptom improvement (P=0.002) and a stronger association with typical antipsychotics (HR=4.12) compared to atypical agents (HR=1.87).

Conclusions:

  • Dynamic serum ferritin fluctuations below 30 ng/mL are independent predictors of antipsychotic discontinuation and poorer symptomatic response in pediatric tic disorders.
  • The risk of discontinuation is heightened in patients using typical antipsychotics.
  • Serial monitoring of serum ferritin may aid in identifying children with tic disorders at higher risk for treatment discontinuation, enabling timely interventions.
Abstract

Keywords:
antipsychotic agentsiron metabolismserum ferritintic disorderstreatment discontinuation

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