Pringsheim Tamara, Panagiotopoulos Constadina, Davidson Jana, Ho Josephine
The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) Guideline Project.
J Can Acad Child Adolesc Psychiatry. 2011 Aug;20(3):218-33.
The use of antipsychotics, especially second generation antipsychotics (SGAs), for children with mental health disorders in Canada has increased dramatically over the past five years. These medications have the potential to cause major metabolic and neurological complications with chronic use.
Our objective was to synthesize the evidence for specific metabolic and neurological side effects associated with the use of SGAs in children and make evidence-based recommendations for the monitoring of these side effects.
We performed a systematic review of controlled clinical trials of SGAs in children. Recommendations for monitoring SGA safety were made according to a classification scheme based on the GRADE system. When there was inadequate evidence to make recommendations, recommendations were based on consensus and expert opinion. A multi-disciplinary consensus group reviewed all relevant evidence and came to consensus on recommendations.
Evidence-based recommendations for monitoring SGA safety are provided in the guideline. The strength of recommendations for specific physical examination maneuvers and laboratory tests are provided for each SGA medication at specific time points.
Multiple randomized controlled trials (RCTs) have established the efficacy of many of the SGAs in pediatric mental health disorders. These benefits however do not come without risk; both metabolic and neurological side effects occur in children treated with these SGAs. The risk of weight gain, increased BMI and abnormal lipids appears greatest with olanzapine, followed by clozapine and quetiapine. The risk of neurological side effects of treatment appears greatest with risperidone, olanzapine and aripiprazole. Appropriate monitoring procedures for adverse effects will improve the quality of care of children treated with these medications.
在过去五年中，加拿大使用抗精神病药物，尤其是第二代抗精神病药物（SGA）治疗精神健康障碍儿童的情况急剧增加。长期使用这些药物有可能导致严重的代谢和神经并发症。
我们的目的是综合关于儿童使用SGA相关的特定代谢和神经副作用的证据，并就这些副作用的监测提出基于证据的建议。
我们对儿童使用SGA的对照临床试验进行了系统评价。根据基于GRADE系统的分类方案，对监测SGA安全性提出建议。当证据不足无法提出建议时，则基于共识和专家意见提出建议。一个多学科共识小组审查了所有相关证据，并就建议达成了共识。
指南中提供了监测SGA安全性的基于证据的建议。针对每种SGA药物在特定时间点，给出了特定体格检查操作和实验室检查建议的强度。
多项随机对照试验（RCT）证实了许多SGA在儿童精神健康障碍治疗中的疗效。然而，这些益处并非没有风险；使用这些SGA治疗的儿童会出现代谢和神经方面的副作用。使用奥氮平后体重增加、BMI升高和血脂异常的风险似乎最大，其次是氯氮平和喹硫平。使用利培酮、奥氮平和阿立哌唑治疗后出现神经副作用的风险似乎最大。对不良反应进行适当的监测程序将提高使用这些药物治疗的儿童的护理质量。
