Pringsheim Tamara, Panagiotopoulos Constadina, Davidson Jana, Ho Josephine
Department of Clinical Neurosciences and Pediatrics, University of Calgary, Calgary, Alberta;
Paediatr Child Health. 2011 Nov;16(9):581-9.
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.
To synthesize the evidence for specific metabolic and neurological side effects associated with the use of SGAs in children, and provide evidence-based recommendations for the monitoring of these side effects.
A systematic review of controlled clinical trials of SGAs involving children was performed. Recommendations for monitoring SGA safety were made according to a classification scheme based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. When there was inadequate evidence, recommendations were based on consensus and expert opinion. A multidisciplinary consensus group reviewed all relevant evidence and reached consensus on the recommendations.
The present guidelines provide evidence-based recommendations for monitoring SGA safety. The strength of recommendations for specific physical examination manoeuvres and laboratory tests are provided for each SGA medication at specific time points.
Multiple randomized controlled trials evaluated the efficacy of many of the SGAs in paediatric mental health disorders. These benefits, however, are not without risks - both metabolic and neurological side effects occur in children treated with SGAs. The risk of weight gain, increased body mass index and abnormal lipid levels is greatest with olanzapine, followed by clozapine and quetiapine. The risk of neurological side effects of the treatment is 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，加拿大用于治疗心理健康障碍儿童的抗精神病药物，尤其是第二代抗精神病药物（SGA）的使用量急剧增加。长期使用这些药物有可能导致严重的代谢和神经并发症。
综合关于SGA在儿童中使用所产生的特定代谢和神经副作用的证据，并为这些副作用的监测提供基于证据的建议。
对涉及儿童的SGA对照临床试验进行系统评价。根据基于GRADE（推荐分级评估、制定和评价）系统的分类方案，制定SGA安全性监测建议。当证据不足时，建议基于共识和专家意见。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。
本指南为SGA安全性监测提供了基于证据的建议。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。
多项随机对照试验评估了许多SGA在儿童心理健康障碍中的疗效。然而，这些益处并非没有风险——接受SGA治疗的儿童会出现代谢和神经方面的副作用。使用奥氮平时体重增加、体重指数升高和血脂异常的风险最大，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时神经副作用的风险最大。对不良反应进行适当的监测程序将提高接受这些药物治疗儿童的护理质量。
