Bottom Line: Increases in body fat and decreases in insulin sensitivity were observed in youths with disruptive behavior disorders who were treated for the first time with antipsychotic medications during a 12-week randomized clinical trial.
Why The Research Is Interesting: Treatment with antipsychotic medications has been associated with risks of weight gain, type 2 diabetes and related conditions. Antipsychotic medications are commonly prescribed off-label for children with attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders.
Who and When : 144 youths (ages 6 to 18) with distruptive behavior disorders (almost 56 percent had a primary diagnosis of ADHD with irritability and aggression that was insufficiently responsive to prior therapy) from the St. Louis metropolitan area; participants were enrolled in the trial from 2006-2010
What (Study Interventions and Outcomes) : 12 weeks of treatment with oral aripiprazole (49 younths), olanzapine (46 youths) or risperidone (49 youths) (interventions); percentage total body fat and insulin sensitivity in muscle (primary outcomes), plus abdominal fat and other insulin sensitivity measures (secondary outcomes)
How (Study Design) : This was a randomized clinical trial (RCT). RCTs allow the strongest inferences to be made about the true effect of an intervention. However, not all RCT results can be replicated in real-world settings because patient characteristics or other variables may differ from those studied in the RCT.
Authors: John W. Newcomer, M.D., of Florida Atlantic University, Boca Raton, Florida, Ginger E. Nicol, M.D., of Washington University in St. Louis, and coauthors
Study Limitations: The 12-week trial was shorter than the long-term treatment many patients receive; there was no placebo group for ethical and feasibility reasons
Related Material: The editorial, "The Urgent Need for Optimal Monitoring of Metabolic Adverse Effects in Children and Youngsters Who Take On-Label or Off-Label Antipsychotic Medication," by Marc De Hert, M.D., Ph.D., and Johan Detraux, M.Psy., of Katholieke Universiteit Leuven, Kortenberg, Belgium, also is available on the For The Media website .
To Learn More: The full study is available on the For The Media website .
(doi:10.1001/ jamapsychiatry.2018.1088)
Editor's Note : The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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JAMA Psychiatry