Volume : VII, Issue : III, March - 2018

Sudden weight gain induced by olanzapine in a child: Case report

Rashmi Prakash, Nitin Aggarwal

Abstract :

 

Recently, use of psychotropic medication is on rising in children and adolescents, but, their metabolic and endocrine side–effects (weight gain, obesity, and related metabolic abnormalities such as hyperglycemia and dyslipidemia) are of particular concern, especially within this age group. Risk of antipsychotic–induced metabolic side–effects appears to be more in the pediatric population than adults.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM–1", "itemData" : { "DOI" : "10.1097/01.chi.0000220851.94392.30", "ISBN" : "0890–8567", "ISSN" : "0890–8567", "PMID" : "16832314", "abstract" : "OBJECTIVE: Despite increasing use of psychotropic medications in children and adolescents, data regarding their efficacy and safety are limited. Endocrine and metabolic adverse effects are among the most concerning adverse effects of commonly used psychotropic medications. METHOD: Selective review of endocrine and metabolic effects of psychotropic medications in pediatric populations, with a focus on monitoring and management strategies. RESULTS: Because youth are still developing at the time of psychotropic drug exposure, most reference values need to be adjusted for gender and age. As in adults, youngsters receiving lithium require monitoring for thyroid dysfunction. Psychostimulants appear to cause mild reversible growth retardation in some patients, most likely because of decreased weight or slowing of expected weight gain; some patients may experience clinically significant reductions in adult height. Although still controversial, valproate use has been associated with an increased risk for polycystic ovary syndrome, in addition to causing weight gain. Although more data are required, children and adolescents appear to be at higher risk than adults for antipsychotic–induced hyperprolactinemia, weight gain, and possibly, associated metabolic abnormalities, which is of particular concern. CONCLUSIONS: Clinicians and caregivers need to be aware of potential endocrine and metabolic adverse effects of psychiatric medications. A careful selection of patients, choice of agents with potentially lesser risk for these adverse events, healthy lifestyle counseling, as well as close health monitoring are warranted to maximize effectiveness and safety.", "author" : [ { "dropping–particle" : "", "family" : "Correll", "given" : "Christoph U", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Carlson", "given" : "Harold E", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" } ], "container–title" : "Journal of the American Academy of Child and Adolescent Psychiatry", "id" : "ITEM–1", "issue" : "7", "issued" : { "date–parts" : [ [ "2006" ] ] }, "page" : "771–791", "title" : "Endocrine and metabolic adverse effects of psychotropic medications in children and adolescents.", "type" : "article–journal", "volume" : "45" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=fb5d7db3–f697–41cc–90aa–27afd46a10b3" ] }, { "id" : "ITEM–2", "itemData" : { "DOI" : "10.2165/00148581–200406010–00003", "ISSN" : "1174–5878", "PMID" : "14969568", "abstract" : "Atypical antipsychotics are increasingly prescribed to children and adolescents with neuropsychiatric disorders. Although their profile of potent antagonism at specific serotonin and dopamine receptors offers certain advantages compared with typical antipsychotics, their use has been associated with various adverse effects, including significant weight gain. This adverse effect is of particular concern in children and adolescents, secondary to the immediate and long–term health risks associated with weight gain, including obesity, diabetes mellitus, and hyperlipidemia. Indeed, from 1963 to 1991, the prevalence of obesity has approximately doubled in youth. Prior to selecting an atypical antipsychotic, a detailed review of the predictors of weight gain is necessary for every child and adolescent. Published data suggest that clozapine and olanzapine are associated with considerable weight gain, whereas risperidone and quetiapine have a moderate risk. Alternatively, ziprasidone and aripiprazole may exhibit a low risk for this adverse effect. Whereas behavioral and pharmacologic measures are available to manage weight gain associated with atypical antipsychotics, research is needed to establish more effective and safe interventions for this adverse effect in children and adolescents.", "author" : [ { "dropping–particle" : "", "family" : "Stigler", "given" : "Kimberly a", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Potenza", "given" : "Marc N", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Posey", "given" : "David J", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "McDougle", "given" : "Christopher J", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" } ], "container–title" : "Paediatric drugs", "id" : "ITEM–2", "issue" : "1", "issued" : { "date–parts" : [ [ "2004" ] ] }, "page" : "33–44", "title" : "Weight gain associated with atypical antipsychotic use in children and adolescents: prevalence, clinical relevance, and management.", "type" : "article–journal", "volume" : "6" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=edaff9bc–6d03–4726–8cf6–24149ba068a2" ] }, { "id" : "ITEM–3", "itemData" : { "DOI" : "10.1016/j.clinthera.2004.12.003", "ISBN" : "0149–2918 (Print)n0149–2918 (Linking)", "ISSN" : "1879114X", "PMID" : "15823759", "abstract" : "Background: Compared with the general population, individuals with schizophrenia demonstrate an increased prevalence of obesity, type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD). Increased adiposity is associated with decreases in insulin sensitivity, leading to an increased risk of hyperglycemia and hyperlipidemia. Antipsychotic medications can increase adiposity, and a range of evidence from case reports, observational studies, retrospective database analyses, and controlled experimental studies (including randomized clinical trials) suggests that treatment with antipsychotic medications may be associated with an increased risk for insulin resistance, hyperglycemia, dyslipidemia, and T2DM. Objective: This article reviews current evidence for the hypothesis that treatment with antipsychotic medications may be associated with increased risks for weight gain, insulin resistance, hyperglycemia, dyslipidemia, and T2DM, and examines the relationship of adiposity to medical risk. Methods: Relevant publications were identified through a search of MEDLINE from 1975 to the present using the primary search parameters "diabetes or hyperglycemia or glucose or insulin or lipids" and "antipsychotic." Meeting abstracts and earlier nonindexed articles concerning antipsychotic–associated weight gain and metabolic disturbance were also reviewed. Key studies in this emerging literature were summarized, including case reports, observational studies, retrospective database analyses, and controlled experimental studies. Results: Individual antipsychotic medications are associated with different degrees of treatment–induced increases in body weight and adiposity, ranging from modest effects (<2 kg) with amisulpride, ziprasidone, and aripiprazole to clinically significant increases with olanzapine (4–10 kg). In addition to strong evidence concerning the effect of adiposity on insulin sensitivity in nonpsychiatric populations, increased adiposity in patients with schizophrenia has been associated with decreases in insulin sensitivity; this and other effects may contribute to increases in plasma glucose concentrations and lipid levels. Conclusion: Metabolic changes in psychiatric patients who receive antipsychotic agents can contribute to the development of the metabolic syndrome and increase the risk for T2DM and CVD. Copyright u00a9 2004 Excerpta Medica, Inc.", "author" : [ { "dropping–particle" : "", "family" : "Newcomer", "given" : "John W.", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" } ], "container–title" : "Clinical Therapeutics", "id" : "ITEM–3", "issue" : "12", "issued" : { "date–parts" : [ [ "2004" ] ] }, "page" : "1936–1946", "title" : "Metabolic risk during antipsychotic treatment", "type" : "article", "volume" : "26" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e9d54aaf–f2b3–4d8c–bcba–8edaf5e77522" ] } ], "mendeley" : { "formattedCitation" : "(Correll & Carlson, 2006; Newcomer, 2004; Stigler, Potenza, Posey, & McDougle, 2004)", "plainTextFormattedCitation" : "(Correll & Carlson, 2006; Newcomer, 2004; Stigler, Potenza, Posey, & McDougle, 2004)", "previouslyFormattedCitation" : "(Correll & Carlson, 2006; Newcomer, 2004; Stigler, Potenza, Posey, & McDougle, 2004)" }, "properties" : { }, "schema" : "https://github.com/citation–style–language/schema/raw/master/csl–citation.json" }(Correll & Carlson, 2006; Newcomer, 2004; Stigler, Potenza, Posey, & McDougle, 2004) Poor diet and sedentary lifestyle further contribute to weight gain in psychiatric patients in addition to medications.  Excessive weight further leads to stigmatization, social withdrawal and poor compliance with medications, leading to deterioration in psychiatric symptoms.  Further, excessive obesity may lead to metabolic syndrome hence increasing the future risk of cardiovascular morbidity and mortality.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM–1", "itemData" : { "DOI" : "10.1056/NEJMoa031049", "ISBN" : "1533–4406 (Electronic)", "ISSN" : "1533–4406", "PMID" : "15175438", "abstract" : "BACKGROUND The prevalence and magnitude of childhood obesity are increasing dramatically. We examined the effect of varying degrees of obesity on the prevalence of the metabolic syndrome and its relation to insulin resistance and to C–reactive protein and adiponectin levels in a large, multiethnic, multiracial cohort of children and adolescents. METHODS We administered a standard glucose–tolerance test to 439 obese, 31 overweight, and 20 nonobese children and adolescents. Baseline measurements included blood pressure and plasma lipid, C–reactive protein, and adiponectin levels. Levels of triglycerides, high–density lipoprotein cholesterol, and blood pressure were adjusted for age and sex. Because the body–mass index varies according to age, we standardized the value for age and sex with the use of conversion to a z score. RESULTS The prevalence of the metabolic syndrome increased with the severity of obesity and reached 50 percent in severely obese youngsters. Each half–unit increase in the body–mass index, converted to a z score, was associated with an increase in the risk of the metabolic syndrome among overweight and obese subjects (odds ratio, 1.55; 95 percent confidence interval, 1.16 to 2.08), as was each unit of increase in insulin resistance as assessed with the homeostatic model (odds ratio, 1.12; 95 percent confidence interval, 1.07 to 1.18 for each additional unit of insulin resistance). The prevalence of the metabolic syndrome increased significantly with increasing insulin resistance (P for trend, <0.001) after adjustment for race or ethnic group and the degree of obesity. C–reactive protein levels increased and adiponectin levels decreased with increasing obesity. CONCLUSIONS The prevalence of the metabolic syndrome is high among obese children and adolescents, and it increases with worsening obesity. Biomarkers of an increased risk of adverse cardiovascular outcomes are already present in these youngsters.", "author" : [ { "dropping–particle" : "", "family" : "Weiss", "given" : "Ram", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Dziura", "given" : "James", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Burgert", "given" : "Tania S", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "V", "family" : "Tamborlane", "given" : "William", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Taksali", "given" : "Sara E", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Yeckel", "given" : "Catherine W", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Allen", "given" : "Karin", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Lopes", "given" : "Melinda", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Savoye", "given" : "Mary", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Morrison", "given" : "John", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Sherwin", "given" : "Robert S", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Caprio", "given" : "Sonia", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" } ], "container–title" : "The New England journal of medicine", "id" : "ITEM–1", "issue" : "23", "issued" : { "date–parts" : [ [ "2004" ] ] }, "page" : "2362–74", "title" : "Obesity and the metabolic syndrome in children and adolescents.", "type" : "article–journal", "volume" : "350" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=8d7ed0c7–7468–4205–a4a0–73b9209a4521" ] } ], "mendeley" : { "formattedCitation" : "(Weiss et al., 2004)", "plainTextFormattedCitation" : "(Weiss et al., 2004)", "previouslyFormattedCitation" : "(Weiss et al., 2004)" }, "properties" : { }, "schema" : "https://github.com/citation–style–language/schema/raw/master/csl–citation.json" }(Weiss et al., 2004) Hence, sex– and age–adjusted body mass index (BMI) percentiles are crucial to assess weight gain in children and adolescents.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM–1", "itemData" : { "DOI" : "10.1007/s00586–005–1035–y", "ISBN" : "1042–3931", "ISSN" : "01606689", "PMID" : "16259549", "author" : [ { "dropping–particle" : "", "family" : "Correll", "given" : "Christoph U.", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" } ], "container–title" : "Journal of Clinical Psychiatry", "id" : "ITEM–1", "issue" : "10", "issued" : { "date–parts" : [ [ "2005" ] ] }, "page" : "1331–1332", "title" : "Metabolic side effects of second–generation antipsychotics in children and adolescents: A different story?", "type" : "article", "volume" : "66" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=d1df1e18–02e0–4370–9004–667303101306" ] } ], "mendeley" : { "formattedCitation" : "(Correll, 2005)", "plainTextFormattedCitation" : "(Correll, 2005)", "previouslyFormattedCitation" : "(Correll, 2005)" }, "properties" : { }, "schema" : "https://github.com/citation–style–language/schema/raw/master/csl–citation.json" }(Correll, 2005). Recently, atypical antipsychotic agents have largely replaced traditional agents as first–line drugs for the treatment of schizophrenia and psychotic mood disorders. However atypical antipsychotics are associated with different side effect profile than typical antipsychotics. In adults side effect profile of atypical antipsychotic drugs is well known, but in pediatric age groups is rather new and limited.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM–1", "itemData" : { "ISSN" : "0303–7339 (Print)", "PMID" : "20458678", "abstract" : "BACKGROUND: Adult patients with schizophrenia and bipolar disorder have an increased risk of developing the metabolic syndrome. This is due to their psychiatric illness and to the use of antipsychotic drugs. Children and adolescents are being treated more and more with antipsychotics. The risk of metabolic abnormalities in this age group remains unclear. AIM: To investigate the relationship between psychotic disorders in childhood and metabolic abnormalities and to study the influence of the use of both typical and atypical antipsychotics on this relationship. METHOD: The PubMed database was searched for relevant articles published between 2000 and June 2009. RESULTS: So far, research into the relationship between psychiatric disorders and metabolic abnormalities in children and adolescents has been inadequate. The normal values and meaning of the components of the metabolic syndrome in children and adolescents have not yet been firmly established. Children and adolescents who use antipsychotics run a significantly higher risk of weight gain. The younger the child, the greater the risk. There are no data about the risk of developing diabetes mellitus type 2. The influence of typical antipsychotics on these conditions has not been investigated. CONCLUSION: The risk of significant weight gain due to the use of atypical antipsychotics is greater in younger children. The ‘metabolic syndrome‘ concept is not applicable to children and adolescents. Very little is known about metabolic risks in the long term. Caution is called for in the prescription of antipsychotics for children and adolescents and further research is needed.", "author" : [ { "dropping–particle" : "", "family" : "Overbeek", "given" : "W A", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Vroede", "given" : "M A M", "non–dropping–particle" : "de", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Lahuis", "given" : "B E", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Hillegers", "given" : "M H J", "non–dropping–particle" : "", "parse–names" : false, "suffix" : "" }, { "dropping–particle" : "", "family" : "Graeff–Meeder", "given" : "E R", "non–dropping–particle" : "de", "parse–names" : false, "suffix" : "" } ], "container–title" : "Tijdschrift voor psychiatrie", "id" : "ITEM–1", "issue" : "5", "issued" : { "date–parts" : [ [ "2010" ] ] }, "page" : "311–320", "title" : "[Antipsychotics and metabolic abnormalities in children and adolescents: a review of the literature and some recommendations].", "type" : "article–journal", "volume" : "52" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0154fb54–777f–4372–84f9–80c796a7c140" ] } ], "mendeley" : { "formattedCitation" : "(Overbeek, de Vroede, Lahuis, Hillegers, & de Graeff–Meeder, 2010)", "plainTextFormattedCitation" : "(Overbeek, de Vroede, Lahuis, Hillegers, & de Graeff–Meeder, 2010)", "previouslyFormattedCitation" : "(Overbeek, de Vroede, Lahuis, Hillegers, & de Graeff–Meeder, 2010)" }, "properties" : {  }, "schema" : "https://github.com/citation–style–language/schema/raw/master/csl–citation.json" }(Overbeek, de Vroede, Lahuis, Hillegers, & de Graeff–Meeder, 2010)

The present case report discusses a child who gained weight very rapidly with olanzapine, an atypical antipsychotic.

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Article: Download PDF   DOI : 10.36106/ijsr  

Cite This Article:

Rashmi Prakash, Nitin Aggarwal, Sudden weight gain induced by olanzapine in a child: Case report, INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH : Volume-7 | Issue-3 | March-2018

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