Second-Generation Antipsychotics in Adolescent Psychiatric Patients: Metabolic Effects and Impact of an Early Weight Change to Predict Longer Term Weight Gain

Objectives: To examine the metabolic profile of adolescents at baseline and to determine the potential predictive power of a 1-month weight gain (WG) on weight changes during longer term second-generation antipsychotic (SGA) treatment. Methods: A retrospective chart review study, including patients between 13 and 18 years of age and treated with SGA, was conducted. Available data at baseline, 1, 3, and 12 months of treatment were recorded. Results: Four hundred fifty-six patients were included, with a median age of 15 years. Ten percent of the patients were obese (> 95th percentile) and abdominal obesity (> 90th percentile) was observed in 12% of patients. In a subgroup of 42 patients with both baseline, 1, and 3-month weight data available, WG > 4.5% after 1 month was found to be the best predictor (sensitivity: 100; specificity: 66; area under the curve: 83) for a WG > 15% after 3 months. After adjusting for potential confounders, a threshold of WG > 4% was found as being the best predictor. Conclusions: A worrisome prevalence of metabolic disorders was observed in an adolescent psychiatric cohort. In such patients, a WG > 4% during the first month of treatment should raise concerns about weight controlling strategies. Further research is needed to confirm the present results and to determine the impact of a 1-month WG on a 1-year weight change.