Weight gain in children and adolescents during treatment with atypical antipsychotics

Abstract

Atypical antipsychotics, amongst which risperidone, are increasingly prescribed to children and adolescents with neuropsychiatric disorders. Their use has been associated with various health risks associated with weight gain, including obesity, diabetes mellitus, and dislipidemia. We will report on 2 boys who developed severe overweight during treatment with risperidone. An 8.5 years old boy more than doubled his weight during 4 years of treatment with risperidone resulting in a BMI increase from 17.0 kg/m² (+ 0.6 SDS) to 29.6 kg/m² (+ 2.9 SDS) at the age of 12.4 yrs. A 12.3 years old boy, treated since the age of 9.1 years with risperidone, also doubled his weight during 3 years of treatment with an increase in BMI from 16.4 kg/m² (+ 0.1 SDS) to 26.0 kg/m² (+ 1.9 SDS). Based on these two cases, the mechanisms involved in the by atypical antipsychotics induced weight gain will be discussed. It is hypothesized that atypical antipsychotics interfere with the appetite regulating system by interrupting the pathways between peripheral signals from the fat tissue and the gastrointestinal tract, and the hypothalamic appetite controlling centres. Guidelines for monitoring clinical and metabolic parameters will be proposed and preventive and therapeutic possibilities will be discussed.