Impact of antipsychotic drugs on weight and monitoring of associated cardiometabolic outcomes in Adolescents

The objective of the dissertation was to assess 1) trends in prevalence of overweight and obesity among adolescents (12-19 years), 2) frequency and predictors of regular monitoring of metabolic parameters as recommended by the American Diabetes Association (ADA)/ American Psychiatric Association (APA) guidelines among adolescents, and 3) association of second-generation antipsychotics (SGAs) prescriptions with changes in weight, among adolescents on antipsychotics compared to an age and gender matched randomly selected untreated comparison group. An ecologic study for the first objective and retrospective cohort studies for the second and third objective were conducted using a United States national electronic medical records database. Prevalence of overweight and obesity was assessed among exposed and comparison group adolescents during each calendar quarter between years 2000 and 2009. Frequency and predictors of regular monitoring of metabolic parameters were assessed in the second objective using multivariate logistic regression adjusting for covariates. Multivariate linear regression was used in the third objective to assess the percent change in follow-up body mass index (BMI) from baseline among antipsychotic users compared to the comparison group controlling for covariates. Adolescents on antipsychotics had higher prevalence of overweight and obesity than nonusing adolescents. The trend of prevalence of overweight and obesity among male antipsychotic users decreased while the trend of prevalence increased for female antipsychotic users compared to an untreated iv comparison group respectively. The majority of adolescents on antipsychotics were under-monitored for BMI, lipids and glucose levels. Antipsychotic users with preexisting and newly diagnosed metabolic conditions were more likely to be regularly monitored for metabolic parameters than antipsychotic users without such conditions. Treatment with second-generation antipsychotics was associated with significant increase in BMI among adolescents relative to a matched comparison group. Antipsychotic treatment may have differential impact on weight gain in adolescent males and females. Strategies to increase awareness and adherence to ADA/APA guidelines in monitoring metabolic parameters among primary care physicians need to be developed. Weight gain among adolescents on antipsychotics needs to be controlled, or there may be increased use of limited health resources to treat obesity-related diseases in addition to mental health issues when these adolescents become adults.