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首页> 外文期刊>Journal of the Canadian Academy of Child and Adolescent Psychiatry >Evidence-Based Recommendations for Monitoring Safety of Second Generation Antipsychotics in Children and Youth
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Evidence-Based Recommendations for Monitoring Safety of Second Generation Antipsychotics in Children and Youth

机译：监测儿童和青少年第二代抗精神病药安全性的循证医学建议

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Background: The use of antipsychotics, especially second generation antipsychotics (SGAs), for children with mental health disorders in Canada has increased dramatically over the past five years. These medications have the potential to cause major metabolic and neurological complications with chronic use. Objective: Our objective was to synthesize the evidence for specific metabolic and neurological side effects associated with the use of SGAs in children and make evidence-based recommendations for the monitoring of these side effects. Methods: We performed a systematic review of controlled clinical trials of SGAs in children. Recommendations for monitoring SGA safety were made according to a classification scheme based on the GRADE system. When there was inadequate evidence to make recommendations, recommendations were based on consensus and expert opinion. A multi-disciplinary consensus group reviewed all relevant evidence and came to consensus on recommendations. Results: Evidence-based recommendations for monitoring SGA safety are provided in the guideline. The strength of recommendations for specific physical examination maneuvers and laboratory tests are provided for each SGA medication at specific time points. Conclusion: Multiple randomized controlled trials (RCTs) have established the efficacy of many of the SGAs in pediatric mental health disorders. These benefits however do not come without risk; both metabolic and neurological side effects occur in children treated with these SGAs. The risk of weight gain, increased BMI and abnormal lipids appears greatest with olanzapine, followed by clozapine and quetiapine. The risk of neurological side effects of treatment appears greatest with risperidone, olanzapine and aripiprazole. Appropriate monitoring procedures for adverse effects will improve the quality of care of children treated with these medications.
机译：背景：在过去的五年中，在加拿大患有精神疾病的儿童使用抗精神病药，尤其是第二代抗精神病药（SGA）的情况急剧增加。这些药物长期使用可能引起严重的代谢和神经系统并发症。目的：我们的目标是综合与在儿童中使用SGA相关的特定代谢和神经系统副作用的证据，并提出基于证据的监测这些副作用的建议。方法：我们对儿童SGA的对照临床试验进行了系统评价。根据GRADE系统的分类方案，提出了监控SGA安全性的建议。如果没有足够的证据提出建议，则建议基于共识和专家意见。一个多学科共识小组审查了所有相关证据，并对建议达成共识。结果：指南中提供了基于证据的SGA安全监控建议。在特定的时间点为每种SGA药物提供了针对特定身体检查操作和实验室测试的建议强度。结论：多项随机对照试验（RCT）已建立许多SGA在小儿精神卫生疾病中的疗效。但是，这些好处并非没有风险。接受这些SGA治疗的儿童都会发生代谢和神经方面的副作用。使用奥氮平，其次是氯氮平和喹硫平，体重增加，体重指数增加和血脂异常的风险最大。利培酮，奥氮平和阿立哌唑治疗的神经系统副作用的风险似乎最大。适当的不良反应监测程序将改善接受这些药物治疗的儿童的护理质量。

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