Differences in body mass index z-scores and weight status in a Dutch pediatric psychiatric population with and without use of second-generation antipsychotics

OBJECTIVE: Weight gain and metabolic adverse effects of second-generation antipsychotics (SGAs) have become a major concern, particularly in youth. However, the specific contribution of SGAs versus other medications or the underlying illness is unclear. METHODS: In a chart review study of psychiatric outpatients aged </= 18 years treated with SGAs and psychiatric controls without lifetime SGA, use body mass index (BMI) z-scores between patients and controls were compared in the entire sample, patients without co-medications, diagnostic subgroups, and age subgroups. In patients with follow-up data, weight z-score change was calculated. RESULTS: Altogether, 592 Caucasian patients aged 4-18 (mean: 10.0) years with a psychiatric diagnosis were included. BMI z-scores in 96 youth treated with SGAs for 9.0 +/- 6.1 months were significantly higher than in 496 patients without lifetime SGA use (0.81 +/- 1.1 vs. 0.05 +/- 1.2; p<0.0001). BMI z-score differences remained significant in all age groups <16 years old. In sub-analyses, results remained the same after eliminating patients on any co-medication (0.82 +/- 1.2 vs. 0.23 +/- 1.2; p<0.0001) and in patients with (0.75 +/- 1.2 vs. 0.17 +/- 1.1, p<0.0001) or without autism spectrum disorders (1.1 +/- 1.0 vs. -0.02 +/- 1.2, p<0.0001). Significantly more SGA-treated youth were obese (27.1% vs. 9.5%, odds ratio [OR]: 3.55, 95% confidence interval [CI]:2.07-6.08) or overweight (21.9% vs. 8.3%, OR: 3.11, 95%CI: 1.75-5.52). In 24 patients (92.3% antipsychotic-naive) with 6.6 months follow-up, weight z-score increased significantly from -0.17 +/- 1.5 to 0.25 +/- 1.4 (p