Booster Shots

Oddities, musings and news from the health world

Category: Schizophrenia

Doctors cautioned on Zyprexa for adolescents

January 29, 2010 | 10:02 pm

The Federal Drug Administration on Friday issued a warning to doctors that adolescents taking the drug olanzapine have an "increased potential" -- in comparison with adults taking the new-generation antipsychotic drug -- for weight gain and metabolic disturbances that could result in diabetes or elevated blood cholesterol levels.

"Clinicians should consider the potential long-term risks when prescribing to adolescents," the FDA said in a statement released Friday night. "In many cases, this may lead to prescribe other drugs first," the statement went on.

The agency has not approved the marketing of olanzapine -- sold under the commercial name Zyprexa by the drug maker Eli Lilly -- for use in children under 13 who are diagnosed with schizophrenia or bipolar disorder. But the medication, one of a class of psychiatric medications called the "atypical antipsychotics," is widely prescribed for young patients, despite growing evidence that call its safety profile into question for this population.

The warning comes in the wake of the October publication in the Journal of the American Medical Assn., in which a study showed that children and adolescents taking their first-ever course of Zyprexa gained, on average, more than 17 pounds over a 12-week period, as well as dramatic increases in triglycerides and cholesterol levels -- all factors that put them at higher risk of developing cardiovascular disease. While two other antipsychotic drugs -- Seroquel and Risperdal -- were implicated in significant weight gain and metabolic changes, Zyprexa was found to carry the highest risks of all three.  

The FDA said that in cases where physicians opt to prescribe olanzapine, the drug should be part of a "comprehensive treatment program," which could include psychological, educational and social counseling as well as medication therapy.

--Melissa Healy

Visual and auditory changes may play a role in schizophrenia

December 9, 2009 |  2:44 pm

Brain Visual and auditory deficits are apparent in teenagers developing schizophrenia, and identifying and treating these deficits might restore sensory function and limit the impact of the disease, researchers reported today at the annual meeting of the American College of Neuropsychopharmacology.

Scientists from the Nathan Kline Institute at New York University found that impairment of basic sensory processes -- the way people see and hear -- may cause some of the problems linked to schizophrenia, a severe mental illness that usually develops in late adolescence or early adulthood. Their studies, based on measuring electrical responses from the scalp surface (referred to as biomarkers for the disease), suggest that this low level of visual and auditory functioning erodes peoples' ability to pay attention, understand social cues and read. People with schizophrenia have to overcompensate to pay attention and may not clearly hear or understand words or voice pitch. They may only see isolated objects in their field of vision.

Researchers don't know why or how these sensory processes break down in people with schizophrenia.

"The big hope is that these biomarkers could be a method for early detection and intervention," said the lead author of the study, Dr. Daniel C. Javitt, in a news release. "Using these measures of cognition we can increase the predictability of who is at risk for schizophrenia, and that can be extremely important in guiding treatment for those who are affected."

-- Shari Roan

Photo credit: Stephen Sedam  /  Los Angeles Times

Newer antipsychotics linked to kids' weight gain; all but one linked to metabolic changes

October 27, 2009 |  1:21 pm

Children and adolescents who started on any one of four psychiatric drugs known as "atypical antipsychotics" packed on a significant amount of weight, new research has found. And three of the four psychiatric medications under study came with metabolic side effects that will dramatically boost a child's likelihood of developing cardiovascular disease, according to a study published Tuesday in the Journal of the American Medical Assn.

Patients taking their first-ever course of drugs marketed as Abilify, Risperdal, Seroquel and Zyprexa experienced weight gains ranging from about 9.7 pounds for Abilify to 18.7 pounds for Zyprexa. (Seroquel users gained about 13.2 pounds and Risperdal users gained about 11.7 pounds over 12 weeks. A comparison group of children with a diagnosis of severe mental illness but who were not on the medications gained less than a half-pound in the course of the study.)

Young patients on Risperdal, Seroquel and Zyprexa all experienced a significant increase in their triglycerides, and those taking Zyprexa and Seroquel had a surge in their overall cholesterol readings. Those taking Abilify registered dramatic changes in body composition, but no metabolic changes that reached the level of statistical significance accepted by medical researchers.

Among the 205 patients who completed the study, it was rare for researchers to see metabolic syndrome or diabetes develop in the 12 weeks of treatment they observed. But they took note of two kinds of changes in subjects that were ominous: first, they noted significant changes in the children's fat mass and waist circumference measures--which predict the development of heart disease in the general population and metabolic syndrome in adults taking antipsychotic medicines; and second, they recorded significant changes in many of the children's triglycerides and in the ratios of triglycerides to HDL cholesterol--both considered a reliable predictor of insulin resistance to come.

The latest study is the largest to date focusing on young patients taking one of the new-generation antipsychotics for the first time. Its results were hailed as "timely and sobering" in an editorial accompanying the study's publication. It comes against a backdrop of rapidly expanding use of these drugs, and their growing use among children as young as 5. The Food and Drug Administration is currently considering whether it to accept the recommendation of a panel of outside experts and approve three of the four drugs for use by children diagnosed with schizophrenia and/or bipolar disorder.

JAMA's editorial suggests that such a step might be ill-advised.

"These results challenge the widespread use of atypical antipsychotic medications in youth," wrote University of Washington, Seattle, child psychiatrists Christopher K. Varley and Jon McClellan.

The commenting physicians warned that the change in children's cholesterol levels and insulin resistance readings observed after only 12 weeks of treatment "portends severe long-term metabolic and cardiovascular sequelae." While physicians expanded their use of the drugs because they were "widely touted as being more effective and safer" than older psychiatric drugs, that belief "should be reconsidered," Varley and McClellan wrote.

Several earlier studies of these antipsychotic medications have documented weight gain, changes in body composition and measures of metabolic function. But this study's findings are the most dramatic so far to come to light. The researchers suggested that earlier studies--many of them conducted under the sponsorship of drug makers--may have understated children's weight gain on the drugs by including many subjects who had taken earlier courses of antipsychotic medicine, and thus already had experienced drug-connected weight gain. For all the subjects followed in this study, this was the first time they had taken any drug classified as an antipsychotic medication. 

Scattered in academic medical centers across New York state, all the researchers were sponsored by grants from the National Institutes of Health.

-- Melissa Healy

Jani and the hospital therapy dog

July 19, 2009 |  8:00 am

Jani The June 29 story in the Los Angeles Times "Jani's at the mercy of her mind" generated many e-mails from readers, including one who was upset that Jani Schofield, a 6-year-old diagnosed with schizophrenia, had kicked the hospital therapy dog that was visiting the children's unit at UCLA's Resnick Neuropsychiatric Hospital.

I received this e-mail from the dog's handler, Ellen Morrow of Tarzana, this week, and am sharing it with her permission.

Dear Shari,
Charley, my big, lovable golden doodle, and I have been visiting Jani at UCLA for the past several months. In fact we saw her this morning. In your very moving article, you mentioned a dog that Jani had kicked. That would be Charley. But there is much more to the story, a bit of positive, that I wanted to share with you in the hopes that it will bring a little comfort to her family.
When we arrived for our following visit, Jani immediately came over, apologized and hugged Charley. Two weeks later, she walked over to tell me that she loved Charley and had a present for him. She gave him a picture of a dog that she had taken from a coloring book. She said that she was sorry she hadn't had time to fill it in, but she did sign it "love, Jani."
Ever since the incident she has been very good with him, even exhibiting more patience when she has to wait her turn to pet him or to help him do a trick. Today when I forgot to bring out Charley's brush, Jani was the one who reminded me. She then brushed him gently.
I know that these are brief, isolated moments in a difficult situation. Yet maybe this bit of positive can offer some consolation.
Thank you for all you're doing to try to help.
Best regards,
Ellen Morrow (& Charley)

In another e-mail, Morrow went on to tell me that Charley is 85 pounds and difficult to hurt. "Charley is so mellow and was barely aware that he had been kicked." But, of course, Morrow's message is testimony to the loving heart of a young child dealing with an illness no one should ever experience. When I forwarded the e-mail to Michael and Susan Schofield, Jani's parents, they responded that the letter brought them solace on what had been a difficult day. Jani is still hospitalized at UCLA.

-- Shari Roan

Photo: Jani with a toy. Credit: Lawrence K. Ho / Los Angeles Times


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