I work with adults. When I prescribe antipsychotic medications, the person generally has a psychotic disorder, or a severe mood disorder. I worry about the over use of such medications for anxiety disorders, and for behavioural disorders. I am aware that these medications, in this cohort, can cause metabolic syndrome, in particular diabetes.

In the younger age group, however, the main use of antipsychotics is to manage behaviour, something they were not designed to do.

The mean (SD) age of the antipsychotic-exposed sample (n?=?185?105) was 14.1 (2.1) years (age range, 2-24 years), and a mean (SD) of 59.5% (8.0%) were male. The mean (SD) age of the psychiatric controls (n?=?1?342?121) was 13.8 (1.1) years (age range, 5-24 years), and a mean (SD) of 55.7% (9.2%) were male. The mean (SD) age of the healthy controls (n?=?298?803) was 13.9 (3.2) years (age range, 4-19 years), and a mean (SD) of 52.6% (9.0%) were male.

In the antipsychotic-exposed sample, most had a disruptive behavior disorder (DBD) or attention-deficit/hyperactivity disorder (ADHD) (in 46.9%) or a mood spectrum disorder, including mood disorder not otherwise specified (in 22.8%,), depression (in 26.9%), bipolar disorder (BPD) (in 16.2%), and BPD or psychosis (in 5.1%). Less commonly observed were anxiety disorders (in 7.9%), psychosis (in 5.7%), pervasive developmental disorder or autism (in 5.3%), substance abuse disorder (in 4.6%), and tic disorders (in 0.0003%). In the psychiatric control group, the psychiatric diagnoses were mainly DBD or ADHD (in 51.8%) and mood spectrum disorder (in 34.1%). Other diagnoses included anxiety disorders (in 8.7%), pervasive developmental disorder or autism (in 5.4%), psychosis (in 0.3%), and substance use disorders (in 0.2%).

This paper is a meta analysis of the risk of diabetes in young people. In short, the risk exists. T2DM is Type 2 diabetes risk — that is diabetes secondary to metabolic syndrome, primarily obesity.

I’m quoting from the same paper. An incidence rate of roughly one per thousand for type II diabetes in teenagers is high: the rate is three-fold in the those given antipsychotics.

The meta-analytically calculated T2DM risk was highest in the antipsychotic-exposed cohort, with an unadjusted, cumulative risk of 5.72 (95% CI, 3.45-9.48) per 1000 patients and an incidence rate of 3.09 (95% CI, 2.35-3.82) per 1000 patient-years (P?< ?.001 for both). The risk was intermediate in psychiatric controls, with an unadjusted, cumulative risk of 2.61 (95% CI, 0.80-8.52) per 1000 patient-years and an incidence rate of 1.74 (95% CI, 1.10-2.38) per 1000 patient-years (P?

This makes me cautious in the use of these medications. But then, I avoid child psychiatry — it’s not the kids, or the parents, it is the teachers and social workers. I cannot argue with this conclusion.

Nevertheless, the clinical importance of these findings is underscored by studies60,61 showing increased morbidity and mortality associated with an earlier T2DM onset. The relevance of our findings is further underscored by the fact that T2DM is only the most severe outcome of an interplay between antipsychotic exposure and genetic and lifestyle factors that lead to obesity and insulin resistance, which in and of themselves have serious health risks, especially when starting early in life. Our meta-analysis identified 3.1 and 3.6 excess T2DM cases per 1000 psychiatric controls and healthy controls, respectively, as well as an excess of 1.4 and 2.4 T2DM cases per 1000 patient-years of antipsychotic exposure or follow-up compared with psychiatric controls and healthy controls, respectively. This increased risk must be balanced carefully against the potential benefits of antipsychotics and underscores the need for prescribers to exhaust lower-risk treatment alternatives before initiating antipsychotic treatment and to routinely monitor youth for weight gain and metabolic abnormalities.

As a society, we need to consider the mistakes we are making in child rearing. One of which is to reach for the prescribing pad first.