I n this column I would like to make the readership aware of two recent updates. The first has more application to pediatrics than psychopharmacology, but our readers should be aware of a recent recall of Tylenol Oral Suspension. The product is manufactured by McNeil Consumer Healthcare. These products were distributed throughout last year but may still be around in medication cabinets, etc. Though to date nobody has been reported affected by the oral suspension products, it should be noted that the recall is a result of a possible bacteria in the raw material used to make this compound. The second recall is from Barr Laboratories and their product that contains a mixture of amphetamine salts, specifically, the 20 mg strength pills in lot number 311756. Apparently, the tablet content exceeded statutory requirements and may result in supratherapeutic dosing. In both cases, products should be returned to their pharmacy or distributors.

Continuing our new focus of examining seminal studies, I will synthesize the recently published paper by Christoph Correll et al. (2009) examining cardiometabolic risks of atypical antipsychotics in children and adolescents. In this study patients between the ages of 4 and 19 years old were recruited. Among other criteria, patients were excluded if they had received more than one week's worth of antipsychotics in the past or if they had been on more than one antipsychotic agent. Primary outcome measures included absolute and relative weight change, and there were a slew of secondary cardiometabolic parameters. Measures were obtained at baseline and then at 4, 8, and 12 weeks. The intent-to-treat population consisted of patients who had one or more assessments following baseline. Patients' diagnoses were not made using structured or semi-structured interviews. Subjects were not randomized to treatment, and the decision for assignment to a specific antipsychotic agent was made clinically by their treating psychiatrist. A total of 338 subjects were enrolled. Enrollment was from both inpatient and outpatients sources.

The results revealed that after a median of 10.8 weeks of treatment, all the antipsychotic medications were associated with substantial weight gain (olanzapine 8.5 kg, quetiapine 6.1 kg, risperidone 5.3 kg, aripiprazole 4.4 kg) as compared to the control group (0.2 kg) who either refused medication or stopped taking their antipsychotic medication within the first 4 weeks of treatment. It should be noted that though the weight changes were greater than seen in some other pediatric studies they were similar to that reported in a 3 month adolescent quetiapine trial (Schimmelmann et al., 2007). Interestingly, in this study subjects receiving doses of risperidone above 1.5 mg daily experienced significantly greater increases in numerous measures of body composition, while those patients receiving more than 10 mg daily of olanzapine experienced significant increases in total and non HDL cholesterol. Discontinuation rates for each agent varied from about 30% to 40%.

The implication of a briefly mentioned subgroup is worthy of further discussion. In the comment section a reference was made to the lack of significant changes noted in weight and metabolic parameters for those patients with short inpatient stays. In another study published by my group in 2007 (Silva et al, 2007) that assessed similar issues (though the study was not as elegantly designed), data on 57 nonrandomized patients (mean age 11 years old) treated with antipsychotics were analyzed. An important distinction between the studies was that in our sample all cases were inpatients, and food consumption consisted of trays with dietician-determined sized portions delivered at mealtime, in addition to limited snacks. Similarly in our report, though patients on all of the antipsychotics gained weight (mean 5.46 lb, average length of stay was 46.8 days), only those in the olanzapine and quetiapine groups experienced significantly greater weight gain than controls (length of stay was statistically controlled for). The cardiometabolic implications associated with the use of these agents are clearly important and pressing topics. However, the role of healthy choices and parental involvement in terms of supervising and monitoring food consumption in youth taking these medications requires further evaluation as it seems it may make a meaningful clinical difference for many of these children.

We are including an updated list of conferences for your consideration.

The 2010 American Psychiatric Association meeting will be held in New Orleans, LA from May 22–26, 2010, contact (888) 357–7924.