ABSTRACT
There are many case reports of seizures apparently associated with the prescription of antipsychotics. This study aimed to examine whether there is an association between the prescription of antipsychotics and incident seizures in individuals with autism spectrum disorder using retrospective data based on patients' chart review. A cohort study was conducted to compare the rate of incident seizure between 3923 users of antipsychotics with 10,086 users of other psychotropics. This was followed by a self-controlled case series (SCCS) analysis of 149 patients to eliminate the effect of time-invariant confounders. The results showed no evidence of increased risk of seizure after exposure to antipsychotic agents (Hazard Ratio 1.28, 95% CI 0.74-2.19) compared to other psychotropics.
Subject(s)
Antipsychotic Agents , Autism Spectrum Disorder , Antipsychotic Agents/adverse effects , Autism Spectrum Disorder/drug therapy , Autism Spectrum Disorder/epidemiology , Cohort Studies , Humans , Psychotropic Drugs/therapeutic use , Retrospective Studies , Seizures/chemically induced , Seizures/drug therapy , Seizures/epidemiologyABSTRACT
Autism spectrum disorder (ASD) is a lifelong disorder. In the UK, risperidone is the only psychotropic medication approved for the management of the behavioural symptoms that may accompany autism. This is a population-based study aimed to provide an evaluation of the changing trend in the incidence and prevalence of ASD and to analyse the pattern of psychotropic medication prescribing in the UK. 20,194 patients with ASD were identified. The prevalence increased 3.3-fold from 0.109 per 100 persons in 2009 to 0.355 per 100 persons in 2016. Approximately one-third of the identified cohort was prescribed at least one psychotropic medication. Although the medications approved to manage the symptoms of ASD are limited, the prescribing of such medications is increasing.
Subject(s)
Autism Spectrum Disorder/drug therapy , Autism Spectrum Disorder/epidemiology , Drug Prescriptions , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Psychotropic Drugs/therapeutic use , Adolescent , Adult , Aged , Autism Spectrum Disorder/diagnosis , Child , Child, Preschool , Cohort Studies , Comorbidity , Databases, Factual , Female , Humans , Male , Mental Disorders/diagnosis , Middle Aged , United Kingdom/epidemiology , Young AdultABSTRACT
BACKGROUND: Antipsychotic medication is a commonly prescribed drug class in individuals with autism spectrum disorder (ASD). However, the safety of these agents has not been fully assessed. OBJECTIVE: Our objective was to investigate the safety and tolerability profile of antipsychotics in individuals with ASD. METHODS: The Cochrane Library, MEDLINE, Embase and PsycINFO databases were searched up to January 2018. We included studies that reported adverse events (AEs) in participants with ASD taking first- or second-generation antipsychotic medication. The studies included in the analysis were randomized controlled trials (RCTs) and observational studies that were comparative or noncomparative and published as full text in the English language. The primary outcome of this review was AEs of any severity reported with antipsychotic use at any dose. Meta-analysis was performed on studies with child and adolescent participants to estimate the pooled prevalence of the overall AEs and the relative risk (RR) of AEs associated with antipsychotic use using a random-effects model. The Cochrane Collaboration tool and the modified Newcastle-Ottawa Scale (NOS) were used to assess the risk of bias of the included RCTs and observational studies, respectively. RESULTS: In total, 54 citations fulfilled the inclusion criteria, of which 40 were RCTs and 14 were observational studies; eight RCTs were included in the meta-analysis to estimate the RR of AEs associated with antipsychotic use and seven observational studies were included to estimate the pooled prevalence of AEs. The RR of AEs with antipsychotic treatment was 22% higher than with placebo (RR 1.22; 95% confidence interval [CI] 1.11-1.34; I2 = 30.6%; p = 0.184). The estimated pooled prevalence of AEs was 50.5% (95% CI 33-67). The most commonly reported AEs were increased appetite and weight gain, which were associated with discontinuation in many participants. CONCLUSION: Antipsychotic-related AEs were common among patients with ASD. Further studies to investigate the implications of antipsychotic-related AEs on health and medication adherence are warranted. PROSPERO registration number: (CRD42018083632).
