ABSTRACT
BACKGROUND: Adult patients with schizophrenia and bipolar disorder have an increased risk of developing the metabolic syndrome. This is due to their psychiatric illness and to the use of antipsychotic drugs. Children and adolescents are being treated more and more with antipsychotics. The risk of metabolic abnormalities in this age group remains unclear. AIM: To investigate the relationship between psychotic disorders in childhood and metabolic abnormalities and to study the influence of the use of both typical and atypical antipsychotics on this relationship. METHOD: The PubMed database was searched for relevant articles published between 2000 and June 2009. RESULTS: So far, research into the relationship between psychiatric disorders and metabolic abnormalities in children and adolescents has been inadequate. The normal values and meaning of the components of the metabolic syndrome in children and adolescents have not yet been firmly established. Children and adolescents who use antipsychotics run a significantly higher risk of weight gain. The younger the child, the greater the risk. There are no data about the risk of developing diabetes mellitus type 2. The influence of typical antipsychotics on these conditions has not been investigated. CONCLUSION: The risk of significant weight gain due to the use of atypical antipsychotics is greater in younger children. The 'metabolic syndrome' concept is not applicable to children and adolescents. Very little is known about metabolic risks in the long term. Caution is called for in the prescription of antipsychotics for children and adolescents and further research is needed.
Subject(s)
Antipsychotic Agents/adverse effects , Diabetes Mellitus, Type 2/chemically induced , Energy Metabolism/drug effects , Metabolic Syndrome/chemically induced , Weight Gain , Adolescent , Antipsychotic Agents/therapeutic use , Child , Diabetes Mellitus, Type 2/epidemiology , Energy Metabolism/physiology , Female , Humans , Male , Mental Disorders/drug therapy , Metabolic Syndrome/epidemiology , Risk AssessmentABSTRACT
BACKGROUND: The DSM-IV-R classification Pervasive Developmental Disorder - Not otherwise Specified (PDD-NOS) is based on the symptoms for autism and includes a wide variety of phenotypes that do not meet full criteria for autism. As such, PDD-NOS is a broad and poorly defined residual category of the autism spectrum disorders. In order to address the heterogeneity in this residual category it may be helpful to define clinical and neurobiological subtypes. Multiple complex developmental disorder (MCDD) may constitute such a subtype. In order to study the neurobiological specificity of MCDD in comparison with other autism spectrum disorders, we investigated brain morphology in children (age 7-15 years) with MCDD compared to children with autism and typically developing controls. METHOD: Structural MRI measures were compared between 22 high-functioning subjects with MCDD and 21 high-functioning subjects with autism, and 21 matched controls. RESULTS: Subjects with MCDD showed an enlarged cerebellum and a trend towards larger grey-matter volume compared to control subjects. Compared to subjects with autism, subjects with MCDD had smaller intracranial volume. CONCLUSIONS: We report a pattern of volumetric changes in the brains of subjects with MCDD, similar to that seen in autism. However, no enlargement in head size was found. This suggests that although some of the neurobiological changes associated with MCDD overlap with those in autism, others do not. These neurobiological changes may reflect differences in the developmental trajectories associated with these two subtypes of autism spectrum disorders.
Subject(s)
Autistic Disorder/diagnosis , Brain/pathology , Child Development Disorders, Pervasive/diagnosis , Developmental Disabilities/diagnosis , Magnetic Resonance Imaging/methods , Phenotype , Adolescent , Child , Humans , Male , Netherlands , Organ SizeABSTRACT
We carried out a small survey among 22 interviewees working as physicians (n = 11) or as nurses (n = 11) in a nursing home. The questions concerned the last case they had seen of a psychogeriatric patient who did not eat any more, and the decision-making process. 35 patients were described to us: 13 in whom feeding was continued (mostly by drip) and 22 in which it was withheld. It appeared that the withholding of artificial feeding was the more common decision. If feeding was continued it was usually a time-limited trial. The decision-making process appeared to be careful and elaborate. Among the reasons to withhold feeding was the thought that the patient did not wish to live any more and was showing this by refusing to eat. Formal criteria for determining mental (in)competence were not used, however. When patients died after discontinuation of feeding, the dying process mostly was peaceful (15/17); five of the 22 patients in whom feeding was discontinued spontaneously resumed eating.
