Emergence of psychiatric adverse events during antipsychotic treatment in naive children and adolescents

Abstract Objective: Over the last decades, antipsychotic prescriptions in children have increased worldwide. Nevertheless, adverse events are frequently observed, with some such as psychiatric adverse events remaining poorly documented. Method: The French ETAPE study is a 12-month naturalistic prospective multisite study that included 190 naïve pediatric patients (mean age = 12±3 years), treated by antipsychotic for psychotic or non-psychotic symptoms. From the ETAPE database, we performed additional analyses focusing on psychiatric adverse events.Results: Children received mainly second-generation antipsychotic for conditions out of regulatory approval, with risperidone and aripiprazole being the most frequent (respectively 52.5% and 30.83%). Clinicians reported 2447 adverse events, mainly non-psychiatric (n=2073, 84.72%), including neuromuscular, metabolic, gastroenterological, and (n=374, 15.28%) psychiatric. 55.88% of psychiatric adverse events were attributable to antipsychotic by the clinician, compared to 89% of non-psychiatric AEs (p<0.001). 63.2% (n=120) of the 190 children and adolescents presented at least one psychiatric adverse event. The most frequent were externalized behaviors such as aggressiveness or agitation (22.7%), mood changes (18.4%) and suicidal ideas or behaviors (11.8%). Half of psychiatric adverse events occurred during the first quarter, 49.46%, compared to 23.79% during the second, 15.77% during the third, and 10.96% during the fourth. Conclusion: This additional analysis from the French ETAPE study emphasizes that psychiatric adverse events might be more frequent than expected in the pediatric population. Also, the potential risk of psychiatric adverse events should be part of the benefit-risk evaluation and sub-sequent follow-up.