Update on the safety of second generation antipsychotics in youths: a call for collaboration among paediatricians and child psychiatrists

Simone Pisano, Gennaro Catone, Stefania Veltri, Valentina Lanzara, Marco Pozzi, Emilio Clementi, Raffaella Iuliano, Maria Pia Riccio, Sonia Radice, Massimo Molteni, Annalisa Capuano, Antonella Gritti, Giangennaro Coppola, Annarita Milone, Carmela Bravaccio, Gabriele Masi

During the past decade, a substantial increase in the use of second generation antipsychotics (SGAs) has occurred for a number of juvenile psychiatric disorders, often as off-label prescriptions. Although they were thought to be safer than older, first generation antipsychotics, mainly due to a lower risk of neurological adverse reactions, recent studies have raised significant concerns regarding their safety regarding metabolic, endocrinological and cardiovascular side effects. Aim of this paper is to update with a narrative review, the latest findings on safety of SGAs in youths. Results suggest that different SGAs may present different safety profiles. Metabolic adverse events are the most frequent and troublesome, with increasing evidences of heightened risk for type II diabetes mellitus. Results are discussed with specific emphasis on possible strategies of an active monitoring, which could enable both paediatricians and child psychiatrists to a possible prevention, early detection, and a timely management of such effects.