Psychopharmacology in the pediatric oncology and bone marrow transplant units: Antipsychotic medications palliate symptoms in children with cancer

Orit Peled, Orly Lavan, Jerry Stein, Inbal Vinograd, Anat Yahel, Avi Valevski, Avraham Weizman, Ella Kimmel-Tamir, Alan Apter, Silvana Fennig, Isaac Yaniv, Yael Bernfeld, Noa Benaroya-Milshtein

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The present study characterized the psychiatric diagnoses and symptoms that led to the administration of antipsychotic medications in children and adolescents with cancer, and to evaluate the benefits and tolerability of these drugs in a large hospital-based pediatric hematology-oncology practice. Methods: Efficacy and adverse effects of two second-generation antipsychotics were retrospectively analyzed in 43 patients 2.9-19.6 (mean 12.1) years of age. The Clinical Global Impression-Severity (CGI-S) Scale and Improvement (CGI-I) Scale were used to evaluate psychiatric symptom severity before and following treatment, while the incidence of side effects and drug-drug interactions were collected from medical records. Results: Olanzapine was administered to 58% of patients and risperidone to 42%; the choice of drug was at the discretion of the treating psychiatrist. The common psychiatric diagnoses among these patients included adjustment disorder (37%) and medication-induced psychiatric disorders (23%). The most common psychiatric-medical symptoms included irritability/ agitation (79%) and depressed mood (74%). CGI-S improved significantly ( p < 0.001) between assessments, with no statistically significant difference between olanzapine- and risperidone-treated patients. CGI-I scores at reassessment indicated superiority of olanzapine as compared with risperidone. Adverse effects of treatment were mild. Conclusions: Olanzapine and risperidone can be well tolerated and ameliorate severe psychiatric-medical symptoms in children and adolescents with cancer. The potential palliative benefits of these second-generation antipsychotics (e.g., rapid onset of action, antiemesis, sedation, and appetite stimulation) increase the utility of their use in children treated in oncology and bone marrow transplant units.

Original languageEnglish
Pages (from-to)486-494
Number of pages9
JournalJournal of Child and Adolescent Psychopharmacology
Volume30
Issue number8
DOIs
StatePublished - Oct 2020

Keywords

  • Liaison
  • Olanzapine
  • Psycho-oncology
  • Risperidone

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