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Reproductive Adverse Events Associated with Antipsychotic Treatment in Children and Adolescents
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NASPAG 22nd Annual Clinical Meeting
the 10 patients also reported similar episodes of painful vulvar ulcerations following acute febrile episodes non-temporally related to those of the patients. Comments: Although linked by no single infectious agent, the occurrence of painful vulvar ulcers in this population of sexually naı¨ve young girls and adolescents all followed an acute febrile illness. At minimum, this population fulfilled the criteria for major vulvar aphthous ulcers, and with concomitant oral ulcerations, complex aphthosis. The possibility of a genetic predisposition is also suggested. doi:10.1016/j.jpag.2008.01.037
Reproductive Adverse Events Associated with Antipsychotic Treatment in Children and Adolescents Jeanette M. Jerrell, PhD, Janice L. Bacon, MD, Judith T. Burgis, MD, and Seema Menon, MD
and other endocrine problems. Nine percent of the patients, predominantly female, treated with antipsychotic and adjunctive medications developed one of the reproductive adverse events. Amenorrhea was most commonly reported, seen in 6% of patients; no patients reported erectile dysfunction. The risk of developing adverse events was higher for adolescents (OR 5 3.77; CI 5 3.05, 4.69), non-African Americans (OR 5 1.33; CI 5 1.07, 1.65), those taking selective serotonin reuptake inhibitors (SSRI) (OR 5 2.62; CI 5 2.04, 3.38), those with pre-existing obesity/weight gain (OR 5 2.18; CI 5 1.51, 3.51), those with incident obesity/weight gain after being exposed to antipsychotic medications (OR 5 2.30; CI 5 1.73, 3.05), and those with comorbid endocrine disorders (OR 5 5.39; CI 5 3.78, 7.69). The mean time elapsed between initiation of treatment and reproductive adverse events was 25.7 months. Conclusions: After initiation of anti psychotic medication, female adolescents already treated with SSRI medications, those with comorbid obesity and weight gain, and endocrine problems were at higher risk of developing a range of sexual and reproductive adverse events. These problems developed two years after initiating therapy. doi:10.1016/j.jpag.2008.01.038
University of South Carolina School of Medicine, Columbia, South Carolina
Background: Limited data is available on the association of adverse reproductive events with mood stabilizing treatment in children and adolescents. We aim to identify the incidence of adverse reproductive events in young patients using mood stabilizing drugs. Risk factors for the development of these adverse events will be identified. Time elapsed from treatment initiation to the development of adverse events will be investigated. Methods: A retrospective cohort analysis was performed to identify associations between use of anti psychotic medication and adverse reproductive events. Data was extracted from Medicaid claims of single state from January 1998 to December 2005. Four thousand one hundred and forty children and adolescents who were newly prescribed one of six atypical or two conventional antipsychotic medications were identified. Occurrence of specific reproductive adverse events in these patients including amenorrhea, oligomenorrhea, erectile dysfunction, hyperprolactinemia, irregular menses, gynecomastia, and galactorrhea was tabulated. Pre existing medical conditions and use of other mood stabilizing medications were collected. Logistic and Cox Proportional Hazards regression and Kaplan-Meier survival analysis were used. The University of South Carolina IRB granted exemption status. Results: Females represented 31.8% of 4140 subjects identified. Pre-existing medical conditions were noted in 558 subjects including obesity, dyslipidemia, diabetes
A Unique Obstructive Mu¨llerian Anomaly: Diagnosis and Management Todd Monroe, MD, Judith T. Burgis, MD, Seema Menon, MD, and Janice L. Bacon, MD University of South Carolina School of Medicine, Columbia, South Carolina
Background: Obstructive Mu¨llerian anomalies prevent normal menstrual outflow and generally present shortly after menarche due to pain and abnormal menstrual bleeding. The fallopian tubes and ovaries are generally unaffected. We describe the presentation and management of a unique obstructive Mu¨llerian anomaly. Case: A nineteen year old nulligravid AfricanAmerican female presented with a two week history of constant, non-radiating, severe lower abdominal pain. She reported her last menstrual period two weeks ago. Her menstrual history is significant for: menarche at age 13, normal menstrual intervals, and mild dysmenorrhea relieved by non steroidal anti inflammatory drugs. Evaluation prior to referral included a pelvic ultrasound which revealed a 7.6cm by 7cm by 6.4cm left adnexal mass interpreted as
NASPAG 22nd Annual Clinical Meeting
the 10 patients also reported similar episodes of painful vulvar ulcerations following acute febrile episodes non-temporally related to those of the patients. Comments: Although linked by no single infectious agent, the occurrence of painful vulvar ulcers in this population of sexually naı¨ve young girls and adolescents all followed an acute febrile illness. At minimum, this population fulfilled the criteria for major vulvar aphthous ulcers, and with concomitant oral ulcerations, complex aphthosis. The possibility of a genetic predisposition is also suggested. doi:10.1016/j.jpag.2008.01.037
Reproductive Adverse Events Associated with Antipsychotic Treatment in Children and Adolescents Jeanette M. Jerrell, PhD, Janice L. Bacon, MD, Judith T. Burgis, MD, and Seema Menon, MD
and other endocrine problems. Nine percent of the patients, predominantly female, treated with antipsychotic and adjunctive medications developed one of the reproductive adverse events. Amenorrhea was most commonly reported, seen in 6% of patients; no patients reported erectile dysfunction. The risk of developing adverse events was higher for adolescents (OR 5 3.77; CI 5 3.05, 4.69), non-African Americans (OR 5 1.33; CI 5 1.07, 1.65), those taking selective serotonin reuptake inhibitors (SSRI) (OR 5 2.62; CI 5 2.04, 3.38), those with pre-existing obesity/weight gain (OR 5 2.18; CI 5 1.51, 3.51), those with incident obesity/weight gain after being exposed to antipsychotic medications (OR 5 2.30; CI 5 1.73, 3.05), and those with comorbid endocrine disorders (OR 5 5.39; CI 5 3.78, 7.69). The mean time elapsed between initiation of treatment and reproductive adverse events was 25.7 months. Conclusions: After initiation of anti psychotic medication, female adolescents already treated with SSRI medications, those with comorbid obesity and weight gain, and endocrine problems were at higher risk of developing a range of sexual and reproductive adverse events. These problems developed two years after initiating therapy. doi:10.1016/j.jpag.2008.01.038
University of South Carolina School of Medicine, Columbia, South Carolina
Background: Limited data is available on the association of adverse reproductive events with mood stabilizing treatment in children and adolescents. We aim to identify the incidence of adverse reproductive events in young patients using mood stabilizing drugs. Risk factors for the development of these adverse events will be identified. Time elapsed from treatment initiation to the development of adverse events will be investigated. Methods: A retrospective cohort analysis was performed to identify associations between use of anti psychotic medication and adverse reproductive events. Data was extracted from Medicaid claims of single state from January 1998 to December 2005. Four thousand one hundred and forty children and adolescents who were newly prescribed one of six atypical or two conventional antipsychotic medications were identified. Occurrence of specific reproductive adverse events in these patients including amenorrhea, oligomenorrhea, erectile dysfunction, hyperprolactinemia, irregular menses, gynecomastia, and galactorrhea was tabulated. Pre existing medical conditions and use of other mood stabilizing medications were collected. Logistic and Cox Proportional Hazards regression and Kaplan-Meier survival analysis were used. The University of South Carolina IRB granted exemption status. Results: Females represented 31.8% of 4140 subjects identified. Pre-existing medical conditions were noted in 558 subjects including obesity, dyslipidemia, diabetes
A Unique Obstructive Mu¨llerian Anomaly: Diagnosis and Management Todd Monroe, MD, Judith T. Burgis, MD, Seema Menon, MD, and Janice L. Bacon, MD University of South Carolina School of Medicine, Columbia, South Carolina
Background: Obstructive Mu¨llerian anomalies prevent normal menstrual outflow and generally present shortly after menarche due to pain and abnormal menstrual bleeding. The fallopian tubes and ovaries are generally unaffected. We describe the presentation and management of a unique obstructive Mu¨llerian anomaly. Case: A nineteen year old nulligravid AfricanAmerican female presented with a two week history of constant, non-radiating, severe lower abdominal pain. She reported her last menstrual period two weeks ago. Her menstrual history is significant for: menarche at age 13, normal menstrual intervals, and mild dysmenorrhea relieved by non steroidal anti inflammatory drugs. Evaluation prior to referral included a pelvic ultrasound which revealed a 7.6cm by 7cm by 6.4cm left adnexal mass interpreted as