Predictors of adverse effects of psychopharmacotherapy in hospitalized adolescents: A pharmacoepidemiological study

Abstract

Adverse effects of psychopharmacotherapy in adolescents are a major clinical concern due to developmental vulnerability, metabolic susceptibility, and frequent combination therapy. This study aimed to identify predictors of adverse effects associated with psychopharmacotherapy in hospitalized adolescents. A retrospective case-control pharmacoepidemiological study was conducted at the Adolescent Department of the Clinic for Mental Disorders "Dr Laza Lazarević", Belgrade, Serbia. The study included 175 adolescents aged 12-18 years treated with psychotropic medications during hospitalization. Demographic, clinical, pharmacotherapeutic, biochemical, and physiological variables were analyzed. Independent predictors were identified using multivariate linear and logistic regression analyses. The mean number of prescribed psychotropic drugs was 2.53, and the mean hospital stay was 17.47 days. Neurological risk was identified in 93.3% of patients, metabolic risk in 79.8%, hematological risk in 57.3%, and cardiovascular risk in 25.8%; 87.6% had at least two concomitant systemic risks. Olanzapine (β=0.48, p=0.009), polypharmacy (β=0.21, p=0.016), and higher body mass index, BMI (β=0.31, p<0.001) independently predicted elevated blood glucose. Metabolic disorders were associated with olanzapine (odds ratio, OR=3.2), polypharmacy (OR=2.6), and BMI >25 (OR=4.8). Valproate was associated with elevated AL T and AST levels, whereas risperidone was the strongest predictor of hyperprolactinemia (β=210 mIU/L, p<0.001), with female sex as an additional risk factor. Adverse effects of psychopharmacotherapy in adolescents result from the interaction of pharmacological, metabolic, and individual factors. Rationalizing polypharmacy, routine laboratory monitoring, and individualized treatment may reduce adverse drug reactions and improve the safety of psychopharmacotherapy in adolescents.