According to the National Research Council and Institute of Medicine, about 14% to 20% of C/A have a psychiatric illness. Up to 80% of these C/A are on multiple psychotropics simultaneously, including atypical antipsychotics. The US - FDA has approved the use of antipsychotics in specific psychiatric disorders include Tourette's and other tics disorders, behavioral and emotional symptoms associated with developmental delay, autistic spectrum disorder, bipolar disorder, and schizophrenia. Also, significant off-label antipsychotic uses (without FDA approval) are of the standard of practice today to manage C/A emotional and behavioral symptoms.
A metanalysis reported a median prevalence of antipsychotics use in autism spectrum C/A of about 17%. Risperidone is the most commonly prescribed antipsychotic (55%), followed by aripiprazole (35%). While the antipsychotics trending pattern in adult psychiatric inpatient show olanzapine prescribed chiefly (51%) followed by risperidone (23%). Antipsychotics cause various endocrine and metabolic side effects, including overweight, hyperlipidemia, uncontrolled diabetes, and hyperprolactinemia. Hyperprolactinemia and movement disorder side effects are common with first-generation antipsychotics due to potent dopamine receptor blocking effects.
Studies indicate that up to two-thirds of patients treated with atypical antipsychotics experience impaired bone marrow density, leading to osteoporosis. The risk of bone disease and bone fracture positively correlates to this category of medication. Antipsychotics can directly alter bone mineral density or indirectly cause obesity due to limited physical activity or excessive somnolence. Evidence shows early onset osteoporosis in patients with mental illness like schizophrenia related to chronic exposure to antipsychotics. Antipsychotics use causes an increased risk of hip fracture up to 1.6 times. The US-FDA cautions in the prescribing package insert of this adverse effect.
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