Faculty development and institutional readiness for incorporating AI in health professions education- A narrative review.

There has been a dramatic increase in the use of psychotropic medications, especially second-generation antipsychotics (SGAs), over the past 20 years to treat children and adolescents with a variety of psychiatric conditions including bipolar disorder, autism spectrum disorder (ASD), and disruptive behavior disorders (). These pharmacological interventions are very effective for symptom management, but are often associated with serious metabolic adverse effects, especially significant weight gain (). Emerging data indicate that pediatric patients are particularly susceptible to metabolic changes associated with antipsychotics and are more rapidly gaining weight than adults (). Such non-age-appropriate weight gain impacts negatively not only on long-term cardiovascular and endocrine morbidities but also on self-esteem, stigmatization and is a major barrier for treatment adherence (). The management of the hospitalized pediatric patient is one of the most difficult clinical tasks. Polypharmacy is often required in the acute inpatient setting to achieve stabilization, which in turn multiplies the overall metabolic and side-effect burden (, ). In addition, many of these youth, particularly those diagnosed with ASD, show marked impulsivity, agitation and aggressive behaviors (). An important dilemma in pediatric psychopharmacology is the management of these complex behavioral presentations while attempting to minimize metabolic deterioration, highlighting the need for adjunctive treatments that can simultaneously target both the metabolic and behavioral domains (). Topiramate is a broad spectrum anticonvulsant that modulates GABAergic and glutamatergic neurotransmission and has shown promise as an adjunctive agent (, ). Numerous studies have demonstrated that topiramate is effective in reducing SGA-associated weight gain and decreasing body mass index (BMI) in children and adolescents (). In addition to its well known metabolic effects, topiramate has been shown to decrease impulsivity in various psychiatric disorders (, ). It has shown promise in the treatment of disruptive and aggressive behaviors in youth with ASD, particularly in pediatric populations (). In addition, preliminary retrospective data suggest that adjunctive topiramate may improve overall clinical severity and mood symptoms in hospitalized children and adolescents without compromising safety ().