Improving Metabolic Monitoring and Promoting Safe Use of Second-Generation Antipsychotics in Children and Adolescents
Background: Second-generation antipsychotics (SGAs) are increasingly being used for the treatment of child and adolescent mental health problems causing concern as there is limited evidence of their safety in this population. SGAs are known to cause metabolic, cardiac and endocrine side effects which may have an amplified effect in youth in periods of growth and development. Metabolic monitoring guidelines from the Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotic Use in Children (CAMESA) exist to guide practice in the prevention and detection of metabolic instability in pediatric SGA users. However, reported rates of metabolic monitoring are inadequate. Evidence of rates and factors associated with metabolic monitoring of youth on SGAs in Canada is limited and the extent to which the CAMESA guidelines are adhered to is not known. Methods: A retrospective chart review analysis of 294 children and adolescents in an outpatient psychiatry setting was conducted to assess baseline and follow-up metabolic monitoring, demographic, treatment and healthcare utilization variables in a one-year period of interest within a two-year study period (2014-2016). Results: Metabolic monitoring did not adhere to CAMESA guidelines and was poor over a 1-year period. 23.5% (n=69) of participants had any monitoring documented at baseline and 22.8% (n=67) had any follow-up monitoring. There were significant differences in between children (ages 4-12, n=99) and adolescents (ages 13-18, n=195). In adolescents, the factors associated with metabolic monitoring documented at baseline were a higher number of psychiatry visits (OR 1.2, 95% CI 1.10-1.41), longer duration of contact (OR 14, 95% CI 2.31-82.4), and prescription of medications in addition to SGA (OR 3.2, 95% CI 1.17-8.94) while in children, factors were having an emergency room visit (OR 3.4, 95% CI 1.01-11.71) and taking aripiprazole as the type of SGA for treatment (OR 7.4, 95% CI 2.02-27.45). Conclusion: Findings from this study support existing literature of inadequate metabolic monitoring of children and adolescents on SGAs and calls for further investigation into factors associated with metabolic monitoring. Recommendations to improve metabolic monitoring in this context include multidisciplinary collaboration and enhancement of the nursing role as a pragmatic approach in improving care for this population.
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