Improving Metabolic Monitoring and Promoting Safe Use of Second-Generation Antipsychotics in Children and Adolescents
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Date
Authors
Coughlin, Mary
Keyword
Metabolic Monitoring , Antipsychotics , Nursing , Child and Adolescent Psychiatry , Drug Safety , Guidelines , Multidisciplinary Collaboration
Abstract
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.