Adherence to antipsychotic laboratory monitoring guidelines in children and youth: a population-based study

Antoniou, Tony; Wang, Tianru; Pajer, Kathleen; Gardner, William; Lunsky, Yona; Penner, Melanie; Tadrous, Mina; Mamdani, Muhammad; Juurlink, David N.; Gomes, Tara

doi:10.3389/fpsyt.2023.1172559

Cited by 3 publications

(1 citation statement)

References 54 publications

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“…Because antipsychotic use did not return to pre-pandemic levels following an initial increase in use, our findings suggest that the number of children at risk of antipsychotic-induced metabolic disorders has increased during the pandemic. Moreover, the transition to virtual care likely exacerbated pre-pandemic findings of low adherence to metabolic monitoring in antipsychotic-treated children and youth, further increasing the risk of harm ( 51 , 52 ). Further research is necessary to clarify the clinical impacts and potential for harm with the increased antipsychotic use among children and youth.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on antidepressant and antipsychotic use among children and adolescents: a population-based study

Antoniou,

Pajer,

Gardner

et al. 2023

Front. Pediatr.

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BackgroundThe COVID-19 pandemic was associated with increases in the prevalence of depression, anxiety and behavioural problems among children and youth. Less well understood is the influence of the pandemic on antidepressant and antipsychotic use among children. This is important, as it is possible that antidepressants and antipsychotics were used as a “stop-gap” measure to treat mental health symptoms when in-person access to outpatient care and school-based supportive services was disrupted. Furthermore, antipsychotics and antidepressants have been associated with harm in children and youth. We examined trends in dispensing of these medications two years following the pandemic among children 18 years of age and under in Ontario, Canada.MethodsWe conducted a population-based time-series study of antidepressant and antipsychotic medication dispensing to children and adolescents ≤18 years old between September 1, 2014, and March 31, 2022. We measured monthly population-adjusted rates of antidepressant and antipsychotics obtained from the IQVIA Geographic Prescription Monitor (GPM) database. We used structural break analyses to identify the pandemic month(s) when changes in the dispensing of antidepressants and antipsychotics occurred. We used interrupted time series models to quantify changes in dispensing following the structural break and compare observed and expected use of these drugs.ResultsOverall, we found higher-than-expected dispensing of antidepressants and antipsychotics in children and youth. Specifically, we observed an immediate step decrease in antidepressant dispensing associated with a structural break in April 2020 (−55.8 units per 1,000 individuals; 95% confidence intervals [CI] CI: −117.4 to 5.8), followed by an increased monthly trend in the rate of antidepressant dispensing of 13.0 units per 1,000 individuals (95% CI: 10.2–15.9). Antidepressant dispensing was consistently greater than predicted from September 2020 onward. Antipsychotic dispensing increased immediately following a June 2020 structural break (26.4 units per 1,000 individuals; 95% CI: 15.8–36.9) and did not change appreciably thereafter. Antipsychotic dispensing was higher than predicted at all time points from June 2020 onward.ConclusionWe found higher-than-expected dispensing of antidepressants and antipsychotics in children and youth. These increases were sustained through nearly two years of observation and are especially concerning in light of the potential for harm with the long-term use of antipsychotics in children. Further research is required to understand the clinical implications of these findings.

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on antidepressant and antipsychotic use among children and adolescents: a population-based study

Antoniou,

Pajer,

Gardner

et al. 2023

Front. Pediatr.

Self Cite

View full text Add to dashboard Cite

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Developing a community-based model of care for venipuncture in children and young adults with an intellectual disability: a retrospective study

Garg,

Passarello,

O’Hea

et al. 2024

bmjpo

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BackgroundRegular blood tests for monitoring metabolic side effects are often unable to be collected for people with an intellectual/developmental disability (ID/DD) and challenging behaviours (CBs) using usual pathways. We aimed to develop a model of care to facilitate venipuncture for children and young adults with ID/DD and CBs.MethodsA systematic tiered model of care was developed for venipuncture to suit the individual needs of children and young adults with ID/DD and CBs. A partnership was formed by the disability health team with a community pathology service provider. An observational retrospective study of the baseline demographic data, severity of disability and diagnosis, oral sedation requirement, and outcome data on the success/failure of venipuncture was done.Results14 children (mean (SD), 12.8 (3.1) years) had 17 attempted venipuncture with ‘reasonable adjustments’ such as preparation with social stories, distraction, low sensory strategies and oral sedation at school clinics. 14 (82%) attempts were successful. After the success of the pilot programme at school, venipuncture was replicated in settings such as home, day programmes, pathology centres and a respite facility. 16 people with ID/DD and CBs (mean (SD)17.3 (3.7) years), had 14 successful venipuncture performed out of 18 attempts (success rate, 77.7%). Overall, 11 attempts (31.4%) succeeded without requiring oral sedation using only reasonable adjustments. 16 attempts (45.7%) succeeded with conscious oral sedation along with reasonable adjustments. Of those 16, 10 required olanzapine (5 mg), 1 required olanzapine (10 mg), 1 required combination of risperidone (1 mg) and diazepam (5 mg), 1 required clonazepam (2.5 mg) and olanzapine (5 mg), 1 required combination of olanzapine (10 mg) and diazepam (10 mg), 1 required combination of olanzapine (10 mg) and diazepam (5 mg) while 1 required only diazepam (5 mg). One had to be switched to the tier-3 pathway.ConclusionA model of care was developed to ensure compassionate and non-stressful venipuncture for children and young adults with disabilities. We demonstrated that a significant proportion of carefully selected children and young adults with ID/DD and CBs, considered ‘challenging for blood collection’ can have venipuncture performed successfully in non-hospital settings using ‘reasonable adjustments’ and oral sedation.

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Evaluation of routine health monitoring for metabolic disorders in patients with serious mental illness on psychotropic medications: a study from Ethiopia

Zeleke,

Teshome,

Assefa

et al. 2024

BMC Psychiatry

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Background Compared to the overall population, patients with mental health problems are more likely to experience concurrent physical illnesses, poorer health outcomes, and mortality. Psychotropic medications, which are the pillars in the management of mental health conditions, are associated with adverse effects such as weight gain, an increased level of glucose, and elevated circulating lipid levels, all of which contribute to metabolic disorders. Inadequate health monitoring may led to suboptimal interventions and worsening of these conditions. However, there is a lack of studies assessing routine health monitoring practices for metabolic disorders and their determinants among patients with serious mental illnesses taking psychotropic medications in Ethiopia. This study aimed to evaluate routine health monitoring for metabolic disorders and its determinants in patients with serious mental illnesses on psychotropic medications in Ethiopia. Method A hospital based prospective follow-up study was conducted among patients with serious mental illness taking psychotropic medications who attended the outpatient psychiatry department at Debre Markos Comprehensive Specialized Hospital. Eligible participants were selected using a simple random sampling technique. Routine health monitoring was evaluated using guidelines and previous literature. Binary logistic regression was employed to identify the determinants of routine health monitoring, with statistical significance determined by a p-value of less than 0.05 and a 95% confidence interval (CI). Results The overall routine health monitoring practice for metabolic disorders was found to be sub-optimal. Vital signs were the most commonly assessed parameters. Key determinants of routine health monitoring included participants aged 45 and above (AOR (95% CI): 2.82 (1.34–5.92), having social insurance (AOR (95% CI): 2.94 (1.86–4.64), availability of laboratory tests at the hospital (AOR (95% CI): 3.46 (2.16–5.55), and reporting of medication-related side effects (AOR (95% CI): 1.96 (1.21–3.17)). Conclusion Routine health monitoring for metabolic disorders in patients with serious mental illnesses attending the outpatient psychiatry department was inadequate. Health care providers should give more attention to younger patients, those without health insurance, and who are not reported side effects. These findings provide crucial insights for improving routine health monitoring and promoting better health outcomes.

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Adherence to antipsychotic laboratory monitoring guidelines in children and youth: a population-based study

Cited by 3 publications

References 54 publications

Impact of the COVID-19 pandemic on antidepressant and antipsychotic use among children and adolescents: a population-based study

Impact of the COVID-19 pandemic on antidepressant and antipsychotic use among children and adolescents: a population-based study

Developing a community-based model of care for venipuncture in children and young adults with an intellectual disability: a retrospective study

Evaluation of routine health monitoring for metabolic disorders in patients with serious mental illness on psychotropic medications: a study from Ethiopia

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