Guideline Adherence of Monitoring Antipsychotic Use for Nonpsychotic Indications in Children and Adolescents

Dinnissen, Mariken; Dietrich, Andrea; Molen, Judith H van der; Verhallen, Anne M.; Buiteveld, Ynske; Jongejan, Suzanne; Troost, Pieter W.; Buitelaar, Jan K.; Hoofdakker, Barbara J. van den; Hoekstra, Pieter J.

doi:10.1097/jcp.0000000000001322

Cited by 6 publications

(9 citation statements)

References 38 publications

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“…A study by McLaren et al has shown that most child psychiatrists reported being aware of the CPGs for antipsychotic drug monitoring,27 while a study by Mangurian et al has shown that a large proportion of the primary care providers seem to be unaware of the consensus guidelines 30. Nevertheless, previous studies have demonstrated that monitoring rates were low and remained low after implementation of monitoring guidelines 12 14. As far as we know, no studies have been conducted that evaluated whether (a) more clear and applicable CPGs lead to better CPG adherence, and (b) whether good adherence to such clinical guidelines for the monitoring of ADR-related parameters indeed leads to better clinical outcomes such as less ADRs or better recognition and management thereof.…”

Section: Discussionmentioning

confidence: 99%

“…A monitoring instruction was defined as an instruction on measuring a physical, laboratory or observational ADR-related parameter before or during antipsychotic drug treatment. In total, 13 ADR-related parameters were included, based on the cardiometabolic, endocrine and extrapyramidal ADRs that can be caused by antipsychotic drugs 13 14. The physical parameters included were weight, height, BMI, waist circumference, blood pressure, pulse and ECG.…”

Section: Methodsmentioning

confidence: 99%

“…Nevertheless, previous studies have shown that the monitoring of children treated with antipsychotic drugs is suboptimal and improved only marginally after the introduction of monitoring instructions provided in the CPGs. [12][13][14] To enable the implementation of the monitoring instructions provided in the CPGs in daily clinical practice, first, the quality of the CPG is important, for example, the clarity of presentation. Second, each monitoring instruction included in the CPG has to be easily identifiable, clear, unambiguous and easy to apply.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…Regardless of these differences in the content of the instructions, all instructions aim to provide guidance to improve monitoring practices. Nevertheless, previous studies have shown that the monitoring of children treated with antipsychotic drugs is suboptimal and improved only marginally after the introduction of monitoring instructions provided in the CPGs 12–14…”

Section: Introductionmentioning

confidence: 99%

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Clarity and applicability of adverse drug reaction-related monitoring instructions in clinical practice guidelines for children and adolescents treated with antipsychotic drugs: a review of six clinical practice guidelines

et al. 2022

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ObjectivesMonitoring instructions related to adverse drug reactions (ADRs) are not always clearly described in clinical practice guidelines (CPGs) and not always easily applicable in daily clinical practice. The aim of this study was to assess the clarity of presentation and the applicability of ADR-related monitoring instructions in CPGs for children and adolescents treated with antipsychotic drugs.SettingGuidelines from different countries were selected, and monitoring instructions for 13 ADR-related parameters were assessed.Primary and secondary outcome measuresTo assess the clarity and the applicability of the sections concerning monitoring instructions in each CPG, the Appraisal of Guidelines for Research and Evaluation instrument was used. To assess the clarity and the applicability of the monitoring instructions for each ADR-related parameter, the Systematic Information for Monitoring score was used.ResultsSix CPGs were included. Overall, the presentation of the monitoring instructions in the different CPGs was clear; three CPGs scored >75%. All CPGs scored lower on applicability, as, for example, the barriers and facilitators were poorly described. The number of ADR-related parameters included in the CPGs varied between 8 and 13. Why and what to monitor was always described for each parameter. When to start monitoring was also often described (90.2%), but when to stop monitoring was less frequently described (37.4%).ConclusionsThe CPGs differed on the parameters that needed to be monitored. Overall, the monitoring instructions were clearly presented, but improvement in their applicability is required. By improving the monitoring instructions, CPGs can provide better guidance on monitoring ADRs in daily clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clarity and applicability of adverse drug reaction-related monitoring instructions in clinical practice guidelines for children and adolescents treated with antipsychotic drugs: a review of six clinical practice guidelines

et al. 2022

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“… 33 , 34 The prescription patterns could be changed over time according to the patient’s symptoms and disease severities. 35 , 36 , 37 , 38 , 39 Thus, we might more precisely estimate the risk of movement disorders and seizures associated with the use of antipsychotics and antidepressants in the treatment of children and adolescents with depression.…”

Section: Discussionmentioning

confidence: 99%

Association of Treatment With Antipsychotics, Antidepressants, or Both With Movement Disorders and Seizures Among Children and Adolescents With Depression in Korea

Jeon

Park

et al. 2022

JAMA Netw Open

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Key Points Question Is treatment with antipsychotics in children and adolescents who are taking antidepressant medications associated with neurological adverse events? Findings In this cohort study of 9890 children and adolescents prescribed antidepressants for depression, the hazard ratios of movement disorders and seizures with adjuvant antipsychotics were 2- to 3-fold higher compared with antidepressant monotherapy. Hazard ratios increased with increasing doses of adjuvant antipsychotics and varied according to which antipsychotic was concomitantly used. Meaning These results suggest that adjuvant use of antipsychotics needs to be carefully considered in the treatment children and adolescents with depression.

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What Role for Long-Acting Injectable Antipsychotics in Managing Schizophrenia Spectrum Disorders in Children and Adolescents? A Systematic Review

et al. 2023

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Background Long-acting injectable antipsychotics (LAIAs) are an efficacious and well-tolerated treatment in adults with schizophrenia spectrum disorders (SSD). However, there is less evidence for their use in children and adolescents. Objectives The aim of this systematic review was to summarize findings regarding the effectiveness and side effects of LAIA in children and adolescents with SSD. Methods Four databases (Web of Science, PubMed, MEDES, and Dialnet) were systematically searched for articles published between inception and 12 March, 2022, with the following inclusion criteria: (1) original articles or case reports; (2) providing data on efficacy/effectiveness or safety/tolerability of LAIA treatment in children and adolescents diagnosed with SSD (schizophrenia, schizoaffective disorder, schizophreniform disorder, non-affective psychotic disorder); (3) mean age of samples ≤ 18 years; and (4) written in English or Spanish. Exclusion criteria were review articles, clinical guides, expert consensus as well as posters or oral communication in conferences. The risk of bias was assessed using the ROBIS tool. Results From 847 articles found, 13 met the inclusion criteria. These included seven single case reports or case series, four retrospective chart reviews, a 24-week open-label trial, and one observational prospective study, covering a total of 119 adolescents (aged 12–17 years) with SSD. Almost all the articles described data on second-generation LAIA (53 patients on risperidone [once every other week], 33 on paliperidone palmitate [once monthly], 10 on aripiprazole [once monthly], and two on olanzapine pamoate [once monthly]). Twenty-one patients were reported to be only on first-generation LAIAs. Non-adherence was the main reason for starting an LAIA. In all of the studies, the use of LAIAs was associated with improvement in the patients’ symptoms. Conclusions There are few studies assessing the use of LAIAs in adolescents with SSD. Overall, these treatments have suggested good effectiveness and acceptable safety and tolerability. However, we found no studies examining their use in children aged < 12 years. The problems and benefits linked to this type of antipsychotic formulation in the child and adolescent population require further study, ideally with prospective, controlled designs. Supplementary Information The online version contains supplementary material available at 10.1007/s40272-023-00558-x.

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Guideline Adherence of Monitoring Antipsychotic Use for Nonpsychotic Indications in Children and Adolescents

Abstract: Supplemental digital content is available in the text.

Cited by 6 publications

References 38 publications

Clarity and applicability of adverse drug reaction-related monitoring instructions in clinical practice guidelines for children and adolescents treated with antipsychotic drugs: a review of six clinical practice guidelines

Clarity and applicability of adverse drug reaction-related monitoring instructions in clinical practice guidelines for children and adolescents treated with antipsychotic drugs: a review of six clinical practice guidelines

Association of Treatment With Antipsychotics, Antidepressants, or Both With Movement Disorders and Seizures Among Children and Adolescents With Depression in Korea

What Role for Long-Acting Injectable Antipsychotics in Managing Schizophrenia Spectrum Disorders in Children and Adolescents? A Systematic Review

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