Metabolic Monitoring of Child and Adolescent Patients on Atypical Antipsychotics by Psychiatrists and Primary Care Providers

Abstract

Background: Antipsychotic drug use in children has doubled from 2001 to 2007 with concomitant increase in obesity. Second-generation antipsychotic (SGA) medication use is associated with weight gain, metabolic derangements, and blood sugar and lipid abnormalities in children. The American Psychiatric Association and the American Diabetes Association have recommended metabolic monitoring guidelines for patients using SGA. Study Question: The study objective was to investigate and compare metabolic monitoring for SGA medications in psychiatry (PSY), and pediatrics and family medicine [primary care providers (PCP)] outpatient clinics of a university medical center. Study Design: This is a retrospective study of 149 charts of patients newly prescribed with SGA, ages 5–18 years, from their initial visit in the outpatient clinics. Measures and Outcomes: Compliance with recommended metabolic monitoring was evaluated for initial and subsequent clinic visits. Parameters included body mass index, waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile. Results: Of the 149 charts, 110 patients were in PSY and 39 in PCP. The parameter most regularly monitored was body mass index (baseline: PSY 88.3%, PCP 97.4%; 12 weeks: PSY 86.4%, PCP 85.0%; and 24 weeks: PSY 91.8%, PCP 100%). Fasting plasma glucose (baseline: PSY 18.9%, PCP 25.6% and 12 weeks: PSY 8.6%, PCP 10.0%) and fasting lipid profile (baseline: PSY 12.7%, PCP 25.6% and 12 weeks: PSY 7.0%, PCP 10.0%) had low completions rates. No difference was seen in metabolic monitoring by sex or ethnic group. Conclusions: Metabolic monitoring rate of child and adolescent patients on SGAs was low overall. No statistically significant differences were seen between psychiatry and PCP except a significantly higher rate of fasting plasma glucose level monitoring at baseline among PCP. Limitations to the study include the small sample size obtained for the period investigated and insufficient documentation in some electronic charts. Extending the period studied may increase the statistical significance of the data.

Monitoring of Adverse Drug Reaction-Related Parameters in Children and Adolescents Treated With Antipsychotic Drugs in Psychiatric Outpatient Clinics

“…Although previous studies have shown differences in monitoring frequencies in children treated with antipsychotic drugs, it is clear that the monitoring frequencies were suboptimal (13,15,16,18). Overall, it has been shown that the physical parameter weight was monitored more frequently in children treated with antipsychotic drugs compared to the laboratory parameters glucose and lipids, and waist circumference was monitored much less, which is in line with the results of this current study (14,15,19).…”

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

“…Our findings are generally in line with those found by previous studies, with generally low monitoring of glucose and lipid profiles, and more adequate monitoring of weight and blood pressure, although there was still room for improvement. 16 , 19 , 26 Self-reported monitoring rates have been found to be higher, 34 – 36 but this could reflect socially desirable responding of prescribing clinicians in these studies. Our findings indicate that laboratory assessments are often omitted, which is undesirable because of the risk of developing metabolic conditions such as diabetes, because of not catching any abnormalities in time.…”

Monitoring of metabolic side-effects in children and adolescents prescribed antipsychotic medication: A systematic review

“…Fifteen papers were identified for inclusion in this review comprising four studies of self-reported clinical practice (Curtis et al, 2012;McLaren et al, 2017;Rodday et al, 2015;Walter et al, 2008) (Table 1), five data linkage studies of metabolic monitoring in children and adolescents attending mental health services (Connolly et al, 2015;Hayden et al, 2019;Morrato et al, 2010;Okumura et al, 2018;Raebel et al, 2014) (Table 2) and six retrospective chart review studies to examine metabolic monitoring (Cotes et al, 2017;Coughlin et al, 2018;Featherston et al, 2018;Javaheri and McLennan, 2019;Kauffman et al, 2018;Wakefield et al, 2019) (Table 3). Of the 11 studies which reported data from child and adolescent patients, five provided information about the diagnoses of the children (Connolly et al, 2015;Coughlin et al, 2018;Featherston et al, 2018;Hayden et al, 2019;Morrato et al, 2010).…”