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

Abstract

Aim: To assess the frequency of monitoring of adverse drug reaction (ADR) related parameters in children and adolescents treated with antipsychotic drugs in psychiatric outpatient clinics and the considerations when monitoring was not performed.Methods: This retrospective follow-up study included 100 randomly selected outpatients aged ≤18 years who had a first prescription of an antipsychotic drug recorded in the electronic medical records of psychiatric outpatient clinics between 2014 and 2017. They were followed for up to 3 years. This study assessed the frequency of monitoring for physical parameters (weight, height, body mass index, waist circumference, pulse, blood pressure, and an electrocardiogram) and laboratory parameters (glucose, lipids, and prolactin) before the first prescription of an antipsychotic drug as well as during its use. Monitoring frequencies were stratified by the patient characteristics (sex, age, cardiovascular risk factors, and use of other psychotropic drugs), and by location of antipsychotic drug initiation (psychiatric outpatient clinic or elsewhere). Additionally, this study assessed the considerations mentioned in the medical records for not monitoring ADR-related parameters.Results: Overall, physical parameters were monitored more frequently (weight: 85.9% during the first half-year) than laboratory parameters (glucose and cholesterol: both 23.5%). There were no significant differences in monitoring at least one physical as well as in monitoring at least one laboratory parameter during the baseline period and during the total follow-up of antipsychotic drug treatment between the patient characteristics. In total, 3% of the children and adolescents were never monitored for any physical parameter, and 54% were never monitored for any laboratory parameter. For a minority of the children (14.8%) who were never monitored for laboratory parameters, considerations were recorded in their medical records, including refusal by the child or parents and monitoring performed by the general practitioner or elsewhere.Conclusion: Monitoring frequencies of ADR-related parameters in children and adolescents treated with antipsychotic drugs in psychiatric outpatient clinics varied and especially monitoring of laboratory parameters was infrequent. Considerations why monitoring was not performed were rarely recorded. The optimal method of monitoring and documentation thereof should become clear to optimize the benefit-risk balance of antipsychotic drug treatment for each child.

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

“…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.…”

“…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.…”

“…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…”