Bridging the gap from evidence to policy and practice: Reducing the progression to metabolic syndrome for children and adolescents on antipsychotic medication

Eapen, Valsamma; Shiers, David; Curtis, Jackie

doi:10.1177/0004867412463169

Cited by 16 publications

(11 citation statements)

References 70 publications

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“…With regard to the adherence to evidence based guidelines for the safe prescribing of medication, such as second generation antipsychotics in children, considerable consensus from published guidelines exists. 7 While these guidelines indicate that the assessment, when prescribing these agents, should include weight and body mass index, waist circumference blood pressure, lipid levels and glucose, adherence to these or others guidelines has not been followed at the RMMCH mental health care clinic.…”

Section: Discussionmentioning

confidence: 99%

Clinical and psycho-social profile of child and adolescent mental health care users and services at an urban child mental health clinic in South Africa

Raman

Rensburg

2013

Afr. J. Psych

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Objective: National and international child and adolescent mental healthcare policy and action advocate that the health and well being of children should be increasingly given greater attention. The purpose of this study was to describe the demographic, socio economic and clinical profile of the users at the child and adolescent mental health clinic of the Rahima Moosa Mother and Child Hospital (RMMCH). Method: A descriptive, retrospective clinical audit from users' clinical files was performed over a one-year period from January to December 2007. Descriptive statistical analyses of demographic and socio-economic variables were made and these variables were compared with the presenting clinical problems. Odds ratios were calculated for variables that showed a statistically significant association (p-value less than 0.05). Results: A total of 303 users attended this clinic. Statistical comparisons between demographic data and disorders revealed that being male increased the likelihood of presenting with AHDH and disruptive behaviour disorders; being female increased the likelihood of being sexually abused. Race showed a significant association with parent-child relationship difficulties. Regarding socio-economic variables, the identity of the caregiver of the child influenced the risk of disruptive behaviour disorders, sexual abuse, neglect and academic problems. Where the child was placed was a risk factor for disruptive behaviour disorders, sexual abuse, neglect and academic problems. Whether the mother of a user was alive or deceased, was found to be related to ADHD and disruptive behaviour and whether the father of a user was alive or deceased, was found to be related to sexual abuse and academic problems. The education level of the caregiver showed a significant association with sexual abuse, neglect and academic problems; the marital status of the parent (widowed mother) showed a significant association with bereavement. Household income was associated with sexual abuse, neglect and academic problems. Conclusion: This study demonstrated the impact that socio-economic circumstances have on the prevalence of childhood disorders; hence the urgent need for government and social welfare departments to improve the socio-economic status of communities. There is a need to improve psychiatric services for the population served by this hospital, including more clinics in its catchment area, as well as child psychiatry training posts and extended social work services.

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Section: Discussionmentioning

confidence: 99%

Clinical and psycho-social profile of child and adolescent mental health care users and services at an urban child mental health clinic in South Africa

Raman

Rensburg

2013

Afr. J. Psych

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“…Apart from monitoring absolute weight gain or BMI changes, the rate of weight gain might be even more important in assessing future cardiometabolic abnormalities [106]. Especially in children and adolescents, close monitoring of metabolic disturbances and weight gain appears to be crucial, as data point towards a lack in monitoring these parameters in youth [107]. The good and bad news is that weight gain occurs quite early in the course of treatment with a later decrease in speed of weight gain [39,108].…”

Section: Monitoring Weight Gainmentioning

confidence: 99%

Weight gain and antipsychotics: a drug safety review

Musil

Obermeier²,

Russ

et al. 2014

Expert Opinion on Drug Safety

153

111

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Recently published data still support the hierarchical ranking of SGAs already proposed in previous reviews ranking clozapine and olanzapine as having the highest risk, followed by amisulpride, asenapine, iloperidone, paliperidone, quetiapine, risperidone and sertindole in the middle, and aripiprazole, lurasidone and ziprasidone with the lowest risk. Number needed to harm varied considerably in our meta-analysis. Younger patients and patients with a lower baseline body mass index are most vulnerable. The greatest amount of weight gain occurs within the first weeks of treatment. AIWG occurs in all diagnostic groups and is also common in treatment with first-generation antipsychotics; therefore, awareness of this adverse event is essential for anyone prescribing antipsychotics.

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“…The increased risk for type 2 diabetes in association with antipsychotic drug treatment and interventions directed at related weight gain have deservedly received substantial attention . Much less attention has been paid to other risk factors which contribute to the context within which treatment effects are expressed.…”

mentioning

confidence: 99%

Predictors of type 2 diabetes in a nationally representative sample of adults with psychosis

et al. 2014

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Antipsychotic drugs such as clozapine and olanzapine are associated with an increased risk for type 2 diabetes, but relatively little is known about the relationship between risk factors for type 2 diabetes established in the general population and type 2 diabetes in people with psychosis. We estimated the prevalence of established risk factors and their association with type 2 diabetes in a nationally representative sample of people with an ICD-10 psychosis (N51642) who gave a fasting blood sample (N51155). Logistic regression was used to summarize associations adjusted for age and sex. In this sample, whose mean duration of psychosis was 14.7 years, 12.1% (13.1% of women and 11.5% of men) had type 2 diabetes at age 18-64 years based on current fasting blood glucose levels or treatment with a hypoglycaemic drug. Risk was greatly increased in young adults compared with the general population and peaked in middle age. Risk factors in the general population were common in people with psychosis and strongly associated with type 2 diabetes in those people. Treatment with clozapine was associated with an increased risk and treatment with olanzapine with a decreased risk for type 2 diabetes. The development of diabetes or pre-diabetes may therefore influence the likelihood of treatment with olanzapine over time. The strongest predictors of type 2 diabetes in a multivariate model were a body mass index of at least 40 and treated hypercholesterolemia, followed by a body mass index between 35 and 39.9, a family history of diabetes and treated hypertension. There was minimal to no confounding of the association between type 2 diabetes and current clozapine or olanzapine treatment, but neither association remained significant after adjustment for other predictors. Longitudinal relationships among predictors are likely to be complex, and previous antipsychotic drug treatment may at least partly explain risks associated with severe obesity, dyslipidemia and hypertension. A focus on weight loss is warranted in people with psychosis, but prevention strategies for type 2 diabetes should be broadened to include those with emerging dyslipidemia, hypertension and a family history of diabetes.

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Bridging the gap from evidence to policy and practice: Reducing the progression to metabolic syndrome for children and adolescents on antipsychotic medication

Cited by 16 publications

References 70 publications

Clinical and psycho-social profile of child and adolescent mental health care users and services at an urban child mental health clinic in South Africa

Clinical and psycho-social profile of child and adolescent mental health care users and services at an urban child mental health clinic in South Africa

Weight gain and antipsychotics: a drug safety review

Predictors of type 2 diabetes in a nationally representative sample of adults with psychosis

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