Enhancing metabolic monitoring for children and adolescents using second‐generation antipsychotics

Abstract

The prevalence of children and adolescents using second-generation antipsychotics (SGAs) has increased significantly in recent years. In this population, SGAs are used to treat mood and behavioural disorders although considered 'off-label' or not approved for these indications. Metabolic monitoring is the systematic physical health assessment of antipsychotic users utilized to detect cardiovascular and endocrine side effects and prevent adverse events such as weight gain, hyperglycaemia, hyperlipidemia, and arrhythmias. This practice ensures safe and efficacious SGA use among children and adolescents. Despite widely available, evidence-based metabolic monitoring guidelines, rates of monitoring continue to be suboptimal; this exposes children to the unnecessary risk of developing poor cardiovascular health and long-term disease. In this discursive paper, existing approaches to metabolic monitoring as well as challenges to implementing monitoring guidelines in practice are explored. The strengths and weaknesses of providing metabolic monitoring across outpatient psychiatry, primary care, and collaborative community settings are discussed. We suggest that there is no one-size-fits-all solution to improving metabolic monitoring care for children and adolescents using SGA in all settings. However, we advocate for a pragmatic global approach to enhance safety of children and adolescents taking SGAs through collaboration among healthcare disciplines with a focus on integrating nurses as champions of metabolic monitoring.

Compliance with the guidelines for laboratory monitoring of patients treated with lithium: A retrospective follow‐up study among ambulatory patients in the Netherlands

“…Although the need for monitoring of patients treated with psychotropic drugs is widely recognized, adherence to monitoring guidelines is often found to be suboptimal . For example, monitoring rates of metabolic parameters such as weight, glucose, and lipids in patients using antipsychotic drugs have been found not to correspond with advice given in CPGs, posing unnecessary risks of morbidity to patients …”

Long-Term Metabolic Monitoring of Youths Treated with Second-Generation Antipsychotics 5 Years after Publication of the CAMESA Guidelines Are We Making Progress? Surveillance Métabolique à Long Terme des Jeunes Traités par Antipsychotiques de Deuxième Génération, Cinq ans Après la publication des Lignes Directrices Camesa: Faisons-Nous des Progrès?

“…[21][22][23] Prioritizing metabolic monitoring could prevent these consequences in SGA-treated patients through early detection, better management, education of the clinical team members and families about monitoring guidelines, as well as increasing involvement of nurses in clinical practice. 67,68 "Petits trésors" Foundation and the Lenval Foundation had no involvement or restrictions regarding this publication.…”

“…Other AMs were the best documented of the recommended tests, (see also the studies of Nolt et al, 37 Ronsley et al, 38 and Coughlin et al 39 ). The discrepancy between monitoring rates of AMs could reflect inadequate medical/nursing habits or the lack of sufficient time for medical/nursing staff or clinical coordination and resources, as well as limited patient engagement/collaboration with these procedures 68 or interpretation issues. Waist circumference percentile curves are available for Canadian youth between 6 and 18 years of age, 69 but measure interpretation is confronted to unstable consistency and ethnic variations.…”

“…39 Monitoring rates for patients diagnosed with psychotic and/or affective disorders were higher than those diagnosed with personality, anxiety, and other disorders and neurodevelopmental disorders, as previously reported for glucose and lipid monitoring, 47 possibly related to their increased risk of developing obesity, type 2 diabetes, and metabolic syndrome, independently of SGA exposure. 15,44,45,58,74 Conversely, challenging behaviors associated with youths with ADHD 68 or an autism diagnosis 75 could explain the low monitoring rates in this later population.…”

To Assess the Compliance of Monitoring Metabolic Symptoms Associated with Antipsychotics in an Inpatient Setting in a Tertiary Care Hospital in Karachi, Pakistan

“…Prescription of antipsychotics has increased considerably as evidenced by several studies. [2,[4][5][6] They work via affecting the activity of certain neurotransmitters in the brain. The key one is Dopamine; hyperactivity of which results in psychotic symptoms.…”