Metabolic Monitoring for Youths Initiating Use of Second-Generation Antipsychotics, 2003–2011

Connolly, John G.; Toomey, Timothy; Schneeweiss, Maria C.

doi:10.1176/appi.ps.201400222

Cited by 25 publications

(28 citation statements)

References 38 publications

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“…Previous research demonstrates that psychiatrist's metabolic monitoring behaviour is frequently insufficient (Connolly et al 2015;Cotes et al 2015;Delate et al 2014;Dhamane et al 2013;Honey et al 2013;Mitchell et al 2012;Rodday et al 2015). It is well known that the prescriber who initiates SGA therapy is assigned the primary responsibility of ensuring patients are appropriately monitored (Horn et al 2012).…”

Section: Challenges Associated With Meta-bolic Monitoringmentioning

confidence: 99%

“…This results in suboptimal monitoring rates during critical periods of SGA treatment such as at baseline, short-term, and long-term follow-up (Connolly et al 2015;Cotes et al 2015;Delate et al 2014;Dhamane et al 2013;Honey et al 2013;Mitchell et al 2012;Rodday et al 2015). Psychiatrists may operate independently and assume the sole responsibility of providing comprehensive care to their patients (i.e.…”

Section: Metabolic Monitoring In Outpatient Psychiatrymentioning

confidence: 99%

“…Publication of metabolic monitoring guidelines in the United States (USA) has demonstrated suboptimal increases in screening practices. One large study of commercial insurance claims of children and adolescents taking SGAs (n = 52 407) from 2003 to 2011 revealed that rates of glucose screening increase minimally from 17.9% to 18.9% for baseline and 14.7% to 16.6% for follow-up (Connolly et al 2015).…”

Section: Current Metabolic Monitoring Practicesmentioning

confidence: 99%

“…However, previous research has demonstrated that this model has several drawbacks such as lack of resources for monitoring and lack of multidisciplinary staff and is threatened by high patient demand. This results in suboptimal monitoring rates during critical periods of SGA treatment such as at baseline, short-term, and long-term follow-up (Connolly et al 2015;Cotes et al 2015;Delate et al 2014;Dhamane et al 2013;Honey et al 2013;Mitchell et al 2012;Rodday et al 2015).…”

Section: Metabolic Monitoring In Outpatient Psychiatrymentioning

confidence: 99%

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

Coughlin

Goldie

Tregunno

et al. 2017

Int J Mental Health Nurs

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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.

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Section: Challenges Associated With Meta-bolic Monitoringmentioning

confidence: 99%

Section: Metabolic Monitoring In Outpatient Psychiatrymentioning

confidence: 99%

Section: Current Metabolic Monitoring Practicesmentioning

confidence: 99%

Section: Metabolic Monitoring In Outpatient Psychiatrymentioning

confidence: 99%

See 2 more Smart Citations

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

Coughlin

Goldie

Tregunno

et al. 2017

Int J Mental Health Nurs

View full text Add to dashboard Cite

show abstract

“…Tackling inequalities in physical health and life expectancy demands improved access and quality of physical health care for people with mental illness. There is often inconsistent and low access to quality physical health services such as screening, effective referral processes, continuity of care and participation in health-behaviour programmes (Connolly et al 2015;Hyland et al 2003;Nasrallah et al 2006). In recent years, the debate on how to address physical health service gaps has become more prominent (De Hert et al 2011;Ehrlich et al 2015;Lawrence & Kisely 2010;Richardson et al 2005).…”

Section: Introductionmentioning

confidence: 99%

Physical health nurse consultant role to improve physical health in mental health services: A carer's perspective

Happell

Wilson

Platania‐Phung

et al. 2016

Int J Mental Health Nurs

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The physical health of people diagnosed with a mental illness is significantly poorer in comparison with the general population. Awareness of this health disparity is increasing; however, strategies to address the problem are limited. Carers play an important role in the physical health care of people with mental illness, particularly in facilitating navigation of and advocating in the health care system. A specialist physical health nurse consultant position has been suggested as a way to address the physical health care disparity and limited research available suggests that positive outcomes are possible. In the present study, a qualitative exploratory research project was undertaken, involving in-depth interviews with people identifying as mental health carers. Two focus groups and one individual interview were conducted involving a total of 13 carers. The resulting data were analyzed thematically. Views and opinions about the proposed physical health nurse consultant (PHNC) position were sought during these interviews and are reported in this paper. Two main sub-themes were evident relating to characteristics of this role: reliability and consistency; and communication and support. Essentially carers expressed a need for support for themselves and consumers in addressing physical health concerns. Successful implementation of this position would require a consistent and reliable approach. Carers are significant stakeholders in the physical health of consumers of mental health services and their active involvement in identifying and tailoring services, including development of the physical health nurse consultant must be seen as a priority.

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Association of Low-Dose Quetiapine and Diabetes

et al. 2021

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IMPORTANCE Quetiapine has been associated with increased risk of type 2 diabetes when used in medium or high doses for the treatment of severe mental disorders. It is not known whether low doses, commonly used off-label for sedative-hypnotic purposes, are also associated with increased risk of type 2 diabetes. OBJECTIVE To investigate whether there is an association between prescription of low-dose quetiapine and the risk of type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTSThis cohort study examined nationwide Danish health registers for data regarding new users of quetiapine (n = 185 938) or selective serotonin reuptake inhibitors (SSRIs) (n = 1 031 920) who were aged 18 years or older between January 1, 1998, and December 31, 2018. Individuals with schizophrenia or bipolar disorder were excluded. Quetiapineinitiators were matched 1:1 with initiators of SSRIs, using a high-dimensional propensity score (hdPS).Maximum follow-up was 5 years. Association with cumulative dose was investigated, using a casecontrol approach nested among quetiapine users. Data analysis was performed from May to September 2020. EXPOSURES Dispensing of quetiapine or SSRIs. Quetiapine prescriptions were limited to tablet strengths of 25 mg and 50 mg to focus on low-dose use. MAIN OUTCOMES AND MEASURESIncident type 2 diabetes was defined as first filling of an antidiabetic medication, first register diagnosis of type 2 diabetes or first hemoglobin A 1C measurement greater than or equal to 6.4% (Ն48 mmol/mol). Incidence rates (IRs), incidence rate ratios (IRRs), and number-needed-to-harm (NNH) were calculated for full and matched cohorts using as-treated and intention-to-treat approaches. Odds ratios (ORs) were calculated for the association with cumulative quetiapine dose. RESULTS Altogether, 896 285 patients were included in the full cohort; 538 164 (60%) were female and the median (interquartile range) age was 47 (33-67) years. There were 57 701 low-dose quetiapine initiators and 838 584 SSRI initiators. The matched cohort consisted of 54 616 pairs. In as-treated analyses, the incidence of type 2 diabetes during treatment with low-dose quetiapine (425 cases) was 9.59 cases/1000 person-years (PY) (95%

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Metabolic Monitoring for Youths Initiating Use of Second-Generation Antipsychotics, 2003–2011

Abstract: The small improvement in metabolic screening immediately after the 2004 ADA guidelines were issued was not sustained. Overall, metabolic screening rates remained suboptimal throughout the study period.

Cited by 25 publications

References 38 publications

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

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

Physical health nurse consultant role to improve physical health in mental health services: A carer's perspective

Association of Low-Dose Quetiapine and Diabetes

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