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.
Highlights
Antipsychotic drugs are frequently prescribed to children and adolescents to treat psychiatric disorders, including anxiety disorders, behavioral disorders, irritability associated with autism, tic disorders, and attentiondeficit/hyperactivity disorder (ADHD) [1, 2]
After 6 months, 85 children were still treated with an antipsychotic drug, and the physical parameters monitored most frequently in these children during this first half-year of antipsychotic drug treatment were weight (n = 73; 85.9%) and height (n = 66; 77.6%), and the laboratory parameters monitored most frequently were glucose and cholesterol
There were no significant differences in monitoring of adverse drug reactions (ADRs)-related parameters between sex and between children with and without cardiovascular risk factors at the start of the antipsychotic drug treatment, and only a few between age categories, children who did or did not use other psychotropic drugs within the 6 months before the start of the antipsychotic drug treatment, and between the initiation of the antipsychotic drug treatment at the psychiatric outpatient clinics or elsewhere
Summary
Antipsychotic drugs are frequently prescribed to children and adolescents (hereafter referred to as children) to treat psychiatric disorders, including anxiety disorders, behavioral disorders, irritability associated with autism, tic disorders, and attentiondeficit/hyperactivity disorder (ADHD) [1, 2]. Prescribing is commonly off-label because the evidence for efficacy of these drugs in this young and vulnerable population is scarce [3, 4] It is well-documented that antipsychotic drugs frequently cause bothersome and even severe adverse drug reactions (ADRs), including cardiometabolic, endocrine, and extrapyramidal adverse effects [4, 5]. Examples of these adverse effects include weight gain, hypertension, gynecomastia, and parkinsonism [4,5,6]. Next to monitoring efficacy, monitoring of ADRs is important to carefully evaluate and optimize the benefit-risk balance of antipsychotic drug treatment for each child
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