Metabolic Monitoring in Children 5 Years of Age and Younger Prescribed Second-generation Antipsychotic Medications

Overview

Journal Ment Health Clin

Specialty Psychiatry

Date 2018 Jun 30

PMID 29955489

Citations 3

Authors

Yardlee S Kauffman

Thomas Delate

Sheila Botts

Affiliations

Soon will be listed here.

Abstract

Introduction: The objective of this article was to identify the rates of patients ≤5 years of age who received recommended monitoring before and after second-generation antipsychotic (SGA) initiation and had an SGA metabolic adverse effect (MAE).

Methods: This was a retrospective cohort analysis conducted at Kaiser Permanente Colorado, an integrated health care delivery system, between January 1, 2002, and June 30, 2011. Commercially insured patients ≤5 years of age newly initiated on an SGA were included. Patients were followed for up to 3 years. Metabolic monitoring included lipid profile, blood glucose, blood pressure, and weight measurements. Patient characteristics and outcomes were described using descriptive statistics.

Results: A total of 40 patients were included. Overall, 2 (5.0%) patients received all recommended baseline monitoring, and no (0.0%) patients received all recommended follow-up monitoring. Weight monitoring was completed most frequently with rates of completion of 57.5%, 95.0%, 85.0%, and 76.5% at baseline and years 1, 2, and 3, respectively. At least 1 MAE was identified in 14/40 (35.0%), 5/28 (17.9%), and 2/17 (11.8%) patients during years 1, 2, and 3, respectively. The most frequent MAE identified was weight gain. Among patients identified with at least 1 MAE, 4/14 (28.6%), 2/5 (40.0%), and 2/2 (100%) received a behavioral intervention during years 1, 2, and 3, respectively.

Discussion: Overall, baseline and follow-up metabolic monitoring were poor. Future studies should focus on examining barriers to monitoring in order to improve health care quality.

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References

Rodday A, Parsons S, Mankiw C, Correll C, Robb A, Zima B . Child and adolescent psychiatrists' reported monitoring behaviors for second-generation antipsychotics. J Child Adolesc Psychopharmacol. 2015; 25(4):351-61. PMC: 4442598. DOI: 10.1089/cap.2014.0156. View

Krill R, Kumra S . Metabolic consequences of second-generation antipsychotics in youth: appropriate monitoring and clinical management. Adolesc Health Med Ther. 2014; 5:171-82. PMC: 4186493. DOI: 10.2147/AHMT.S49807. View

. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004; 27(2):596-601. DOI: 10.2337/diacare.27.2.596. View

Pringsheim T, Lam D, Ching H, Patten S . Metabolic and neurological complications of second-generation antipsychotic use in children: a systematic review and meta-analysis of randomized controlled trials. Drug Saf. 2011; 34(8):651-68. DOI: 10.2165/11592020-000000000-00000. View

Olfson M, Crystal S, Huang C, Gerhard T . Trends in antipsychotic drug use by very young, privately insured children. J Am Acad Child Adolesc Psychiatry. 2010; 49(1):13-23. DOI: 10.1097/00004583-201001000-00005. View

Vitiello B, Correll C, van Zwieten-Boot B, Zuddas A, Parellada M, Arango C . Antipsychotics in children and adolescents: increasing use, evidence for efficacy and safety concerns. Eur Neuropsychopharmacol. 2009; 19(9):629-35. DOI: 10.1016/j.euroneuro.2009.04.008. View

Baker J, Olsen L, Sorensen T . Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med. 2007; 357(23):2329-37. PMC: 3062903. DOI: 10.1056/NEJMoa072515. View

Srinivasan S, Myers L, Berenson G . Predictability of childhood adiposity and insulin for developing insulin resistance syndrome (syndrome X) in young adulthood: the Bogalusa Heart Study. Diabetes. 2002; 51(1):204-9. DOI: 10.2337/diabetes.51.1.204. View

Sikich L, Frazier J, McClellan J, Findling R, Vitiello B, Ritz L . Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizo-affective disorder: findings from the treatment of early-onset schizophrenia spectrum disorders (TEOSS) study. Am J Psychiatry. 2008; 165(11):1420-31. DOI: 10.1176/appi.ajp.2008.08050756. View

10.

Morrato E, Nicol G, Maahs D, Druss B, Hartung D, Valuck R . Metabolic screening in children receiving antipsychotic drug treatment. Arch Pediatr Adolesc Med. 2010; 164(4):344-51. DOI: 10.1001/archpediatrics.2010.48. View

11.

Hasnain M, Vieweg W, Fredrickson S, Beatty-Brooks M, Fernandez A, Pandurangi A . Clinical monitoring and management of the metabolic syndrome in patients receiving atypical antipsychotic medications. Prim Care Diabetes. 2008; 3(1):5-15. DOI: 10.1016/j.pcd.2008.10.005. View

12.

Correll C, Manu P, Olshanskiy V, Napolitano B, Kane J, Malhotra A . Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA. 2009; 302(16):1765-73. PMC: 3055794. DOI: 10.1001/jama.2009.1549. View

13.

Ho J, Panagiotopoulos C, McCrindle B, Grisaru S, Pringsheim T . Management recommendations for metabolic complications associated with second generation antipsychotic use in children and youth. J Can Acad Child Adolesc Psychiatry. 2011; 20(3):234-41. PMC: 3143701. View

14.

Honey B, Ramos L, Brahm N . Evaluation of monitoring for metabolic effects in children treated with second generation antipsychotics in a pediatric clinic. J Pediatr Pharmacol Ther. 2014; 18(4):292-7. PMC: 3979051. DOI: 10.5863/1551-6776-18.4.292. View

15.

Correll C . Antipsychotic use in children and adolescents: minimizing adverse effects to maximize outcomes. J Am Acad Child Adolesc Psychiatry. 2008; 47(1):9-20. DOI: 10.1097/chi.0b013e31815b5cb1. View

16.

Galling B, Roldan A, Nielsen R, Nielsen J, Gerhard T, Carbon M . Type 2 Diabetes Mellitus in Youth Exposed to Antipsychotics: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2016; 73(3):247-59. DOI: 10.1001/jamapsychiatry.2015.2923. View

17.

Delate T, Kauffman Y, Botts S, Wong C, Gaughan K . Metabolic monitoring in commercially insured pediatric patients newly initiated to take a second-generation antipsychotic. JAMA Pediatr. 2014; 168(7):679-81. DOI: 10.1001/jamapediatrics.2014.224. View