Published online Mar 22, 2018. doi: 10.5498/wjp.v8.i1.27
Peer-review started: October 27, 2017
First decision: December 11, 2017
Revised: December 29, 2017
Accepted: January 16, 2018
Article in press: January 16, 2018
Published online: March 22, 2018
Processing time: 145 Days and 13.9 Hours
Despite limited literature on long term effectiveness and side effects of antipsychotics in children and adolescents, antipsychotics are frequently used in this population in Europe and North America. In fact, recent trends of increased antipsychotic prescribing for this population has been well-documented. These medication are associated with physical health side effects though the extent of these side effects when used in lower doses or prolonged duration in children and adolescents have not been adequately studied. However, a number of popular guidelines exist pertaining to physical health monitoring in children and adolescents on antipsychotics.
The current study is an audit of physical health monitoring in children and adolescents prescribed antipsychotics in neurodevelopmental clinics in Northumberland. A comparative review of similar audits carried out from different regions can address pertinent issues like association between standards set by different guidelines and the concordance rates with the same.
To ascertain performance against the standards set by National Institute for Clinical Excellence (NICE) guidelines on physical health monitoring of thirty children and adolescents prescribed antipsychotics in neurodevelopmental clinics in Northumberland and identifying areas for improvement in practice.
The audit involved a review of recorded documentation pertaining to physical health monitoring in patient electronic records pertaining to those children and adolescents attending neurodevelopmental clinics in Northumberland prescribed antipsychotics. Clients were also contacted by telephone if relevant documentation could not be identified or retrieved to confirm the details. 32 case notes were perused of which 2 were excluded as they had refused to have venepuncture which was documented in the electronic records.
The overall audit results demonstrated partial compliance with NICE guidelines on physical health monitoring in children and adolescents prescribed antipsychotics. Bi-annual recording of height, weight, blood pressure, pulse rate and review of side effects was completed in 100% of subjects. However, annual monitoring for blood tests including liver function, renal function full blood count as well as biannual monitoring of serum prolactin, serum lipid profile was completed only in 56% of subjects. Comparative e baseline characteristics between the two groups (compliant and non-compliant with guidelines) found no differences based on any socio-demographic or clinical variables. However, the proportion of patients in the compliant group was higher in the age group of 12-17 years as compared to < 12 years (70.58% vs 38.46%), though not statistically significant (χ2 = 1.236; P = 0.24).
Development of tailored and specific guidelines for physical health monitoring in children and adolescents prescribed antipsychotics taking into consideration clinical effectiveness and safety profile is likely to improve adherence rates.
The methodology into development of tailored guidelines for antipsychotic monitoring in children and adolescents need to be adequately focused upon. A comparative review of the audits on antipsychotic physical health monitoring guidelines carried out till date in different regions of the world based on different guidelines might shed some light on this important topic.