Antipsychotic medications increasingly are used in children and adolescents for a variety of indications. In adolescents these include schizophrenia and other psychotic conditions and bipolar disorder. In younger children they are used in autism spectrum disorders, disruptive behaviour disorders and tic disorders.
Antipsychotic medication can cause a variety of adverse effects including extrapyramidal side effects, hyperprolactinaemia, weight gain and its associated metabolic and cardiovascular problems. Children and adolescents are more prone to some adverse effects compared to adults and some of these may be irreversible. Monitoring physical health and adverse effects in young people prescribed antipsychotics is important to enable timely intervention to occur to ensure optimal treatment outcomes.
The "Women's and Children's Health Network (WCHN) Antipsychotic Physical Health and Adverse Effect Monitoring Package" is an evidence-based guideline that is intended to guide health care professionals in monitoring antipsychotics when they are prescribed for children and adolescents. It also serves to provide information to consumers about potential short- and long-term adverse effects associated with antipsychotic medication usage in young people. It provides recommendations for observation and monitoring of adverse effects. It also recommends interventions that can be made in the event that adverse effects are identified. Guidelines in isolation seldom result in improved care of patients. Therefore, the package has been developed as a multi-faceted strategy to facilitate monitoring of adverse effects in young people prescribed antipsychotic medication. The aim is to improve the quality use of antipsychotic medicines in young people.
The package recommendations are not intended to be directive or a substitute for clinical judgment. However It is intended that health care providers be aware of the package and consider its use when prescribing antipsychotic medications for children and adolescents.
The package is comprised of three parts including;
Monitoring Chart (90Kb)
The use of antipsychotic medications in children and adolescents (32Kb) - summarises key information regarding antipsychotic medications, adverse effects that can occur with use and the importance of monitoring physical health and adverse effects.
Preventing weight gain associated with medication use (25Kb) - highlights ways to address the risk of weight gain by healthy lifestyle interventions.
In 2004, three consensus guidelines were published in major medical journals directing physical health monitoring in adults taking antipsychotics for psychotic disorders. At this time, there were no guidelines available for monitoring physical health in children or adolescents taking antipsychotics for any disorder. Recommendations for antipsychotic monitoring in young people were subsequently published in 2005 and differ somewhat from recommendations for adults.
Despite the availability of antipsychotic monitoring guidelines, many patients prescribed antipsychotics continue to receive little or no monitoring. It seems that despite clinicians being aware of the importance of monitoring adverse effects in patients prescribed antipsychotics, there is difficulty applying the evidence based monitoring recommendations into clinical practice. It was recognised that the evidence-to-practice gap needed to be addressed with a multi-faceted intervention strategy. In 2005 and 2006, the "WCHN Antipsychotic Physical Health and Adverse Effect Monitoring Package" for use in children and adolescents was developed as a joint project between the Women’s and Children’s Health Network (WCHN) and the School of Pharmacy and Medical Sciences at the University of South Australia. This package took into consideration all available published information with an emphasis on being consistent with Australian adult guidelines for monitoring physical health.
In 2007, the package was approved by the WCHN Drug and Therapeutics Committee for use in South Australia. In 2011, the first revision of the package took place including updating the guidelines, monitoring chart and patient information leaflets. At the Women's and Children's Hospital, audits of antipsychotic prescribing periodically occur. The 2012 audit of antipsychotic prescribing will also include an audit of the use of the monitoring package within the hospital.
Grzeskowiak L, Ellis D, Phillips A & Angley M (2008) 'Implementation of a chart and guidelines for monitoring physical health and adverse effects in children and adolescents prescribed antipsychotics.' Journal of Pharmacy Practice and Research, Vol.38 no.1 pp.9-13.
Ellis D, Shirzadi K, Grzeskowiak L & Angley M (2008) 'Development of a novel program to facilitate monitoring physical health and adverse effects in children and adolescents prescribed antipsychotic medication.' Australasian Psychiatry, Vol.16 no.2 pp.368-369.
Web Sites that calculate BMI:
Centres for Disease Control and Prevention BMI-for-age percentile chart for:
Boys: http://www.cdc.gov/nchs/data/nhanes/growthcharts/set1/chart15.pdf (58Kb)
Girls: http://www.cdc.gov/nchs/data/nhanes/growthcharts/set1/chart16.pdf (58Kb)
Epi Info Web Site
Monitoring Scales for assessing Extrapyramidal Side Effects (EPSE)
Questions regarding this package can be answered by:
Mr David Ellis
Senior Specialist Pharmacist,
Women's & Children's Hospital
Phone: 8161 6115 Email: firstname.lastname@example.org
Dr Manya Angley
Adjunct Senior Research Fellow,
Sansom Institute for Health Research
School of Pharmacy and Medical Sciences,
University of South Australia
Phone: 0400 951 179 Email: Manya.Angley@unisa.edu.au