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. Antipsychotics are also used in children and adolescents with autism spectrum disorders, disruptive behaviour disorders and tic disorders.
Antipsychotic medications 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 comprised of an evidence-based guideline and a suite of supporting documents. The guideline is intended to support health care professionals in monitoring adverse effects associated with antipsychotic use when they are prescribed for children and adolescents. The guideline also serves to provide information to consumers about potential short- and long-term adverse effects that can occur when antipsychotic medications are used 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 guideline and supporting documents have been developed as a multi-faceted strategy to facilitate monitoring of adverse effects in young people prescribed antipsychotic medications. 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 expected that health care providers be aware of the ‘Package’ and consider its use whenever 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 (196kb) – 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 (197kb) – highlights ways to address the risk of weight gain by implementing 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. A brief outline of recommendations for antipsychotic monitoring in young people was subsequently published in 2005 and differed somewhat from recommendations for adults.
Despite the availability of antipsychotic monitoring guidelines, many patients prescribed antipsychotics continued to receive little or no monitoring. It seemed that despite clinicians being aware of the importance of monitoring adverse effects in patients prescribed antipsychotics, there was 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 to ensure WCHN patients who were prescribed antipsychotics received appropriate monitoring. 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 comprehensive package took into consideration all available published information with an emphasis on being consistent with Australian adult guidelines for monitoring physical health and adverse effects.
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. Subsequent revisions have occurred at four yearly intervals.
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.
Ellis D & Angley M (2013). Prescribing Antipsychotics in Young People and Use of a Program to Monitor Physical Health and Adverse Effects. Journal of Pharmacy Practice and Research, Vol 43 (3) pp 182-185.
Web Sites that calculate BMI:
Pediatric Z-Score Calculator — Children's Hospital of Philadelphia
Body Mass Index (BMI) – Centers for Disease Control
Child Growth Charts — Royal Children's Hospital Melbourne
Monitoring Scales for assessing Extrapyramidal Side Effects (EPSE)
Oregon Health & Science University – Abnormal Involuntary Movement Scale (AIMS)
Questions regarding this package can be answered by:
Mr David Ellis
Senior Specialist Pharmacist
Women's and Children's Hospital
Phone: 8161 6115
Dr Manya Angley
Manya Angley Research and Consulting (MARAC)
(formerly University of South Australia)
Phone: 0400 951 179