CYWHS Antipsychotic Physical Health and Adverse Effect Monitoring Package

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 pervasive developmental 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 “Children, Youth and Women’s Health Service (CYWHS) Antipsychotic Physical Health and Adverse Effect Monitoring Package” is an evidence-based guideline that is intended to guide health care professionals and provide information to consumers about potential short- and long-term adverse effects associated with antipsychotic medication usage in children and adolescents. 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. In parallel, we have developed a multi-faceted strategy to facilitate implementation of the package which includes an educational outreach visit to prescribers and prescriber and consumer resources. 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.

This package is comprised of four parts including;

Monitoring Chart (90Kb)

• Enables patient monitoring data to be compiled at a specific point and filed in case notes.
• Serves as a prompt at each patient visit.
• Enables efficient transfer of patient health monitoring information along the continuum of care and can be faxed or posted to other health care providers involved in the patient’s care.

Guidelines (697Kb)

• A comprehensive document supporting the monitoring chart.

Guide to using the Monitoring Chart (118Kb)

• Is the quick reference guide for the monitoring chart
• Gives specific instructions on how to use the chart

Patient information leaflets

• These leaflets are intended to be given to the parents, carers and children at initiation of antipsychotic treatment but are useful at any time point.

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.

Development Process

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 monitoring physical health in children or adolescents taking antipsychotics for any disorder.

Subsequently, it was noted that despite the availability of guidelines to monitor physical health in adults, many adults with schizophrenia prescribed antipsychotics still received little or no monitoring. Despite clinicians being aware of the importance of monitoring, there appeared to be difficulty translating these evidence based recommendations into clinical practice. Other tools and programs were needed to change practice.

In 2005 and 2006, the “CYWHS Antipsychotic Physical Health and Adverse Effect Monitoring Package” for use in children and adolescents was developed as a joint project between the Children, Youth and Women's Health Service (CYWHS) 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 CYWHS Drug and Therapeutics Committee for use in South Australia.

Publications

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.

Resources

Web Sites that calculate BMI:

http://www.kidsnutrition.org/bodycomp/bmiz2.html

http://www.cdc.gov/nccdphp/dnpa/bmi/index.htm

http://nhlbisupport.com/bmi/bmi-m.htm

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

http://www.cdc.gov/epiinfo

Monitoring Scales for assessing Extrapyramidal Side Effects (EPSE)

http://www.cnsforum.com/clinicalresources/ratingscales/ratingpsychiatry/side_effects/

Contact Us

Questions regarding this package can be answered by:

Mr David Ellis
Senior Specialist Pharmacist,
Pharmacy Department,
Women's & Children's Hospital
Phone: 8161 6115         Email: david.ellis@cywhs.sa.gov.au

Dr Manya Angley
Senior Research Fellow,
Sansom Institute
School of Pharmacy and Medical Sciences,
University of South Australia
Phone: 8302 1227         Email: Manya.Angley@unisa.edu.au

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