Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, TX.
Department of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Am J Ther. 2020 Sep/Oct;27(5):e425-e430. doi: 10.1097/MJT.0000000000000853.
Antipsychotic drug use in children has doubled from 2001 to 2007 with concomitant increase in obesity. Second-generation antipsychotic (SGA) medication use is associated with weight gain, metabolic derangements, and blood sugar and lipid abnormalities in children. The American Psychiatric Association and the American Diabetes Association have recommended metabolic monitoring guidelines for patients using SGA.
The study objective was to investigate and compare metabolic monitoring for SGA medications in psychiatry (PSY), and pediatrics and family medicine [primary care providers (PCP)] outpatient clinics of a university medical center.
This is a retrospective study of 149 charts of patients newly prescribed with SGA, ages 5-18 years, from their initial visit in the outpatient clinics.
Compliance with recommended metabolic monitoring was evaluated for initial and subsequent clinic visits. Parameters included body mass index, waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile.
Of the 149 charts, 110 patients were in PSY and 39 in PCP. The parameter most regularly monitored was body mass index (baseline: PSY 88.3%, PCP 97.4%; 12 weeks: PSY 86.4%, PCP 85.0%; and 24 weeks: PSY 91.8%, PCP 100%). Fasting plasma glucose (baseline: PSY 18.9%, PCP 25.6% and 12 weeks: PSY 8.6%, PCP 10.0%) and fasting lipid profile (baseline: PSY 12.7%, PCP 25.6% and 12 weeks: PSY 7.0%, PCP 10.0%) had low completions rates. No difference was seen in metabolic monitoring by sex or ethnic group.
Metabolic monitoring rate of child and adolescent patients on SGAs was low overall. No statistically significant differences were seen between psychiatry and PCP except a significantly higher rate of fasting plasma glucose level monitoring at baseline among PCP. Limitations to the study include the small sample size obtained for the period investigated and insufficient documentation in some electronic charts. Extending the period studied may increase the statistical significance of the data.
从 2001 年到 2007 年，儿童使用抗精神病药物的比例翻了一番，同时肥胖率也有所上升。第二代抗精神病药物（SGA）的使用会导致儿童体重增加、代谢紊乱以及血糖和血脂异常。美国精神病学协会和美国糖尿病协会已经为使用 SGA 的患者推荐了代谢监测指南。
本研究的目的是调查和比较大学医疗中心精神病学（PSY）和儿科及家庭医学[初级保健提供者（PCP）]门诊中 SGA 药物的代谢监测情况。
这是一项回顾性研究，共纳入了 149 名年龄在 5-18 岁之间、新处方 SGA 的患者的病历，这些患者均在门诊首次就诊。
评估了初始和后续门诊就诊时对推荐代谢监测的依从性。参数包括体重指数、腰围、血压、空腹血糖和空腹血脂谱。
在 149 份病历中，110 份来自 PSY，39 份来自 PCP。监测最频繁的参数是体重指数（基线：PSY 88.3%，PCP 97.4%；12 周：PSY 86.4%，PCP 85.0%；24 周：PSY 91.8%，PCP 100%）。空腹血糖（基线：PSY 18.9%，PCP 25.6%；12 周：PSY 8.6%，PCP 10.0%）和空腹血脂谱（基线：PSY 12.7%，PCP 25.6%；12 周：PSY 7.0%，PCP 10.0%）的完成率较低。性别的差异或种族群体的差异并未对代谢监测产生影响。
总体而言，接受 SGA 治疗的儿童和青少年患者的代谢监测率较低。精神病学和 PCP 之间没有统计学上的显著差异，但 PCP 基线时空腹血糖水平监测的比例明显更高。本研究的局限性包括在所研究期间获得的样本量较小以及一些电子病历记录不足。延长研究期间可能会增加数据的统计学意义。
