Javaheri Khodadad R, McLennan John D
1 Department of Psychiatry, University of Toronto, Toronto, Canada.
2 Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
J Child Adolesc Psychopharmacol. 2019 Apr;29(3):235-240. doi: 10.1089/cap.2018.0167. Epub 2019 Feb 27.
Despite frequent use of antipsychotic medications to target severe behavioral problems among children with intellectual disabilities (ID), there is little information as to the extent to which adverse effect monitoring is in place for this population. The aim of this pilot study was to determine the extent to which monitoring for adverse effects was documented in health records of a cohort of children with ID who had been prescribed antipsychotic medication.
Data were available on all children referred to a mental health clinic at a children's hospital in Canada who had ID and behavioral difficulties with intake appointments between September 1, 2016 and November 30, 2017. Charts of all those on antipsychotic medications were reviewed for a 12-week period to determine the extent to which adverse effect monitoring was documented using the parameters stipulated by the Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA), including laboratory, anthropometric, and neurological measures.
The database was composed of 47 patients of whom 25 were on antipsychotics (56% boys; mean age 13 [SD 3] years). The most commonly used antipsychotic was risperidone (48%). The extent of adherence to the guidelines was (1) 96% for weight, height, and body mass index; (2) 84% for extrapyramidal symptom screening; (3) 80% for blood pressure; (4) 64% for abdominal girth and liver enzymes; (5) 60% for fasting plasma glucose; and (6) 56% for fasting lipids. Only 20% had all core recommended parameters documented.
There were significant gaps in adverse effect monitoring in this cohort. Examination of variation in larger samples from multiple clinical services are required to determine the extent of this quality care gap. Several barriers to adherence are proposed with suggested solutions.
尽管经常使用抗精神病药物来解决智力障碍（ID）儿童的严重行为问题，但对于该人群不良反应监测的实施程度却知之甚少。这项试点研究的目的是确定在一组接受抗精神病药物治疗的ID儿童的健康记录中，不良反应监测的记录程度。
数据来自加拿大一家儿童医院心理健康诊所所有在2016年9月1日至2017年11月30日期间就诊且有ID和行为困难的儿童。对所有服用抗精神病药物的儿童的病历进行了为期12周的审查，以确定使用加拿大儿童抗精神病药物有效性和安全性监测联盟（CAMESA）规定的参数记录不良反应监测的程度，这些参数包括实验室、人体测量和神经学指标。
数据库由47名患者组成，其中25名服用抗精神病药物（男孩占56%；平均年龄13岁[标准差3岁]）。最常用的抗精神病药物是利培酮（48%）。指南的遵循程度如下：（1）体重、身高和体重指数为96%；（2）锥体外系症状筛查为84%；（3）血压为80%；（4）腹围和肝酶为64%；（5）空腹血糖为60%；（6）空腹血脂为56%。只有20%的患者记录了所有核心推荐参数。
该队列在不良反应监测方面存在重大差距。需要对来自多个临床服务机构的更大样本的差异进行检查，以确定这种优质护理差距的程度。提出了几个依从性障碍及建议的解决方案。
