From the Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen.
De Bascule Child and Adolescent Psychiatry Center Amsterdam, Amsterdam.
J Clin Psychopharmacol. 2021;41(1):13-18. doi: 10.1097/JCP.0000000000001322.
Antipsychotics are frequently prescribed to children and adolescents for nonpsychotic indications. Guidelines recommend regularly assessing treatment response and adverse effects and the ongoing need for their use. We aimed to assess adherence to recommendations of available guidelines regarding monitoring antipsychotic use and to test the influence of children's age, sex, intelligence quotient, and diagnosis on adherence.
We reviewed 426 medical records from 26 centers within 3 large Dutch child and adolescent psychiatry organizations, excluding children with schizophrenia, psychosis, mania, or an intelligence quotient below 70. We investigated whether there was regular assessment of treatment response, adverse events (physical and laboratory), and at least annual discussion of the need of continued use.
On average, treatment response was assessed in 69.3% of the recommended treatment periods, height in 25.6%, weight in 30.6%, blood pressure in 20.6%, evaluation of adverse events in 19.4%, and cardiometabolic measures in 13.7%; discontinuation and/or continued need was discussed at least annually in 36.2%. Extrapyramidal and prolactin-related adverse effects, waist circumference, glucose, and lipids were rarely investigated. Higher age was associated with lower rates of assessment of treatment response. Most antipsychotics were prescribed long-term. In those children with sufficient documentation of the course of treatment, 57.7% was still using an antipsychotic 3 years after initiation.
Our findings indicate insufficient adherence to guideline recommendations for monitoring antipsychotic use in children and adolescents, as well as long duration of use in the majority of children. Especially, older children are at higher risk of receiving suboptimal care.
抗精神病药经常被开给儿童和青少年用于非精神病适应证。指南建议定期评估治疗反应和不良反应，并持续评估其使用的必要性。我们旨在评估监测抗精神病药使用的现有指南建议的遵守情况，并测试儿童的年龄、性别、智商和诊断对遵守情况的影响。
我们回顾了来自 3 个荷兰儿童和青少年精神病学组织的 26 个中心的 426 份病历，排除了患有精神分裂症、精神病、躁狂症或智商低于 70 的儿童。我们调查了是否定期评估治疗反应、不良事件（身体和实验室），并至少每年讨论继续使用的必要性。
平均而言，在推荐的治疗期间，有 69.3%的患者评估了治疗反应，25.6%评估了身高，30.6%评估了体重，20.6%评估了血压，19.4%评估了不良事件，13.7%评估了心血管代谢指标；至少每年有 36.2%讨论了停药和/或继续使用的必要性。锥体外系和催乳素相关不良反应、腰围、血糖和血脂很少被调查。年龄较高与治疗反应评估率较低相关。大多数抗精神病药被长期处方。在那些有足够治疗过程记录的儿童中，有 57.7%在开始治疗 3 年后仍在使用抗精神病药。
我们的发现表明，儿童和青少年抗精神病药使用监测的指南建议遵守情况不足，而且大多数儿童的使用时间较长。特别是，年龄较大的儿童接受次优治疗的风险更高。
