Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia.
Aust N Z J Psychiatry. 2021 Aug;55(8):763-771. doi: 10.1177/00048674211009620. Epub 2021 May 5.
Prescribing antipsychotic medications to children and adolescents with severe mental and developmental disorders is common; however, there is a lack of consensus on appropriate metabolic monitoring for this population. This review systematically evaluates studies examining metabolic monitoring of children and adolescents prescribed antipsychotic medication to understand the clinical practice of metabolic monitoring and identify opportunities to improve the safety of antipsychotic prescribing in this population.
A systematic search for original research on metabolic monitoring in children and adolescents prescribed antipsychotics was conducted in six databases (PubMed, EMBASE, PsycINFO, The Cochrane Library [Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CENTRAL], Cochrane Methodology Register and Web of Science [Science and Social Science Citation Index]) from inception to February 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were assessed for quality and findings summarised using narrative synthesis.
Fifteen papers were identified. Studies agreed on the need for metabolic monitoring; however, there was a gap between guideline-recommended practice and clinical practice. Variable rates of baseline and subsequent monitoring were reported for both physical and biochemical parameters, with particularly low rates for monitoring requiring venesection. Younger age was also associated with lower monitoring rates. Implementation of quality improvement activities (new guidelines, staff education and checklists) improved monitoring rates although the measurement of biochemical parameters still occurred in only a minority of children.
Despite widespread awareness and concern regarding metabolic side-effects, monitoring occurred inconsistently and infrequently, particularly for biochemical parameters requiring venesection. Monitoring of anthropometric measures (weight, body mass index and waist circumference) with escalation to more laboratory testing where metabolic concerns are identified may improve monitoring. Minimising iatrogenic harm, through reduced antipsychotic prescription where possible, is a clinical priority in this population.
为患有严重精神和发育障碍的儿童和青少年开抗精神病药物是很常见的；然而，对于这一人群，缺乏关于适当代谢监测的共识。本综述系统评估了研究儿童和青少年服用抗精神病药物的代谢监测，以了解代谢监测的临床实践，并确定改善这一人群抗精神病药物处方安全性的机会。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，从开始到 2020 年 2 月，在六个数据库（PubMed、EMBASE、PsycINFO、Cochrane 图书馆[Cochrane 系统评价数据库、Cochrane 对照试验中心注册库、CENTRAL]、Cochrane 方法学登记册和 Web of Science[科学和社会科学引文索引]）中系统地搜索了关于儿童和青少年服用抗精神病药物的代谢监测的原始研究。使用叙述性综合评估研究的质量和发现。
确定了 15 篇论文。研究一致认为需要进行代谢监测；然而，指南推荐的做法与临床实践之间存在差距。无论是物理参数还是生化参数，都报告了基线和后续监测的可变比率，而需要静脉穿刺的监测比率尤其低。年龄较小也与较低的监测率有关。实施质量改进活动（新指南、员工教育和检查表）提高了监测率，尽管只有少数儿童进行生化参数的测量。
尽管人们普遍意识到代谢副作用的问题并对此表示关注，但监测的一致性和频率都不理想，特别是对于需要静脉穿刺的生化参数。通过在代谢问题出现时将对人体测量（体重、体重指数和腰围）的监测升级为更实验室检测，可能会改善监测。在这一人群中，尽可能减少抗精神病药物的处方，从而减少医源性伤害，是临床的重点。
