Adherence to recommended metabolic monitoring of children and adolescents taking second-generation antipsychotics

Authors: SANYAL, SWARNAVA - University Of Houston; CALARGE, CHADI - Baylor College Of Medicine; ROWAN, PAUL - University Of Texas; APARASU, RAJENDER - University Of Houston; ABUGHOSH, SUSAN - University Of Houston; SISLEY, STEPHANIE - Children'S Nutrition Research Center (CNRC); CHEN, HUA - University Of Houston

Submitted to: Psychiatric Services
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/24/2023
Publication Date: 10/4/2023
Citation: Sanyal, S., Calarge, C., Rowan, P.J., Aparasu, R.R., Abughosh, S., Sisley, S., Chen, H. 2023. Adherence to recommended metabolic monitoring of children and adolescents taking second-generation antipsychotics. Psychiatric Services. 75(4):342-348. https://doi.org/10.1176/appi.ps.20220584.
DOI: https://doi.org/10.1176/appi.ps.20220584

Interpretive Summary: Physicians are supposed to check kids taking certain psychiatric medications for problems like weight gain, high blood sugar, and high cholesterol. Researchers at Houston, Texas looked at medical records for over 9,000 kids ages 1-17 who were prescribed these medications between 2010-2018. They found that very few kids received all the recommended health checks - only 4.7% for weight, 6.5% for blood sugar, and 0.8% for cholesterol. However, kids with higher risk like those taking certain medications were more likely to have additional monitoring for metabolic problems. Overall, patients did not receive the recommended metabolic checks when prescribed these medications for potential health issues. This work identifies that more research is needed to help physicians implement proper monitoring more consistently.

Technical Abstract: Clinical guidelines recommend periodic monitoring for adverse metabolic effects associated with second-generation antipsychotic medications. The authors sought to evaluate adherence to the guideline-recommended metabolic monitoring schedule for children and adolescents prescribed second-generation antipsychotics. The authors used a national electronic medical records database for a retrospective study of children and adolescents ages 1–17 years (N=9,620) who were prescribed second-generation antipsychotics in January 2010–December 2018. Adherence to guideline-recommended monitoring of body mass index (BMI), blood glucose, and cholesterol was categorized as full, partial, and no monitoring. Full monitoring of patients was defined as strict metabolic monitoring, following the guideline-recommended schedule. Patients who received any monitoring, but not meeting the full monitoring criteria, were considered partially monitored. Three multinomial logistic regression models were fitted for each metabolic parameter to identify predictors associated with monitoring status. BMI was the metabolic parameter with the highest adherence to guideline-recommended monitoring (full monitoring, 4.7% of patients; partial monitoring, 44.8%), followed by blood glucose (full monitoring, 6.5%; partial monitoring, 29.4%) and cholesterol (full monitoring, 0.8%; partial monitoring, 22.4%). Being Black (vs. non-Black), having a comorbid mood disorder (vs. none), receiving olanzapine as the index second-generation antipsychotic (vs. aripiprazole), and receiving an antidepressant as a concurrent medication (vs. none) were associated with a higher likelihood of receiving both full and partial monitoring of all three metabolic parameters. Both full and partial adherence to guideline-recommended monitoring of children and adolescents prescribed second-generation antipsychotics were poor. However, children and adolescents at increased metabolic risk tended to be more closely monitored.