Best practice guidelines for treating children and adolescents with antipsychotics are only followed around half of the time, with many clinicians failing to monitor patients’ cholesterol and blood glucose levels, according to research published in Pediatrics
Researchers from the University of Vermont wanted to find out what was influencing the antipsychotic prescribing rate for children under the Medicaid insurance scheme in the United States, which increased by 62% between 2002 and 2007.
They surveyed clinicians who prescribed the antipsychotics risperidone, quetiapine and aripiprazole to children or young people between July 2012 and October 2012. A total of 147 prescribers replied and between them they wrote prescriptions for 647 patients.
“These data do not indicate that this class of medication is being used casually or in a ‘knee-jerk’ manner,” say the researchers, led by David Rettew of the Vermont Center for Children, Youth and Families.
The researchers checked the appropriateness of the prescribing decisions against guidelines issued by the American Academy of Child and Adolescent Psychiatry and also considered whether clinical indications matched those approved by the US Food and Drug Administration (FDA).
Clinicians prescribed for an appropriate indication in 92% of cases, according to best practice guidelines, mainly using the antipsychotics as secondary treatment for aggression and mood instability. However, only 27.2% of cases matched an FDA-approved indication.
Lack of metabolic monitoring was the primary reason for lack of adherence to best practice guidelines; metabolic monitoring was more likely to happen in cases where the child was being treated by a psychiatrist. Psychiatrists were also more likely to follow best practice guidelines than non-psychiatrists — 57.7% compared with 35.1%.
Glen Spielmans, associate professor at the department of psychology at Metropolitan State University, questioned the researchers’ definition of ‘best practice guidelines’.
“I am not impressed with what counted as following ‘best practice guidelines’,” he says. “For instance, prescribing these drugs to manage aggressive and delinquent behaviours was considered best practice but there is really not much evidence to support these drugs as behaviour management tools.”
Spielmans also points out that clinicians self-reported their prescribing behaviours.
“Respondents might have reported what they perceived they should be doing, not what they are actually doing,” he says, although this limitation was acknowledged by the study authors.