Prescribing Antipsychotics for Young People and Monitoring Physical Health and Adverse Effects

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Abstract

Background:

Antipsychotics are increasingly prescribed in young people for psychiatric and behavioural disorders.

Aim:

To determine the appropriateness of antipsychotic prescribing in young people; to ascertain the usage of an antipsychotic monitoring program; and to determine congruence with the antipsychotic monitoring program.

Method:

A prospective 3-month audit was conducted of patients aged < 18 years prescribed antipsychotics. Prescribing was deemed ‘appropriate’ if the diagnosis was listed as an indication for the antipsychotic in the Therapeutic Guidelines: Psychotropic and/or the Australian Medicines Handbook and within the recommended dose. For patients on an antipsychotic long term (>1 month), case notes were examined to determine if patients had a monitoring chart and if it was being used as recommended.

Results:

Medical records of 60 young patients prescribed antipsychotics were reviewed. 41/70 (59%) antipsychotic prescriptions were congruent with Australian guidelines. Intellectual disability with comorbid psychiatric disorder/behavioural disturbance (20/70; 29%) was the most common indication followed by autism spectrum disorder with behavioural disturbance (13/70; 19%), and schizophrenia and related psychoses (10/70; 14%). Risperidone (36/70; 51%) was the most commonly prescribed antipsychotic. 54/60 patients were prescribed antipsychotics long term (>1 month) and it was deemed necessary they have a monitoring chart. Only 10/54 (19%) patients had an antipsychotic monitoring chart and only 4/54 (7.4%) patients were optimally monitored.

Conclusion:

Most antipsychotics prescribed for the young people were congruent with Australian guidelines. In most instances of ‘inappropriate’ prescribing, there was evidence that ‘appropriate’ antipsychotics and doses were trialled and had been unsuccessful. Use of the antipsychotic monitoring program was low; strategies are needed to ensure monitoring occurs in this vulnerable population.

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