Clinical use of second-generation antipsychotics in children

FIGURE 1.

FIGURE 2.

FIGURE 3.

Recommendations for monitoring second-generation antipsychotic treatment according to National Institute for Health and Care Excellence (NICE), American Academy of Child and Adolescent Psychiatry (AACAP), and Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) (39,40,42)

Follow-ups
Issued by	Baseline	1	2	3	4
NICE		Weekly (first 6 weeks)	12 weeks	Every 6 months
	Growth chart* Includes weight and height , WHC, RR, pulse, fb-gluc, HbA1c, lipids, prolactin, MD, nutritional status, diet, physical activity	Growth chart, MD, efficacy, side-effects	Growth chart, MD, RR, pulse, fb-gluc, HbA1c, lipids, prolactin, physical health, efficacy, side effects	Growth chart, MD, WHC, RR, pulse, fb-gluc, HbA1c, lipids, prolactin, physical health, efficacy, side effects	–
AACAP		Regular intervals
	Family history, BMI, WC, RR, pulse, fb-gluc, lipids, MD	BMI, RR, pulse, fb-gluc (HbA1c if needed), lipids† If significant weight changes and/or a family history indicating risk , MD	–	–	–
CAMESA		1, 2, 9 months	3 months	6 months	1 year
	Growth chart, BMI, WC, RR, NEU, fb-gluc, insulin, lipids, ASAT, ALAT, TSH (with quetiapine), prolactin	Growth chart, BMI, WC, RR, NEU	Growth chart, BMI, WC, RR, NEU, fb-gluc, insulin, lipids, prolactin	Growth chart, BMI, WC, RR, NEU, fb-gluc, insulin, lipids ASAT, ALAT, TSH (with quetiapine)	Same as baseline

International Statistical Classification of Diseases and Related Health Problems, 10th Revision, diagnoses of second-generation antipsychotic (SGA)-treated children (n=133)

Diagnoses	ICD-10 class	%
Hyperkinetic disorders	F90	50
Conduct/mixed conduct and emotional disorder	F91-92	40
Pervasive developmental disorders	F84	30
Obsessive compulsive disorder	F42	13
Disorders of social functioning with onset specific to childhood and adolescence ICD-10, International Statistical Classification of Diseases and Related Health Problems, 10th Revision	F94	13
Reaction to severe stress/adjustment disorders	F43	10
Tic disorders	F95	8
Emotional disorder with onset specific to childhood	F93	7
Disorders of psychological development	F80-82	7
Depressive episode	F32	6
Bipolar affective disorder	F31	5
Psychotic disorders	F23, F29	5
Mixed specific developmental disorders	F83	5
Other mood (affective) disorders	F38	5
Phobic and other anxiety disorders	F40-41	3
Dissociative (conversion) disorders	F44	3
Other behavioural and emotional disorders with onset usually occurring in childhood and adolescence* Reactive attachment disorder F94.1 (n=5), other childhood disorders of social functioning F94.8 (n=12)	F98	2
Eating disorders	F50	1
Unspecified mental retardation	F79	1

Family background of the second-generation antipsychotic-treated children

	All (%)	PDD/DD (%)	Non-PDD/DD (%)	p
Family status (n=133)				<.001
Biological parents	37	57	26
Parental separation	40	36	42
Foster home	18	6	24
Other (e.g. adoption)	5	0	8
Number of siblings (n=126)				NS
None	21	23	20
One	38	40	37
Two or more	41	36	43
Mother’s working status (n=133)				.018
Working at least part time	53	68	45
Other or not known	47	32	55
Father’s working status (n=133)				NS
Working at least part time	57	64	54
Other or not known	43	36	47
Alcohol/drugs (n=83)	60	44	71	.021
Psychiatric history of first-degree relatives
Schizophrenia, bipolar disease or other psychosis (n=67)	33	15	45	.016
Depression (n=88)	67	61	72	NS
Suicide (n=133)				NS
Committed	2	2	2
At least one attempt	7	2	9
Child exposed to violence (n=133)	41	30	48	.065
Exposed to domestic violence	11	4	15
Been object of physical punishment or other domestic violence	12	13	12
Both exposed and been object	11	6	13
Other kind of violence exposure (e.g. war experiences)	8	6	8