Antipsychotic medications offer the potential for effective treatment of psychiatric disorders in children and adolescents (such as childhood schizophrenia, bipolar disorder, psychosis, or severe conduct problems that are resistant to other types of treatment, including behavioral symptoms associated with Tourette’s syndrome and autistic disorders); however, they pose an increased risk for the child developing serious health concerns, including metabolic health complications. These medications being prescribed for off-label use (such as attention deficit hyperactivity disorder) is increasing these risks in children and adolescents.1
There are new medications (atypical antipsychotics/second generation antipsychotics) that have fewer side effects - especially extrapyramidal symptoms - than first generation antipsychotics; however, there are still inherent risks which must be weighed against the benefits of taking these medications. Studies have shown that metabolic monitoring rates associated with second generation antipsychotics are well below optimal levels, especially for lipid monitoring.2 Early interventions can decrease the possibility of long term sequelae associated with this class of drugs, especially cardiac disease, type 2 diabetes, and obesity.
Because these antipsychotic medications are most often associated with risk of weight gain, hyperlipidemia, and diabetes, the American Academy of Child and Adolescent Psychiatry (AACAP) guidelines recommend that children and adolescents, who are taking antipsychotic medications, should be routinely monitored for blood glucose and cholesterol levels, as well as BMI percentile documentation.3
In an effort to ensure that our members are receiving the best care possible, Highmark Health will be periodically reviewing the trends in metabolic monitoring for those pediatric/adolescent members taking antipsychotic medications. If gaps in care are identified, prescribing providers will receive a letter identifying the gaps associated with their attributed Highmark patients, including non-compliance for blood glucose testing and lipid profiles.
NOTE: Highmark does not recommend particular treatments or health care services. This informational article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The member’s provider should determine the appropriate treatment and follow-up with his or her patient. This informational article is based upon a search of literature. There may be other recommendations or suggested practices that may be suitable in the care of patients. Coverage of services is subject to the terms of each member’s benefit plan. Additionally, state laws and regulations governing health insurance, health plans, and coverage may apply and will vary from state to state.
1Sohn, Minji et al. “National trends in off-label use of atypical antipsychotics in children and adolescents in the United States.” Medicine vol. 95,23 (2016): e3784. doi:10.1097/MD.0000000000003784
2Jennifer D. Hayden, Libby Horter, Taft Parsons, III, Matthew Ruble, Sabrina Townsend, Christina C. Klein, Rodrigo Patino Duran, Jeffrey A. Welge, Stephen Crystal, Nick C. Patel, Christoph U. Correll, and Melissa P. DelBello. “Metabolic Monitoring Rates of Youth Treated with Second-Generation Antipsychotics in Usual Care: Results of a Large US National Commercial Health Plan” Journal of Child and Adolescent Psychopharmacology.Mar 2020.119-122.http://doi.org/10.1089/cap.2019.0087
3American Academy of Child and Adolescent Psychiatry. AACAP practice parameter for the use of atypical antipsychotic medications in children and adolescents. 2011 Retrieved from https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/Atypical_Antipsychotic_Medications_Web.pdf