scholarly journals Long-Term Metabolic Monitoring of Youths Treated with Second-Generation Antipsychotics 5 Years after Publication of the CAMESA Guidelines Are We Making Progress? Surveillance Métabolique à Long Terme des Jeunes Traités par Antipsychotiques de Deuxième Génération, Cinq ans Après la publication des Lignes Directrices Camesa: Faisons-Nous des Progrès?

2020 ◽  
pp. 070674372097484
Author(s):  
Sarra Jazi ◽  
Leila Ben-Amor ◽  
Pascale Abadie ◽  
Marie-Line Menard ◽  
Rachel Choquette ◽  
...  
Keyword(s):  
Second Generation ◽  
Diagnostic Category ◽  
Fisher Exact Test ◽  
Anthropometric Measures ◽  
Psychiatric Comorbidities ◽  
Mental Health Clinics ◽  
Exact Test ◽  
Metabolic Monitoring ◽  
Second Generation Antipsychotics

Objective: The potential metabolic adverse effects of second-generation antipsychotics (SGA) need to be monitored. The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics (CAMESA) offers guidelines for this purpose. We aimed to evaluate the long-term rates of youths receiving monitoring in mental health clinics and document the factors that may influence them. Method: The charts of 180 patients (13.3 ± 3.1 years, 54.4% males) receiving SGA treatment for the first time between January 2016 and June 2018 were reviewed. Monitoring was divided into baseline and 1- to 6-month and 9- to 24-month periods. Population under study was stratified into children (4 to 12 years) and adolescents (13 to 18 years). Sociodemographic characteristics, psychiatric diagnosis and comorbidities, prescribed SGAs and comedications, anthropometric measures (AM), blood pressure (BP), blood tests (BT), electrocardiogram, and the psychiatrist’s years of practice were collected. Cross tables were used to present the monitoring rates. Categories were compared by covariate analysis. Rates of patients monitored across categories were compared using Fisher exact test. Results: Monitoring rates for AM, BT, and BP were 55%, 47.8%, and 46.7% at baseline; 50%, 41.7%, and 45.2% at 1 to 6 months; and 47.2%, 41.5%, and 40.6% at 9 to 24 months, respectively. Higher monitoring rates were significantly associated with adolescent status (baseline, 1 to 6 months), a diagnosis of psychotic and/or affective disorder (baseline, 1 to 6 months, 9 to 24 months), having ≤1 psychiatric comorbidities (1 to 6 months), high SGA dose (baseline, 1 to 6 months), and clinician’s experience (baseline, 9 to 24 months). Significantly lower monitoring rates were associated with the psychostimulant/atomoxetine comedication (baseline, 1 to 6 months, 9 to 24 months). Conclusion: Five years after publication of the CAMESA guidelines, metabolic monitoring is conducted for less than half of patients. In our sample, age, diagnostic category, psychiatric comorbidities, SGA dose, clinician’s experience, and comedications influenced the monitoring rates. Major progress still needs to be made before reaching a satisfactory level of monitoring.

Monitoring and Treatment of Weight Gain in Children and Adolescents Treated with Second Generation Antipsychotics (SGAs)

2011 ◽  
Vol 1 (1) ◽  
pp. 3-5
Author(s):  
Shannon N. Saldaña ◽  
Jaclyn Kawsky
Keyword(s):  
Insulin Resistance ◽  
Weight Gain ◽  
Children And Adolescents ◽  
Second Generation ◽  
Adverse Outcomes ◽  
Metabolic Effects ◽  
Psychiatric Illnesses ◽  
Metabolic Monitoring ◽  
Second Generation Antipsychotics

ABSTRACT The use of second generation antipsychotics (SGAs) for the treatment of psychiatric illnesses in children and adolescents is increasing. Adverse effects of SGAs include weight gain, dyslipidemia, insulin resistance, and glucose intolerance that can subsequently progress to diabetes. Data suggest that the metabolic effects of SGAs may be more severe in children and adolescents than in adults. The mechanism of SGA-related weight gain is not fully understood and almost certainly due to a combination of factors. A vital first step to minimize risk and long-term adverse outcomes from SGA treatment is to implement consistent metabolic monitoring.

scholarly journals Monitoring of metabolic adverse events of second-generation antipsychotics in a naive paediatric population followed in mental health outpatient and inpatient clinical settings: MEMAS prospective study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040764
Author(s):  
Marie-Line Menard ◽  
Drigissa Ilies ◽  
Pascale Abadie ◽  
Thaïna Jean-Baptiste ◽  
Rachel Choquette ◽  
...  
Keyword(s):  
Adverse Events ◽  
Study Protocol ◽  
Repeated Measures ◽  
Second Generation ◽  
Paediatric Population ◽  
Anthropometric Measures ◽  
Cardiovascular Morbidity And Mortality ◽  
Second Generation Antipsychotics ◽  
Registration Number ◽  
Prospective Longitudinal

IntroductionSecond-generation antipsychotics (SGAs) are widely used in the paediatric population. It is currently established that SGAs may induce metabolic adverse events (AEs) such as weight gain, perturbation of blood lipids or glucose with risk of potential cardiovascular morbidity and mortality. The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in children (CAMESA) has published recommendations for monitoring the metabolic AEs of SGAs. Factors that may be associated with the onset of SGA’s metabolic AEs and long-term consequences are less studied in the literature. The objectives of our research are to evaluate some factors that can influence the development of the SGA’s metabolic AEs and to study clinical adherence to CAMESA guidelines.Methods and analysisThe Monitoring des Effets Métaboliques des Antipsychotiques de Seconde Génération study is a multicenter, prospective, longitudinal observational study with repeated measures of metabolic monitoring over 24 months. Two recruiting centres have been selected for patients under 18 years of age, previously naive of antipsychotics, starting an SGA or who have started an SGA for less than 4 weeks regardless of the diagnosis that motivated the prescription. Assessments are performed for anthropometric measures, blood pressure, blood tests at baseline and 1, 2, 3, 6, 9, 12 and 24 months of follow-up.Ethics and disseminationThe study protocol was approved by the CHU Sainte-Justine’s Research Ethics Board (MP-21-2016-1201) in 2016 and obtained institutional suitability for the ‘Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal’ Research Center in May 2018. For all participants, written consent will be obtained from parents/caregivers as well as the participant’s assent in order to enable their participation in this research project. The results of this research will be published.Trial registration numberClinicalTrials.gov (number NCT04395326).

scholarly journals New antipsychotic drugs for the treatment of agitation and psychosis in Alzheimer’s disease: focus on brexpiprazole and pimavanserin

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 686 ◽  
Author(s):  
Filippo Caraci ◽  
Mario Santagati ◽  
Giuseppe Caruso ◽  
Dario Cannavò ◽  
Gian Marco Leggio ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Receptor Antagonist ◽  
Safety Profile ◽  
Antipsychotic Drugs ◽  
Second Generation ◽  
Phase Iii ◽  
Second Generation Antipsychotics ◽  
Recent Phase

Behavioral and psychological symptoms of dementia are symptoms of disturbed perception, mood, behavior, and thought content that occurred frequently. These symptoms, which include apathy, depression, anxiety, psychosis, agitation, and aggression, can serve as predictors of and early clinical diagnostic markers for Alzheimer’s disease (AD) and are common precipitants of institutional care. Agitation and psychosis are associated with accelerated disease progression and increased tau phosphorylation in patients with AD. Current guidelines recommend the use of second-generation antipsychotics for the treatment of agitation and psychosis in AD, but only after first-line non-pharmacological interventions and for no longer than 12 weeks because long-term use of these drugs is associated with an increased risk of mortality and an increased frequency of cerebrovascular events. Therefore, new antipsychotic drugs with improved efficacy and safety are needed as an alternative to current antipsychotic drugs. In this report, we discuss some of the most relevant advances in the field of agitation and psychosis in AD and focus on the recent positive clinical evidence observed with two new antipsychotics drugs: brexpiprazole and pimavanserin. Brexpiprazole is a receptor partial agonist (D2, D3, 5-HT1A), receptor antagonist (5-HT2A/B, α1B/α2C) according to the neuroscience-based nomenclature. Two recent phase III clinical trials have shown that brexpiprazole 2 mg/day is effective for the treatment of agitation in patients with AD and has an improved tolerability and safety profile compared with currently available second-generation antipsychotics. Pimavanserin is a receptor antagonist (5-HT2A, 5-HT2C) that has been given market authorization for psychosis occurring in Parkinson’s disease. Recent phase II studies suggest that this drug is effective in AD patients with more severe psychosis, although further long-term studies are needed to better define the efficacy and long-term safety profile of pimavanserin for the treatment of psychosis in AD.

scholarly journals Overcoming barriers to monitoring patients taking second-generation antipsychotics

2018 ◽  
Vol 8 (2) ◽  
pp. 49-55 ◽  
Author(s):  
Anita Peña ◽  
Beth DeJongh ◽  
Matthew Haas ◽  
Michelle Harms
Keyword(s):  
Metabolic Syndrome ◽  
Second Generation ◽  
Vital Signs ◽  
Baseline Monitoring ◽  
Metabolic Monitoring ◽  
Increased Risk ◽  
Second Generation Antipsychotics ◽  
Awareness Information ◽  
Before And After ◽  
Patient Referrals

Abstract Introduction: Patients taking second-generation antipsychotics (SGAs) are at increased risk of developing metabolic syndrome because of the side effect profiles of these medications. A medication use evaluation (MUE) was conducted and showed that baseline monitoring rates of metabolic parameters in patients taking SGAs are low. A pharmacist-run metabolic syndrome monitoring clinic (MSMC) is available to mental health (MH) outpatients; however, the clinic is underused by providers. The purpose of this project was to increase baseline metabolic syndrome monitoring rates in patients taking SGAs by implementing interventions to overcome barriers to monitoring and to accessing the MSMC. Methods: Appropriate tools to improve monitoring were obtained, and an electronic consult for the MSMC was created. A presentation and pamphlet were developed to improve awareness. Information about free patient transportation was obtained and distributed. Efficacy was assessed by evaluating patient referrals to the clinic before and after intervention, comparing baseline monitoring rates after implementation with the MUE data, and administering an anonymous survey to outpatient MH providers. Results: There was a 37.5% increase in overall referral rates to the MSMC after intervention, but only 51.5% of patients attended appointments as scheduled. Monitoring of vital signs increased, but monitoring of laboratory parameters decreased. A total of 60% (9 of 15) of providers completed a survey, of which one third indicated they still forget to refer patients to the MSMC. Discussion: Overall, baseline metabolic monitoring rates remained low despite implementing several interventions. Patient and provider outreach is crucial for initiating and maintaining a successful metabolic monitoring system for patients taking SGAs.

Sign in / Sign up

Export Citation Format

Share Document