WEIGHT GAIN AND METABOLIC SCREENING IN YOUNG PEOPLE WITH EARLY PSYCHOSIS ON INJECTABLE DEPOT ANTIPSYCHOTIC MEDICATION (ARIPIPRAZOLE VS PALIPERIDONE)

Objective: Aripiprazole is often prescribed to young people, although there remain unanswered questions about its effects on weight gain. This study undertook a meta-analysis of weight gain occurring in young people with early psychosis who were prescribed aripiprazole. Method: A systematic search was conducted for studies reporting on aripiprazole and weight change in young people with a psychotic disorder. A meta-analysis integrated the data into an estimate of effect size. Results: Eleven studies met the inclusion criteria amounting to 886 participants (mean age 18 years). The results showed significant weight gain averaging 2.7 kg. These increases were associated with a longer duration of exposure to aripiprazole but not a higher dosage. Conclusions: The results highlight the importance of regular patient monitoring and the early implementation of interventions to manage antipsychotic-related weight gain.

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Suicide Prevention in First Episode Psychosis: The Development of a Randomised Controlled Trial of Cognitive Therapy for Acutely Suicidal Patients With Early Psychosis

Australian & New Zealand Journal of Psychiatry ◽

10.1046/j.1440-1614.2003.01209.x ◽

2003 ◽

Vol 37 (4) ◽

pp. 414-420 ◽

Cited By ~ 94

Author(s):

P.J.R. Power ◽

R.J. Bell ◽

R. Mills ◽

T. Herrman-Doig ◽

M. Davern ◽

...

Keyword(s):

Early Intervention ◽

Treatment Group ◽

Young People ◽

Controlled Trial ◽

First Episode Psychosis ◽

Early Psychosis ◽

First Episode ◽

Episode Psychosis ◽

Randomised Controlled ◽

Suicidal Patients

Background: Young people with early psychosis are at particularly high risk of suicide. However, there is evidence that early intervention can reduce this risk. Despite these advances, first episode psychosis patients attending these new services still remain at risk. To address this concern, a program called LifeSPAN was established within the Early Psychosis Prevention and Intervention Centre (EPPIC). The program developed and evaluated a number of suicide prevention strategies within EPPIC and included a cognitively oriented therapy (LifeSPAN therapy) for acutely suicidal patients with psychosis. We describe the development of these interventions in this paper. Method: Clinical audit and surveys provided an indication of the prevalence of suicidality among first episode psychosis patients attending EPPIC. Second, staff focus groups and surveys identified gaps in service provision for suicidal young people attending the service. Third, a suicide risk monitoring system was introduced to identify those at highest risk. Finally, patients so identified were referred to and offered LifeSPAN therapy whose effectiveness was evaluated in a randomised controlled trial. Results: Fifty-six suicidal patients with first episode psychosis were randomly assigned to standard clinical care or standard care plus LifeSPAN therapy. Forty-two patients completed the intervention. Clinical ratings and measures of suicidality and risk were assessed before, immediately after the intervention, and 6 months later. Benefits were noted in the treatment group on indirect measures of suicidality, e.g., hopelessness. The treatment group showed a greater average improvement (though not significant) on a measure of suicide ideation. Conclusions: Early intervention in psychosis for young people reduces the risk of suicide. Augmenting early intervention with a suicide preventative therapy may further reduce this risk.

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New Antipsychotic Medication Does Not Cause Weight Gain

Journal of Psychosocial Nursing and Mental Health Services ◽

10.3928/0279-3695-20010401-10 ◽

2001 ◽

Vol 39 (4) ◽

pp. 21-21

Author(s):

Anonymous

Keyword(s):

Weight Gain ◽

Antipsychotic Medication

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Audit of physical health monitoring during initiation and ongoing treatment with antipsychotic medication in a tier 3 outpatient CAMHS service, Belfast

BJPsych Open ◽

10.1192/bjo.2021.851 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S323-S324

Author(s):

Pam Hamlyn ◽

Aaron McMenamin ◽

Hilary Boyd ◽

Lara Patton

Keyword(s):

Young People ◽

Physical Health ◽

Antipsychotic Medication ◽

Health Monitoring ◽

Care Pathway ◽

Electronic System ◽

Clinical Notes ◽

Medication Monitoring ◽

Tier 3 ◽

Health Parameters

AimsTo evidence that physical health monitoring during antipsychotic initiation and continued treatment within the Child and Family Clinic is current, as per the agreed Antipsychotic Medication Monitoring Schedule for Belfast Trust CAMHS (2015), supporting Quality Network for Community CAMHS(QNCC) accreditation.BackgroundThe Antipsychotic Medication Monitoring Schedule CAMHS(2015) was agreed by a working group of consultant psychiatrists and pharmacists, based on evidence from The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMSEA), NICE Guidelines CG 185(2014), CG155(2013) and Maudsley Guidelines, and was to be located on the electronic system (PARIS).MethodIn January 2019, a list of all children/young people on antipsychotic medication was collated (n = 12). Presence of the monitoring schedule in the clinical notes or PARIS was recorded. The Electronic Care Record was reviewed for blood results and PARIS letters for documentation of physical health parameters (heart rate, blood pressure, height, weight, BMI, extrapyramidal side effects, ECG) and to identify documentation of risk/benefit review where monitoring was declined. Re-audit January 2020 (n = 9). Criteria:All patients commenced on antipsychotic medication will have baseline blood investigations and other physical health parameters documented as per the monitoring schedule. If monitoring was declined, the reason for this and indications for prescribing must be documented as a risk/benefit analysis.All patients on antipsychotic medication will be current with their physical health Monitoring Schedule.All patients will have their Monitoring Schedule completed in clinical notes or on PARIS.ResultFirst cycle results (n = 12):Baseline bloods (or documented declined) = 92%, Baseline ECG (or documented declined) = 75%Complete monitoring bloods = 33%, Physical health monitoring parameters complete = 42%Monitoring schedule present in the notes and current = 42% (0% on PARIS).Initial Recommendations: Standardised recording of monitoring using PARIS clinic letters and the schedule in front of clinical notes; Baseline ECG mandatorySecond cycle results (n = 9):Baseline bloods (or declined) = 89%, Baseline ECG (or declined) = 67%Complete monitoring bloods = 44%, Physical health monitoring parameters complete = 56%Monitoring schedule present in notes and current = 38%, Present, not current = 50% (0% on PARIS).ConclusionLower numbers at re-audit limit interpretation.Further recommendations: Antipsychotic initiation checklist; Central bloods diary for clinicians; Antipsychotic care-pathway booklet, co-produced with young people, incorporating the monitoring schedule.

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S241. FACTORS ASSOCIATED WITH EARLY RISK OF DISENGAGEMENT FROM EARLY PSYCHOSIS INTERVENTION SERVICES

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.307 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S130-S131

Author(s):

Nicole Kozloff ◽

Aristotle Voineskos ◽

George Foussias ◽

Alexia Polillo ◽

Sean Kidd ◽

...

Keyword(s):

At Risk ◽

Substance Use ◽

Logistic Regression ◽

Young People ◽

Family Involvement ◽

The Body ◽

Early Psychosis ◽

First Episode ◽

Factors Associated ◽

Race Ethnicity

Abstract Background Despite the body of evidence supporting early psychosis intervention (EPI) programs for young people with psychotic disorders, approximately 30% of individuals with first-episode psychosis disengage from care. To date, two factors, lack of family involvement and presence of a substance use disorder, have emerged as robust predictors of EPI disengagement. Several factors associated with service disengagement in mental health care more broadly have not been well-studied in EPI; some of these, such as homelessness and ethnicity, may be of particular importance to urban, multicultural populations, and ethnicity in particular has been shown to affect pathways into EPI services. Early missed appointments may signal risk for subsequent service disengagement. We sought to identify early predictors of disengagement risk in an urban EPI program. Methods We conducted a prospective chart review of consecutive patients accepted for services in a large, urban EPI program in Toronto, Canada in a 3-month period from July 4-October 3, 2018. Patients were observed in their first 3 months of treatment. The primary outcome of interest was risk of disengagement, defined as having missed at least 1 appointment without cancellation. Extracted data included a variety of demographic and clinical information. The principal investigator trained 2 data abstractors on the first 50 charts; subsequent agreement on the next 5 charts was 88%. Based on previous literature, we hypothesized that risk of disengagement would be increased in individuals with problem substance use, experiences of homelessness, and nonwhite race/ethnicity and decreased in individuals with family involvement in their care. We used logistic regression to examine the odds of disengagement associated with univariate predictors individually, and then together in a multivariate model. Results Seventy-three patients were consecutively admitted to EPI services in the 3-month period. Of these individuals, 59% (N=43) were identified as being at risk of disengagement based on having missed at least 1 appointment without cancellation. In the full sample, 71% (N=52) identified as nonwhite, 23% (N=17) had a documented experience of homelessness, 52% (N=38) had problem substance use, and 73% (N=53) had family involved in their care. In univariate logistic regression, only problem substance use was associated with risk of disengagement (OR=2.91, 95% CI 1.11–7.66); no significant associations were identified with race/ethnicity, experience of homelessness, or family involvement. In multivariate logistic regression, once we controlled for these other factors, the association between risk of disengagement and problem substance use was attenuated and no longer statistically significant (OR=2.15, 95% CI 0.77–5.97). Discussion In this small study of early disengagement in an urban EPI program, only problem substance use was associated with increased odds of missing an appointment, but not when we controlled for other factors thought to be associated with disengagement. Larger studies may be required to identify factors with small but important effects. These factors may be used to identify young people at risk of disengagement from EPI services early in care in order to target them for increased engagement efforts.

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The psychiatric, psychosocial and physical health profile of young people with early psychosis: Data from an early psychosis intervention service

Child & Youth Services ◽

10.1080/0145935x.2018.1553613 ◽

2019 ◽

Vol 40 (1) ◽

pp. 93-115 ◽

Cited By ~ 2

Author(s):

Dominiek Coates ◽

Leeanna Wright ◽

Tim Moore ◽

Susan Pinnell ◽

Catherine Merillo ◽

...

Keyword(s):

Young People ◽

Physical Health ◽

Early Psychosis ◽

Health Profile ◽

Intervention Service

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Metabolic screening in primary care for patients with schizophrenia or schizoaffective disorder and taking antipsychotic medication

Journal of Primary Health Care ◽

10.1071/hc19023 ◽

2020 ◽

Vol 12 (1) ◽

pp. 29 ◽

Cited By ~ 2

Author(s):

Rawiri Keenan ◽

Lynne Chepulis ◽

Joanna Ly ◽

Sally Carter ◽

Chunhuan Lao ◽

...

Keyword(s):

Primary Care ◽

New Zealand ◽

Antipsychotic Medication ◽

Schizoaffective Disorder ◽

Best Practice ◽

Complete Blood Count ◽

Guideline Recommendation ◽

Primary Care Doctors ◽

Metabolic Screening ◽

Practitioner Education

ABSTRACT INTRODUCTIONLife expectancy in patients with schizophrenia is 15–20 years less than the general population. A dominant cause of morbidity and mortality in these patients is cardiovascular disease. Adverse consequences of modifiable cardiovascular risk factors can be reduced by regular monitoring of metabolic outcomes and intervention if required. AIMTo evaluate the metabolic screening in primary care for patients with schizoaffective disorders managed in primary care. To show the usefulness of combining simple practice audits in evaluating such areas of clinical practice. METHODSAn audit was undertaken in eight general practices in the Waikato and Bay of Plenty regions of New Zealand. Specifically, the monitoring of patients with schizophrenia or schizoaffective disorder whose antipsychotic medication was prescribed by primary care doctors was audited. Patient monitoring was compared to the guideline recommendation of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Best Practice Advisory Centre (BPAC). RESULTSIn total, 117 patients were included in the audit and none were fully monitored, as recommended by the RANZCP guidelines. Although two-thirds of patients had been evaluated for glycosylated haemoglobin (HbA1c), lipids, blood pressure, complete blood count and weight, <10% of patients had had prolactin, waist circumference or electrocardiogram measurements recorded. The proportion of patients having a HbA1c measured was also significantly higher in younger patients and patients who were non-Māori or enrolled with an urban practice (all P<0.05). When using the simplified BPAC guidelines, half of all patients were correctly monitored. DISCUSSIONThese findings show there is room for improvement in the monitoring of patients receiving antipsychotic medication in primary care. This may indicate the need for clear guidance and general practitioner education around the monitoring requirements of these patients. Alternatively, a more simplified monitoring protocol may need to be developed. This audit has also shown that there is value in several practices completing the same audit and providing a larger cohort of patients for pooled data analysis.

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