Audit on Baseline Physical and Metabolic Investigations Before Prescribing Antipsychotics in Children and Adolescent With Psychosis and Schizophrenia

Abstract

Aims

INTRODUCTION: The term ‘psychosis’ is used in NICE guidelines to refer to the group of psychotic disorders that includes schizophrenia, schizoaffective disorder, schizophreniform disorder, and delusional disorder as identified by the International Classification of Diseases – 10th revision (ICD 10; World Health Organization, 1992).BACKGROUND: Children and young people with psychosis and schizophrenia have poorer physical health than the general population as get older. Life expectancy is reduced by 16 to 25 years (Brown et al., 2010; Parks et al 2006).AIMS & OBJECTIVES: To compare the west-midlands child psychiatrist practice with the standard NICE clinical guidelines on baseline physical and metabolic investigations before prescribing antipsychotics in children and adolescents. To compare if fulfilling criteria. Early detection and intervention in order to delay or possibly prevent the onset of psychosis and schizophrenia. To improve the services.

Methods

• • The sample was collected via ‘WEST MIDLANDS CAMHS CONSULTANT SURVEY’.

• • Information collection through the questionnaire.

• • Nine members of the west midlands CAMHS Consultant CLENT group participated in 2019.

Results

• • Indications to use antipsychotics, Record keeping and Assessment of nutritional status & level of physical activity: 100%.

• • Pulse and B.P check: 88.9% yes, 11% not always.

• • Weight and Height plotted on growth chart: 77.8% yes, 22% not always.

• • Antipsychotics (must be initiated by suitably qualified health care professional with expertise in prescribing: 33% consultant, 55% doctor, 11.1% doctor or nurse.

• • Assessment of movement disorders was done by 44.4%always, 11.1% never and 44.4% sometimes.

• • Lipid Profile was checked by 44.4% always, 11.1% never and 44.4% sometimes.

• • Fasting blood Glucose and Hb1ac check: 33.3% yes, 66.7% never and 33.3% sometimes.

Conclusion

Data collected suggest meeting the set standards for indications of antipsychotics, record keeping and physical activity checks but not in other domains.

Recommendations:

• • To create a checklist Performa for physical / metabolic Health Checks for children and adolescent initiated on antipsychotic medications under the care of CAMHS.

• • Clinicians to stay up to date with NICE guidelines.

• • To regularly monitor physical health and blood test before prescribing antipsychotics.

• • To re-audit after introducing Performa in our CAMHS centre, if effective to introduce it in other local CAMHS centres after negotiation with them.