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Monitoring of prolactin levels in children and adolescents prescribed antipsychotic medication: a complete audit cycle

Published online by Cambridge University Press:  15 March 2016

E. Uduehi*
Affiliation:
St Joseph’s Adolescent Unit, St Vincent’s Hospital, Fairview, Dublin, Ireland
L. Gallagher
Affiliation:
Department of Psychiatry, Trinity College Dublin, Dublin, Ireland Linn Dara Beechpark Services, Tallaght, Dublin, Ireland
T. Alugo
Affiliation:
Horizon Health Network, Saint John, New Brunswick, Canada
*
*Address for correspondence: E. Uduehi, St Joseph’s Adolescent Unit, St. Vincent’s Hospital, Fairview, Dublin 3, Ireland. (Email: [email protected])

Abstract

Aims and methods

Antipsychotics have proven benefits in children and adolescents with autism spectrum disorders. However, notwithstanding some therapeutic benefits significant side effects are associated with the use of antipsychotics, such as hyperprolactinaemia. We completed an audit cycle between April 2013 and December 2013 to evaluate the practice in the Beechpark Autism Service with respect to monitoring and managing hyperprolactinaemia in children and adolescents prescribed antipsychotics. The re-audit assessed whether the recommended guidelines and changes had been implemented. The National Institute for Health and Care Excellence guidelines were used as a gold standard for this audit.

Results

Basal determinations of serum prolactin improved significantly at the end of the audit cycle (28.6% v. 57%) with slight improvement in six monthly repeat prolactin monitoring (28.6% v. 39.1%) showing some change in clinical practice. However, there was minimal improvement in managing hyperprolactinaemia (0% v. 12.5%).

Clinical implication

There is growing awareness about hyperprolactinaemia associated with the use of antipsychotic medication in children and adolescents and the long-term effects. Clear documented guidelines will help increase and improve the monitoring and management of hyperprolactinaemia in these groups of patients. However, more needs to be done in improving the practice of monitoring and managing hyperprolactinaemia in children and adolescent prescribed antipsychotic medication giving the documented long-term effects.

Type
Short Report
Copyright
© College of Psychiatrists of Ireland 2016 

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References

Ali, J, Khemka, M (2008). Hyperprolactinemia: monitoring children on long-term risperidone. Current Psychiatry 7, 6472.Google Scholar
Aman, M, Arnold, L, McDougle, C, Vitiello, B, Scahill, L, Davies, M, McCracken, J, Tierney, E, Nash, P, Posey, D, Chuang, S, Martin, A, Shah, B, Gonzalez, N, Swiezy, NB, Ritz, L, Koenig, K, McGough, J, Ghuman, JK, Linsay, RL (2005). Acute and long-term safety and tolerability of risperidone in children with autism. Journal of Child and Adolescent Psychopharmacology 15, 869884.Google Scholar
Bak, M, Franken, A, Janssen, J, van Os, J, Drunker, M (2014). Almost all antipsychotics result in weight gain: a meta-analysis. PLoS ONE 9, e94112.CrossRefGoogle ScholarPubMed
Bargiota, S, Bonotis, K, Messinis, I, Angelopoulos, N (2013). The Effects of Antipsychotics on Prolactin Levels and Women’s Menstruation. Schizophrenia Research and Treatment 2013, Article ID 502697, doi:10.1155/2013/502697.Google Scholar
Berinder, K, Olaf Akre, O, Granath, F, Hulting, A (2011). Cancer risk in hyperprolactinaemia patients: a population-based cohort study. European Journal of Endocrinology 165, 209215.Google Scholar
Bostwick, J, Guthrie, S, Ellingrod, V (2009). Antipsychotic induced hyperprolactinaemia. Pharmacotherapy 29, 6473.CrossRefGoogle Scholar
Calarge, C, Zimmerman, B, Xie, D, Kuperman, S, Schlechte, J (2010). A cross-sectional evaluation of the effect of risperidone and selective serotonin reuptake inhibitors on bone mineral density in boys. The Journal of Clinical Psychiatry 71, 338347.CrossRefGoogle Scholar
Leucht, S, Pitschel-Walz, G, Abraham, D, Kissling, W (1999). Efficacy and extrapyramidal side effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials. Schizophrenia Research 35, 5168.CrossRefGoogle ScholarPubMed
Marken, P, Haykal, R, Fisher, J (1992). Management of psychotropic-induced hyperprolactinaemia. Clinical Pharmacy 11, 851856.Google Scholar
National Collaborating Centre for Mental Health (2013). Psychosis and Schizophrenia in Children and Young People (Clinical Guideline No. 155). National Institute for Health and Clinical Excellence (NICE), London: 51 pp.Google Scholar
North Hampshire Healthcare NHS Foundation Trust (2013). Guidelines for the management of antipsychotic induced hyperprolactinaemia (http://www.nht.nhs.uk/mediaFiles/downloads/102018381/MMG007%20Management%20of%20antipsychotic-induced%20hyperprolactinaemia%20-%20_Sept13-Sept15_.pdf). Accessed 19 September 2015.Google Scholar
Oswald, DP, Sonenklar, NA (2007). Medication use among children with autistic spectrum disorders. Journal of Child and Adolescent Psychopharmacology 17, 348355.Google Scholar
Oxford Health NHS Foundation Trust (2012). Antipsychotic induced hyperprolactinaemia: trust guidelines for identification, monitoring, and management (http://www.seqo.nhs.uk/buckinghamshire/shared/images/files/ccg-prescribing/Clinical/04.%20Central%20Nervous%20System/Mental%20Health/Antipsychotic%20induced%20hyperprolactinaemia.pdf). Accessed 5 May 2014.Google Scholar
Rosenbloom, A (2010). Hyperprolactinaemia with antipsychotic drugs in children and adolescents. International Journal of Paediatric Endocrinology 2010, 159402, doi: 10.1155/2010/159402.Google Scholar
Scahill, L, McDougle, C, Aman, M, Johnson, C, Handen, B, Bearss, K, Dziura, J, Butter, E, Swiezy, N, Arnold, L, Stigler, K, Sukhodolsky, D, Lecavalier, L, Pozdol, S, Nikolov, R, Hollway, J, Korzekwa, P, Gavaletz, A, Kohn, A, Koenig, K, Grinnon, S, Mulick, J, Yu, S, Vitiello, B (2012). Effects of risperidone and parent training on adaptive functioning in children with pervasive developmental disorders and serious behavioral problems. Journal of the American Academy of Child and Adolescent Psychiatry 51, 136146.Google Scholar
Sussex Partnership NHS Foundation Trust (2014). Guidance for the treatment of antipsychotic induced hyperprolactinaemia in adults (http://www.sussexpartnership.nhs.uk/component/jdownloads/finish/2030/8963?Itemid=0). Accessed 5 May 2014.Google Scholar
Szarfman, A, Tonning, JM, Levine, JG, Doraiswamy, PM (2006). Atypical antipsychotics and pituitary tumors: a pharmacovigilance study. Pharmacotherapy 26, 748758.Google Scholar
Takahashi, T, Uchida, H, John, M, Hirano, J, Watanabe, K, Mimura, M, Correll, CU, Kishimoto, T (2013). The impact of prolactin-raising antipsychotics on bone mineral density in patients with schizophrenia: findings from a longitudinal observational cohort. Schizophrenia Research 147, 383386.Google Scholar
Taylor, D, Paton, C, Kapur, S (2012). The Maudsley Prescribing Guidelines, 11th Edition. Wiley Blackwell: London.Google Scholar
Tee, Esk, Weer Valleys NHS Foundation Trust (2013). Guidelines for the management of hyperprolactinaemia in patients receiving antipsychotics (http://www.tewv.nhs.uk/Global/Policies%20and%20Procedures/Pharmacy/PHARM-0032-v3%20Hyperprolactinaemia%20Guidelines.pdf). Accessed 5 May 2014.Google Scholar
Torre, DL, Falorni, A (2007). Pharmacological causes of hyperprolactinemia. Therapeutics and Clinical Risk Management 3, 929951.Google Scholar
Vaishya, R, Gupta, R, Arora, S (2010). Macroprolactin; a frequent cause of misdiagnosed hyperprolactinaemia in clinical practice. Journal of Reproduction & Infertility 11, 161167.Google Scholar
Yumru, M, Savas, HA, Kurt, E, Cemal Kaya, M, Selek, S, Savas, E, Timucin Oral, E, Atagun, I (2007). Atypical antipsychotics related metabolic syndrome in bipolar patients. Journal of Affective Disorders 98, 247252.Google Scholar