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Child and Adolescent Mental Health Service, Moore House, 10–11 Lindum Terrace, Lincoln LN2 5RT, email: walid.sorour{at}lpt.nhs.uk

Anne Thompson, Consultant in Child and Adolescent Psychiatry

Lincoln

A typical antipsychotic medication is used for children and adolescents, not only for childhood schizophrenia but also for adolescents with aggressive conduct disorders (Findling et al, 2000) and young people who have autistic-spectrum disorders and severe aggression (RUPP Autism Network, 2002). Unlike the adult population with enduring mental illness, research into the management of these childhood disorders is in its infancy and medication is almost always used off licence. However, child and adolescent psychiatrists in the UK have become more concerned about the metabolic side-effects of atypical antipsychotic drugs in children than about involuntary movement disorders. A consensus view is emerging that children and adolescents treated with atypical antipsychotic medication should have baseline and regular blood glucose monitoring, but there are no standards to guide and audit practice. To date it is unclear how far this practice is followed by child and adolesent psychiatrists across the country.

Most prescribing of atypical antipsychotic medication to children and adolescents will occur in out-patient rather than in-patient settings. We anticipate that the same difficulties described by Tarrant (Psychiatric Bulletin, August 2006, 30, 286–288) in the management of adult out-patients will also apply in child and adolescent psychiatry. In addition, the attitudes of practitioners, parents and children to venepuncture will influence the uptake of these tests. Some children with severe behaviour disorders cannot tolerate venepuncture. In our practice, we believe that recommending blood tests before and during treatment with atypical antipsychotic drugs emphasises the gravity of the decision to use these drugs in children.

With increased concern about the level of obesity and type 2 diabetes in young people in general (Dietz, 2001), psychiatrists and general practitioners need to work closely and cooperatively to decrease the risk of iatrogenic metabolic disease in children and adolescents.

References

DIETZ, W. H. (2001) The obesity epidemic in young children. BMJ, 322, 313 –314.[Free Full Text]

FINDLING, R. L., McNAMARA, N. K., BRANICKY, I. A. A., et al (2000) A double-blind study of risperidone in the treatment of conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 504 –516.

RUPP AUTISM NETWORK (2002) Risperidone in children with autism and serious behaviour problems. New England Journal of Medicine, 347, 314 –321.[Abstract/Free Full Text]

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Sorour, W. Articles by Thompson, A. Search for Related Content PubMed Articles by Sorour, W. Articles by Thompson, A.