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Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP) and Metabolic Monitoring

The APP measure was created as a result of rising concern over observed increased use of antipsychotic medications and potential side effects for developing children.  Use of these medications should only occur after it has been determined that the child has received a thorough evaluation, such as a psychiatric or psychological evaluation.

Antipsychotic medications may be helpful for those who have been diagnosed with Schizophrenia or psychosis. When prescribed for other disorders, efforts should be made to attempt psychotherapy and/or other forms of psychotropic medications before resorting to these drugs.

Possible Side Effects

The most common side effects for children and adolescents include:

  • Dizziness
  • Dry mouth
  • Fatigue
  • Increased appetite
  • Nausea
  • Somnolence
  • Tachycardia
  • Weight gain

In the case of long-term use there is a heightened risk of tardive dyskinesia.

Patient population: patients below the age of 18 years

Quality Goal: Ensure that children taking antipsychotic medications have been appropriately evaluated and diagnosed, and that there is not an alternative course of treatment.

Next Steps

What can you do for your patients who are taking antipsychotic medication?

  • Conduct a thorough physical exam of your patient.
  • Collaborate and refer to mental health providers regarding the care of your patient.
  • Ensure patient’s weight and blood sugar are monitored routinely. Click here for more information.
  • Educate parents about the possibility that their child may gain a significant amount of weight and about the risks that must be monitored with regular blood tests. Metabolic screening during the initial phase of use and ongoing monitoring will be necessary.
  • Encourage young patients to be physically active and discuss diet with their caretakers.
  • Encourage families to keep the patient’s appointments with all treating providers and for preventive health care.

We Can Help

Call us for help to coordinate behavioral healthcare for member at 1-800-818-8581.

Metabolic monitoring for children and adolescents on antipsychotics

Antipsychotics can effectively treat psychiatric disorders in children and adolescents, but some of these medications increase a person’s risk for weight gain and diabetes. For instance, the association between atypical antispsychotics and diabetes is stronger among youth under age 17 than among adults (Hammerman, et al., 2008). Young people with metabolic disorders are at greater risk of negative outcomes as adults, including high risk of heart disease. Therefore, it is important to closely monitor young people taking antipsychotics.

Patient population: People 1–17 years of age using two or more antipsychotic prescriptions.

Quality Goal: Ensure patients have at least one LDL-C test and at least on HbA1c test every year.

What can you do for your young patients taking antipsychotics?

  • Educate parents about the possibility their child will gain a significant amount of weight and about the risks that must be monitored with annual blood tests.
  • Schedule appointments in advance, and remind patients about appointments.

Provider Resources

24/7 Crisis Line

Let your patients know that they can get confidential help for mental health emergencies by calling
855-CRISIS-1 or 855-274-7471

Behavioral Health Consultation and Referral Line

Speak with an expert M-F 9-5 (ET)