TABLE 4.
A practical tool for metabolic monitoring of children and youth treated with second-generation antipsychotics
| Parameter | Pretreatment baseline | 1 month | 2 months | 3 months | 6 months | 9 months | 1 year | |
|---|---|---|---|---|---|---|---|---|
| Assessment date | ||||||||
| Height, cm* | ||||||||
| Height percentile | ||||||||
| Weight, kg* | ||||||||
| Weight percentile | ||||||||
| BMI, kg/m2* | ||||||||
| BMI percentile | ||||||||
| Waist circumference (at the level of the umbilicus)† | ||||||||
| Waist circumference percentile | ||||||||
| Blood pressure, mmHg‡ | ||||||||
| Blood pressure percentile | ||||||||
| Neurological examination§ | □ completed | □ completed | □ completed | □ completed | □ completed | □ completed | □ completed | |
| Laboratory evaluations | ||||||||
| Fasting plasma glucose (normal ≤6.1 mmol/L)¶ | NR | NR | NR | |||||
| Fasting insulin** (normal ≤100 pmol/L)†† | NR | NR | NR | |||||
| Fasting total cholesterol (normal <5.2 mmol/L) | NR | NR | NR | |||||
| Fasting low-density lipoprotein – cholesterol (normal <3.35 mmol/L) | NR | NR | NR | |||||
| Fasting high-density lipoprotein – cholesterol (normal ≥1.05 mmol/L) | NR | NR | NR | |||||
| Fasting triglycerides (normal <1.5 mmol/L) | NR | NR | NR | |||||
| Aspartate aminotransferase | NR | NR | NR | NR | ||||
| Alanine aminotransferase | NR | NR | NR | NR | ||||
| Thyroid-stimulating hormone (quetiapine only) | NR | NR | NR | NR | ||||
| Prolactin‡‡ | NR | NR | NR | NR | ||||
| Other_____________________ (eg, Amylase, A1C, OGTT etc)§§ |
||||||||
| Physician initials: ➔ | ||||||||
To determine height, weight and body mass index (BMI) percentiles, use age- and sex-specific growth charts (http://www.cdc.gov/growthcharts/);
To determine age- and sex-specific percentiles, visit http://www.idf.org/webdata/docs/Metsdefinitionchildren.pdf (pages 18–19);
To determine age- and sex-specific percentiles, visit http://pediatrics.aappublications.org/cgi/content/full/114/2/S2/555;
Tools available for monitoring extrapyramidal symptoms include Abnormal Involuntary Movement Scale (AIMS), Simpson Angus Scale, Extrapyramidal Symptom Rating Scale and Barnes Akathisia Rating Scale;
For fasting plasma glucose values of 5.6 mmol/L to 6.0 mmol/L, an oral glucose tolerance test (OGTT) should be considered;
This assessment is not recommended for aripiprazole or ziprasidone, but is appropriate for all other second-generation antipsychotics;
For fasting insulin levels >100 pmol/L, an OGTT should be considered. Normal reference range may vary between centres;
Assessment of prolactin levels should be completed according to protocol, except when the patient is displaying clinical symptoms of hyperprolactinemia (ie, menstrual irregularity, gynecomastia or galactorrhea), in which case more frequent monitoring may be warranted. Also note that risperidone has the greatest effect on prolactin;
It is recommended that amylase levels be monitored in cases in which the patient presents with clinical symptoms of pancreatitis (ie, abdominal pain, nausea and vomiting). NR Not recommended