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Baseline monitoring of atypical antipsychotics at a Family Medicine Teaching Unit (FMTU) in Ontario, Canada

Published:January 11, 2023DOI:https://doi.org/10.1016/j.pmip.2022.100099
      Second generation antipsychotic medications, also known as atypical antipsychotics, are useful in treating several mental health conditions including psychosis and “senile agitation”. They are also useful in treating conditions like nausea and vomiting [
      • Maust D.T.
      • Kales H.C.
      Medicating distress.
      ]. However, these medications have several cardiac, metabolic and neurologic side effects which require ongoing monitoring [ ,
      • Ucok A.
      • Gaebel W.
      Side effects of atypical antipsychotics: a brief overview.
      ]. Several organizations including the international Choosing Wisely campaign endorse ongoing monitoring as best practice [

      Choosing Wisely America. American Psychiatric Association Recommendations. Available: https://www.psychiatry.org/psychiatrists/practice/quality-improvement/choosing-wisely.

      ]. In resource rich countries including Canada and the United Kingdom, there has been a rise in recent years in the number of atypical antipsychotics prescribed [

      Roberts R, Neasham A, Lambrinudi C, et al. A quantitative analysis of antipsychotic prescribing trends for the treatment of schizophrenia in England and Wales. JRSM Open;9(4):2054270418758570.

      ]. Despite this spike in prescribing, a proportional rise in screening for side effects from second generation antipsychotics in primary care has not been observed [

      Mitchell AJ, Delaffon V, Vancampfort D, et al. Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices. Psychol Med;42:125–47. 10.1017/S003329171100105X.

      ]. The literature for screening in a teaching unit setting is particularly sparse.

      Keywords

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      References

        • Maust D.T.
        • Kales H.C.
        Medicating distress.
        JAMA Intern Med. 2017; 177: 42-43
      1. Jassen. Product Monograph: Risperidal. Available: https://www.janssen.com/canada/sites/www_janssen_com_canada/files/product/pdf/ris06112014cpm2_snds_0.pdf.

        • Ucok A.
        • Gaebel W.
        Side effects of atypical antipsychotics: a brief overview.
        World Psychiatry. 2008; 7: 58-62
      2. Choosing Wisely America. American Psychiatric Association Recommendations. Available: https://www.psychiatry.org/psychiatrists/practice/quality-improvement/choosing-wisely.

      3. Roberts R, Neasham A, Lambrinudi C, et al. A quantitative analysis of antipsychotic prescribing trends for the treatment of schizophrenia in England and Wales. JRSM Open;9(4):2054270418758570.

      4. Mitchell AJ, Delaffon V, Vancampfort D, et al. Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices. Psychol Med;42:125–47. 10.1017/S003329171100105X.

      5. University of Toronto, Department of Family and Community Medicine. QI Curriculum - blended learning program 2018-19. Available: https://www.dfcm.utoronto.ca/qi-curriculum-blended-learning-program-2018-19.

      6. North Simcoe Muskoka Specialized Geriatric Services. Promoting the Appropriate Use of Antipsychotics: A Toolkit for North Simcoe Muskoka Long-Term Care Home Prescribers Available: https://www.nsmsgs.ca/Uploads/ContentDocuments/9.%20Antipsychotic%20Toolkit%20May17.pdf.