1. Weight gain management guidelines:

Situation 1:

Normal weight gain associated with growth and development

Recommendation: Repeat weight measurement at next scheduled screen. Provide information on the importance of lifestyle for decreasing risk of weight gain.

 

 

Situation 2:

Significant weight gain noted, especially within first three months of medication use and/or child is overweight, obese or has pre-existing metabolic conditions prior to starting SGA treatment

Recommendation:

1.Lifestyle intervention

Second generation antipsychotic medication use in children and youth is associated with weight gain and metabolic complications. It is therefore strongly recommended that patients receive counselling (nutrition, lifestyle and exercise) at the initiation of therapy regardless of baseline body mass index. This is particularly important in a child who is overweight, obese or has existing metabolic symptoms prior to treatment with a second generation antipsychotic medication.

2. Re-evaluate use of SGA to minimize weight gain

Consider the following questions:

  • Can the medication be stopped? Give strong consideration if severe side effects are encountered.
  • Is the lowest effect dose being used? In particular, higher doses of risperidone and olanzapine have been associated with greater weight gain in children.
  • Can an alternative SGA be prescribed that has a lower side effect profile for weight gain?
  • Is the patient taking other medications that also cause weight gain? If yes, can they be stopped, reduced or altered?

1. Abnormal prolactin management guidelines:

Elevations in prolactin levels may be associated with signs and symptoms such as gynecomastia, galactorrhea, infertility, menstrual irregularities, oligomenorrhea, amenorrhea, sexual dysfunction, decreased libido, acne and hirsutism in females. However, hyperprolactinemia may be asymptomatic in some individuals, particularly in prepubertal children.

Situation 1:

Normal Prolactin

Recommendation: Repeat prolactin measurement at next scheduled screen.

Situation 2:

Abnormal Prolactin

Recommendation: Re-evaluate use of SGA:

  1. Is the lowest effective dose of the SGA being used?
  2. Can the SGA be switched to a prolactin-sparing agent, which can result in return to normal levels of prolactin within weeks?

If continued treatment with the current SGA is essential for the patient’s psychiatric illness, consult with a specialist regarding further management of the hyperprolactinemia. There are potential long-term effects of hyperprolactinemia, particularly osteoporosis, even in asymptomatic patients. This is concerning given the importance of bone mineral accrual through adolescence with peak bone mass occurring in late adolescence.

If there are clinical concerns, consider specialist consultation for further investigation regarding other causes of hyperprolactinemia and/or amenorrhea.

2. Abnormal lipid fasting profile – triglycerides management guidelines:

B. Fasting lipid profile — Triglycerides

Situation 1:

Normal TG < 1.5 mmol/L

Recommendation: Repeat TG measurement at next scheduled screen.

Situation 2:

Normal TG ≥ 1.5 mmol/L

Recommendation: Re-evaluate use of SGA to minimize weight. Consider cognitive/behavioural lifestyle intervention aimed at weight loss. Consider consultation with specialist if TG ≥ 5 mmol/L for possible medical therapy.

1. Weight gain management guidelines:

Situation 1:

Normal weight gain associated with growth and development

Recommendation: Repeat weight measurement at next scheduled screen. Provide information on the importance of lifestyle for decreasing risk of weight gain.

 

 

Situation 2:

Significant weight gain noted, especially within first three months of medication use and/or child is overweight, obese or has pre-existing metabolic conditions prior to starting SGA treatment

Recommendation:

1.Lifestyle intervention

Second generation antipsychotic medication use in children and youth is associated with weight gain and metabolic complications. It is therefore strongly recommended that patients receive counselling (nutrition, lifestyle and exercise) at the initiation of therapy regardless of baseline body mass index. This is particularly important in a child who is overweight, obese or has existing metabolic symptoms prior to treatment with a second generation antipsychotic medication.

2. Re-evaluate use of SGA to minimize weight gain

Consider the following questions:

  • Can the medication be stopped? Give strong consideration if severe side effects are encountered.
  • Is the lowest effect dose being used? In particular, higher doses of risperidone and olanzapine have been associated with greater weight gain in children.
  • Can an alternative SGA be prescribed that has a lower side effect profile for weight gain?
  • Is the patient taking other medications that also cause weight gain? If yes, can they be stopped, reduced or altered?

2. Fasting plasma glucose and insulin complications management guidelines:

Situation 1:

Normal FPG = FPG < 6.1 mmol/L

Recommendation: Repeat FPG check at next scheduled screen. If the fasting insulin is above the upper limit of normal for the assay being used, consider an oral glucose tolerance test (OGTT) and specialist consultation. For those individuals with an FPG value of 5.6 to 6.0 mmol/L, consider an OGTT.

Situation 2:

Impaired FPG = 6.1 to 6.9 mmol/L

Recommendation: Consider OGTT and specialist consultation if abnormal. Consider metformin in consultation with a specialist. Situation 3: Abnormal FPG = FPG ≥ 7 mmol/L Recommendation: Consult with specialist for the management of diabetes.

Situation 3:

Abnormal FPG = FPG ≥ 7 mmol/L

Recommendation: Consult with specialist for the management of diabetes.

Situation 1:

Normal weight gain associated with growth and development

Recommendation: Repeat weight measurement at next scheduled screen. Provide information on the importance of lifestyle for decreasing risk of weight gain.

 

 

Situation 2:

Significant weight gain noted, especially within first three months of medication use and/or child is overweight, obese or has pre-existing metabolic conditions prior to starting SGA treatment

Recommendation:

1.Lifestyle intervention

Second generation antipsychotic medication use in children and youth is associated with weight gain and metabolic complications. It is therefore strongly recommended that patients receive counselling (nutrition, lifestyle and exercise) at the initiation of therapy regardless of baseline body mass index. This is particularly important in a child who is overweight, obese or has existing metabolic symptoms prior to treatment with a second generation antipsychotic medication.

2. Re-evaluate use of SGA to minimize weight gain

Consider the following questions:

  • Can the medication be stopped? Give strong consideration if severe side effects are encountered.
  • Is the lowest effect dose being used? In particular, higher doses of risperidone and olanzapine have been associated with greater weight gain in children.
  • Can an alternative SGA be prescribed that has a lower side effect profile for weight gain?
  • Is the patient taking other medications that also cause weight gain? If yes, can they be stopped, reduced or altered?