Guidelines and practice on antipsychotics prescribing and physical health monitoring in children and young people: a cohort study using primary care data.

This study looked at how antipsychotic medications are prescribed to children and teenagers in England. It found that many autistic children (62% of those with mental health conditions) were prescribed these medications, often for long periods. Worryingly, about 1 in 5 children had no clear medical reason for the prescription. Most children didn't receive proper health monitoring like blood tests that should accompany these medications.

The researchers suggest better guidelines and monitoring are needed.

This cohort study examined antipsychotic prescribing patterns and physical health monitoring (PHM) in children and young people aged 5-17 using English primary care data from 2006-2021. Among 2,158 children prescribed antipsychotics, 47% had recorded mental health conditions (62% were autism spectrum disorder). Notably, 19% had no relevant indication for prescription. Physical health monitoring was inadequate, with over 50% of children receiving no blood tests during 2-year follow-up.

For autism and Tourette syndrome patients, initial antipsychotic exposure often exceeded 10 months. The study highlights gaps between clinical guidelines and practice, suggesting need for improved data recording and standardized recommendations across conditions.

Findings suggest need for improved antipsychotic prescribing practices in children, particularly better documentation of indications and enhanced physical health monitoring. Development of standardized guidelines across conditions and improved data recording systems may help address identified gaps in care quality.

Study relies on primary care data which may have gaps in recording treatment information. Some apparent poor adherence to guidelines may reflect data recording issues rather than actual practice. Study cannot determine appropriateness of prescribing without full clinical context.

Antipsychotic treatments require physical health monitoring (PHM), especially among children and young people (CYP). For CYP aged 5-17, to investigate recorded indications for antipsychotics prescribing and first-treatment durations, and, for psychosis, bipolar disorder, autism spectrum disorder (ASD) and Tourette's syndrome, recorded levels of PHM for CYP with antipsychotics prescriptions and those without. All CYP registered with QResearch English general practices between 2006 and 2021 were considered. To quantify PHM, 2158 CYP with antipsychotics prescriptions and 22 151 CYP with a condition but no prescriptions were followed for 2 years. 47% (2363) of CYP with antipsychotics prescriptions had a recorded mental health condition of interest (of which 62% were ASD). 19% (921) had no relevant indication.

For patients with ASD and Tourette syndrome, top quartiles for initial exposure to antipsychotics were >10 months. Recorded PHM was generally low, with over 50% of CYP showing no blood test during the 2-year follow-up. Coverage of best practice is uneven across the condition-related national CYP guidelines, and this requires improvement. However, we suspect some apparently poor adherence to best practice also derives from treatment complexities and associated data flows leading to gaps in the encoded general practice data.

To audit more exactly clinical practice against guidelines, we propose qualitative studies, targeted to cover the full range of local circumstances, nationally. General practices should be encouraged to prioritise encoding of all treatment data. Development of one central gold-standard set of recommendations for antipsychotics use could encourage better adherence levels across conditions.