Antipsychotic use in under 25’s - think carefully!

TL;DR

This paper highlights the risks of using Risperidone in young people under 25 and the lack of proper monitoring despite guidelines.

Contribution

The study evaluates Risperidone prescribing patterns and monitoring in adolescents in Norfolk/Suffolk, revealing significant gaps in adherence to guidelines.

Findings

Almost 20% of 18-25-year-olds in youth mental health services were prescribed Risperidone.

Only 44% of these patients had their prolactin levels checked, as recommended.

60% of patients showed symptoms of hyperprolactinemia, a known side effect of Risperidone.

Abstract

Antipsychotic use for adolescents (defined here as under 25 year olds) must be done with caution, giving due thought to advantages and potential side effects. Antipsychotics are extremely useful and effective drugs, but have side effects and many of these are problematic.

It has been noted that Risperidone is often used for this age group, despite the UK guidance being cautious about its use.

To assess the extent of Risperidone prescribing in Norfolk/Suffolk for this patient group and to consider the monitoring of this.

Given that bone mass density is set down in teens – mid 20’s, this is a particularly concerning issue when given to this age group. Additionally, distressing side effects and issues with fertility shoudl be considered. If risperidone is used, Maudsley is very clear that this must be monitored: baseline/annual prolactin levels done, and action should be taken if these are elevated and/or the patient symptomatic.

Evaluate numbers of adolescents, under 2ndry care Mental health service who have been prescribed RisperidoneConsider who prescibed it and the indicationto consider if routine monitoring had been completed (specifically, baseline prolactin and then annual prolactin levels)to consider if these patients had developed side effects

Evaluate numbers of adolescents, under 2ndry care Mental health service who have been prescribed Risperidone

Consider who prescibed it and the indication

to consider if routine monitoring had been completed (specifically, baseline prolactin and then annual prolactin levels)

to consider if these patients had developed side effects

Almost 20% of 18-25 years olds, due to be seen in Youth Community Service had been prescribed Risperidone. Of these, only 44% had had prolactin levels done, despite the guidance. This equates to the over half not having prolactin checked. 60% of patients reveiwed had symptoms of hyperprolactinemia. Indications for use included emotional dysregulation/EUPD, psychosis, ADHD, OCD/ASD and depression

Risperidone should be used with extreme caution in this patient group. Medication can be very useful for some young people experiencing distressing symptoms but, as Hippocrates advises, “do no harm” and seek not to cause iatrogenic harm.

Given that many of the young people seen by mental health services are experiencing emotional dysregulation (not necessarily an abnormal state in adolescent, when much is in flux), it is tempting to consider medication as one means of trying to alleviate distress. There is no clear treatment for dysregulated feelings, and most would accept that psychological support is more appropriate.

None Declared