Quality statement 6: Monitoring adverse effects of pharmacological interventions

Quality statement

Children and young people with a conduct disorder and severely aggressive behaviour who have been prescribed risperidone have a baseline physical and metabolic investigation and are monitored for efficacy and adverse effects at regular intervals.

Rationale

Pharmacological interventions should not be offered for the routine management of behavioural problems in children and young people with a conduct disorder. Risperidone may be considered for the short-term management of severely aggressive behaviour in children and young people with a conduct disorder who have problems with explosive anger and severe emotional dysregulation and which has not responded to psychosocial interventions. This medication can have significant physical effects and, in some cases, significant adverse effects. Current practice information suggests that there is variation in the baseline investigations and monitoring carried out in children and young people taking risperidone.

Quality measures

Structure

Evidence of local arrangements to ensure that children and young people with a conduct disorder and severely aggressive behaviour who have been prescribed risperidone have a baseline physical and metabolic investigation and are monitored for efficacy and adverse effects at regular intervals.

Data source: Local data collection.

Process

a) The proportion of children and young people with a conduct disorder and severely aggressive behaviour who have been prescribed risperidone who have a baseline physical and metabolic investigation carried out and recorded before the start of treatment.

Numerator – the number of children and young people in the denominator who have a baseline physical and metabolic investigation carried out and recorded before the start of treatment.

Denominator – the number of children and young people with a conduct disorder and severely aggressive behaviour who have been prescribed risperidone.

b) The proportion of children and young people with a conduct disorder and severely aggressive behaviour who are taking risperidone who have physical and metabolic investigations repeated and recorded at regular intervals.

Numerator – the number of children and young people in the denominator who have physical and metabolic investigations repeated and recorded at regular intervals.

Denominator – the number of children and young people with a conduct disorder and severely aggressive behaviour who are taking risperidone.

c) The proportion of children and young people with a conduct disorder and severely aggressive behaviour who are taking risperidone who have changes in their symptoms and behaviour monitored and recorded at regular intervals.

Numerator – the number of children and young people in the denominator who have changes in their symptoms and behaviour monitored and recorded at regular intervals.

Denominator – the number of children and young people with a conduct disorder and severely aggressive behaviour who are taking risperidone.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that there are protocols in place for all children and young people with a conduct disorder and severely aggressive behaviour who have been prescribed risperidone to have a baseline physical and metabolic investigation and to be monitored for efficacy and adverse effects at regular intervals.

Healthcare professionals ensure that children and young people with a conduct disorder and severely aggressive behaviour who have been prescribed risperidone have a baseline physical and metabolic investigation and are monitored for efficacy and adverse effects at regular intervals.

Commissioners ensure that they commission services that have protocols in place for all children and young people with a conduct disorder and severely aggressive behaviour that have been prescribed risperidone to have a baseline physical and metabolic investigation and be monitored for efficacy and adverse effects at regular intervals.

What the quality statement means for patients, service users and carers

Children and young people who are taking risperidone to help treat their conduct disorder and aggressive behaviour have a number of physical checks carried out before they start treatment, and are regularly monitored to check whether the treatment is working and whether there are any unwanted side effects.

Source guidance

Definitions of terms used in this quality statement

Baseline physical and metabolic investigation

At the start of treatment, a suitably qualified healthcare professional with expertise in prescribing antipsychotics in children and young people for a range of conditions including conduct disorders, should undertake and record the following baseline investigations:

  • weight and height (both plotted on a growth chart)

  • waist and hip measurements

  • pulse and blood pressure

  • fasting blood glucose, glycosylated haemoglobin (HbA1c), blood lipid and prolactin levels

  • assessment of any movement disorders

  • assessment of nutritional status, diet and level of physical activity. [Adapted from Antisocial behaviour and conduct disorders in children and young people (NICE clinical guideline 158), recommendation 1.6.5 and expert consensus]

Regular intervals

Advice on the frequency of monitoring is provided in table 1 of Psychosis and schizophrenia in children and young people (NICE clinical guideline 155) and should be read in conjunction with the British national formulary (BNF), British national formulary for children (BNFC) and summary of product characteristics.

Severely aggressive behaviour

This refers to the behaviour of children and young people with a conduct disorder who have problems with explosive anger and severe emotional dysregulation. [Adapted from Antisocial behaviour and conduct disorders in children and young people (NICE clinical guideline 158), recommendation 1.6.3]