Non-Alcoholic Fatty Liver Disease (NAFLD) in Children and Adolescents taking Atypical Antipsychotic Medications : A Protocol for a Systematic Review and Meta-Analysis

Atypical Antipsychotic medications are commonly prescribed to children and adolescents and are associated with important adverse effects including weight gain and metabolic syndrome. Non-Alcoholic Fatty Liver Disease (NAFLD) is not only the most common pediatric liver disease, but can also be associated with serious complications including liver cirrhosis. Given that both NAFLD and Atypical Antipsychotics (AAP) are associated with metabolic syndrome, we aimed to comprehensively examine the association between AAP and NAFLD in children and adolescents. We will conduct a systematic review following the PRISMA guidelines, of English-language literature published between 1950 and 2019, exploring NAFLD in subjects younger than 18 years on AAP.

Dietary fiber and probiotics for the treatment of atypical antipsychotic-induced metabolic side effects: study protocol for a randomized, double-blind, placebo-controlled trial

Background Atypical antipsychotic medications, which are effective for the treatment of schizophrenia and bipolar disorder, are associated with features of metabolic syndrome, such as weight gain, hyperglycemia, dyslipidemia, and insulin resistance. Although there are a few studies on the effects of dietary fiber or probiotics on weight loss in obese people, no published trials have reported the efficacy of dietary fiber and probiotics on reducing atypical antipsychotic-induced weight gain. Methods For this 12-week randomized, double-blind, placebo-controlled study, 100 patients with a weight gain of more than 10% after taking atypical antipsychotic medications were recruited. Participants were randomized to four groups as follows: probiotics (840 mg twice daily (bid)) plus dietary fiber (30 g bid), probiotics (840 mg bid) plus placebo, placebo plus dietary fiber (30 g bid), or placebo group. The primary outcome was the change in body weight. Secondary outcomes included changes in metabolic syndrome parameters, appetite score, biomarkers associated with a change in weight, and gut microbiota composition and function. Discussion To date, this is the first randomized, placebo-controlled, double-blinded trial investigating the efficacy of dietary fiber and probiotics alone and in combination to reduce metabolic side effects induced by atypical antipsychotic medications. If effective, it is possible to conclude that dietary fiber and probiotics can reduce atypical antipsychotic-induced metabolic side effects. Trial registration number ClinicalTrials.gov NCT03379597. Registered on 19 November 2017.

Improved Prescriber Adherence to Guidelines on Antipsychotic Medication Management Through Increased Access to Metabolic Monitoring Forms

INTRODUCTION: Patients diagnosed with a chronic mental illness have a 2 to 3 times higher likelihood of developing metabolic abnormalities than their non–mentally ill counterparts due to prescription medication use. Metabolic syndrome has been reported in 52% of patients prescribed atypical antipsychotic medications, compared to the general population rate of 23%, and has been found to place individuals at high risk of death from diabetes and cardiovascular disease. OBJECTIVE: This quality improvement project aimed to increase the rate of metabolic monitoring and related lab orders for patients prescribed atypical antipsychotic medications in a rural community mental health center to improve patient outcomes. METHOD: The use of a metabolic monitoring tool was implemented onsite. Chart audits were used to assess the effectiveness of introducing a metabolic monitoring form at a rural community mental health center and explore the feasibility of implementing a metabolic monitoring tool organization-wide. RESULTS: Metabolic lab orders increased from 1 to 59 at 8 weeks postimplementation for Clinic A after the implementation of a metabolic monitoring tool. CONCLUSION: Prescriber lab order rates improved using a metabolic monitoring form. Adherence to guideline-based care will improve patient outcomes by detecting the onset of metabolic syndrome earlier in the disease course. Early monitoring for metabolic changes will improve the health of patients diagnosed with a mental illness.

Management of Hyperactive Delirium in the Pediatric Intensive Care Unit: Case Series of Three Young Children

Children in the intensive care unit (ICU) are at high risk of developing delirium, given their underlying disease processes, the adverse effects of treatments and medications, and the stressful, abnormal environment. If prevention and nonpharmacologic measures to treat delirium are unsuccessful, atypical antipsychotics are considered, although they are not approved by Food and Drug Administration for the treatment of pediatric delirium and could have significant adverse side effects. This case report presents three pediatric patients with hyperactive ICU delirium that risked life-threating complications who were successfully treated with short courses of atypical antipsychotic medications.

Delirium in the Intensive Care Unit: Is Dexmedetomidine Effective?

Delirium in the intensive care unit affects approximately 30% of patients despite vigorous efforts to encourage the use of effective screening tools and preventive strategies. The success of pharmacological treatment of delirium remains equivocal; moreover, a paucity of research supports the use of atypical antipsychotic medications. However, dexmedetomidine appears to have a promising role in delirium management. This review includes an overview of the pathophysiology and types of delirium and describes 2 established tools used to screen for delirium. Published research related to the use of dexmedetomidine in the management of delirium is also discussed. The authors make recommendations for critical care nurses on dexmedetomidine use in the context of providing evidence-based nursing care to intensive care unit patients with delirium.