Affiliations: [a] Child Psychiatry and Psychotherapy Department, Department of Personalized Medicine, Russian Medical Academy of Continuous Professional Education, Moscow, Russia | [b] G.E. Sukhareva Research and Practical Centre for Mental Health of Children and Adolescents, Moscow, Russia | [c] Department of Addictions Medicine, Russian Medical Academy of Continuous Professional Education, Moscow, Russia | [d] Child Psychiatry and Psychotherapy Department, Russian Medical Academy of Continuous Professional Education, Moscow, Russia | [e] Department of Clinical Pharmacology and Therapeutics, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
Correspondence:
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Address for correspondence: D. Ivashchenko, MD, PhD, Child Psychiatry and Psychotherapy Department, Department of Personalized Medicine, Russian Medical Academy of Continuous Professional Education, 125993, Barrikadnaya, 2/1-1, Moscow, Russia. Tel.: +7 926 634 83 91; Fax: +7 495 945 81 39; E-mail: [email protected].
Abstract: OBJECTIVE:To analyse the frequency, structure and risk factors of adverse drug effects in adolescents with acute psychotic episode by the methods of global triggers - Paediatric All-Cause Harm Measurement Tool (PACHMT) and Global Assessment of Paediatric Patient Safety Tool (GAPPS). PATIENTS AND METHODS:We used 151 completed case histories of patients who were admitted to a psychiatric hospital with acute psychotic episode. We applied Global Trigger Tool algorithm to each case retrospectively: we developed a special trigger list for psychiatric patients based on PACHMT, GAPPS and general Global Trigger Tool. We also calculated the Medical Appropriateness Index (MAI) for each case. We applied trigger tool analysis for calculation of treatment safety parameters. Statistical analyses included Pearson’s Chi-square, Mann-Whitney U, and Kruskal-Walles tests. RESULTS:We identified a total of 261 triggers among 151 analysed cases, 51 of which were accompanied by adverse drug effects (ADEs) (overall positive prediction value = 19.54%). The value of ADEs per 1000 bed days was 4.73, ADEs per 100 admissions was 33.77%. Extrapyramidal reactions to antipsychotics (58.8%) were the most common ADEs, followed by an abrupt medication stop of one or more drugs due to ADEs (25.5%). Significant predictors of antipsychotic-induced extrapyramidal symptoms were age, MAI score and total number of hospital admissions. CONCLUSION:We recommend three triggers, “Abrupt medication stop”, “Prescribing of extrapyramidal symptoms corrector”, and “Hospital readmission within 30 days”, with reasonable positive predictive value for incorporation into routine systems for patient safety monitoring in adolescents with an acute psychotic episode. Antipsychotic-induced extrapyramidal symptoms were more prevalent in older adolescents and patients with fewer lifetime hospital admissions. These patients need to be carefully monitored to ensure patient safety.
Keywords: Drug safety, psychiatry, Global Trigger Tool, antipsychotics, safety, adolescents, GAPPS
