The CAMESA guidelines provide parents and doctors with information about the side effects of antipsychotic drugs in children.

About the Guidelines

CAMESA helps parents and doctors manage the side effects of second generation antipsychotics in children.

The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) guidelines were developed by a group of physicians, health professionals and researchers from across Canada, with the support of the Canadian Institutes of Health Research. The goal of the CAMESA guidelines is to improve the quality of life of children with mental health disorders by promoting antipsychotic drug safety.

There are three CAMESA guidelines:

How to monitor antipsychotic drug safety
How to manage or treat metabolic complications of antipsychotic medications if they occur (such as weight gain, or elevated cholesterol)
How to manage or treat extrapyramidal complications of antipsychotic medications if the occur (involuntary movements)

The guidelines synthesize research findings and provide recommendations on how to perform these tasks.

Information for Doctors

Our recommendations

Each of the CAMESA guidelines provides practice recommendations based on a systematic review of the literature and expert group consensus. The monitoring guideline provides a summary of the evidence for metabolic and extrapyramidal symptoms associated with antipsychotic medications, and recommendations on which physical examination procedures and laboratory tests should be conducted as a part of routine drug safety monitoring. The metabolic treatment guideline provides recommendations on the management of antipsychotic associated weight gain, and abnormalities in cholesterol, triglycerides, glucose, insulin, liver enzymes, prolactin, and thyroid hormones. The extrapyramidal symptoms guideline provides recommendations on the management of antipsychotic induced acute dystonic reactions, akathisia, drug-induced parkinsonism, tardive dyskinesia, tardive dystonia, and withdrawl dyskinesias.

Downloads

Each of the CAMESA guidelines may be downloaded. A simplified, non-specific antipsychotic monitoring form is included in the monitoring guideline. We have also created drug-specific monitoring forms for each second generation antipsychotic medication, as recommendations for monitoring differ for each drug. The drug specific monitoring templates can also be downloaded and printed for use in patient records, to help track your monitoring activities.

Information for Parents

Why are antipsychotic medications prescribed to children?

Antipsychotic medications are prescribed to children to treat disorders including aggressive behaviour with attention deficit hyperactivity disorder; oppositional defiant and conduct disorders; irritability with autism spectrum disorders; tic disorders; bipolar disorder; and schizophrenia and psychotic disorders.

Which medications are most commonly prescribed?

Today, newer antipsychotic medications, called Second Generation Antipsychotic medications, are the most common type of antipsychotic medication prescribed to children. The generic names for these medications are risperidone, olanzapine, quetiapine, aripiprazole, clozapine, ziprasidone and paliperidone. Depending on which company makes the medication, there may be a different brand name as well.

What are potential side effects of these medications?

Second Generation Antipsychotic medications are often effective in treating the condition for which they were prescribed. However, side effects may occur. They include weight gain, increased waist size, increased blood glucose and insulin levels, elevated blood cholesterol and/or triglyceride levels, altered prolactin and thyroid hormone levels and involuntary movements. These are only possible side effects and may not occur in your child. Regardless, it is important to be aware of what to watch for when your child is taking any of these medications.

How does a physician test for medication safety?

When your child is prescribed a Second Generation Antipsychotic medication, the physician will typically assess your child’s disorder on a regular basis. Your child’s physician will want to know the severity of your child’s symptoms, if the medication is working, and if there are any side effects. To monitor for potential medication side effects, your child’s physician will usually monitor your child’s height, weight, waist circumference and blood pressure.

Your child’s physician may also conduct a brief neurological exam and order blood work. The neurological exam assesses for potential side effects such as involuntary movements. The type and timing of blood work depends on the medication your child is taking. Blood work may include testing blood glucose, insulin, cholesterol, triglyceride, prolactin and thyroid hormone levels. How often this monitoring is conducted will depend on the status of your child’s disorder, side effects your child may be experiencing, and for how long your child has taken the medication.

Why is it important for your child to be monitored?

Early identification of side effects related to the use of antipsychotic medications may help decrease the severity of these side effects and prevent long-term complications.

What should you do if your child experiences a side effect?

If you think your child is experiencing a drug-related side effect, you should contact the prescribing physician. Antipsychotic medications should not be abruptly discontinued.

Information for Children

A healthy lifestyle can help prevent medication-related problems

Many of the side effects of antipsychotic medications can be prevented through healthy eating and exercise. Please follow the links to these recommended websites for information and resources on healthy living. Each of these websites have sections for kids, teens, parents and educators. The kids sites have information on keeping fit, sport and physical activity ideas, activity diaries, eating healthy and recipes.

For more information, visit kidshealth.org or healthykids.nsw.gov.au

Who We Are

About CAMESA

The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotic Medications in Children is a non-profit group of physicians, allied health care professionals, and researchers with grant support from the Canadian Institutes of Health Research. We are dedicated to improving the quality of life of children and their families through the practice of evidence-based medicine and promoting drug safety. We have been working since 2011 to promote the use of the CAMESA guidelines through open access publication of the guidelines, information booths at international, national and provincial meetings of pediatricians and psychiatrists, and educational outreach activities at universities across Canada. We have distributed our drug safety information pamphlets for families to mental health clinics across Canada, and by request to mental health clinics in the United States.

CAMESA is led by Dr Tamara Pringsheim, neurologist and clinical epidemiologist at the University of Calgary. Dr Pringsheim’s interest in antipsychotic medication safety developed through her clinical work in the area of Tourette Syndrome and drug induced movement disorders. Dr Pringsheim is the director of the Calgary Tourette Syndrome Clinic at the Alberta Children’s Hospital where she sees children and adults with Tourette Syndrome. She sees adults with movement disorders at the Movement Disorders Clinic at the Foothills Medical Centre.

Ongoing Work

Dr Pringsheim is conducting a prospective cohort study at the Alberta Children’s Hospital. In this study we are evaluating the feasibility of the monitoring guideline in clinical practice, as well as examining the rate of antipsychotic medication induced metabolic and extrapyramidal side effects. The results of the study will be used to refine the monitoring protocol in the future.

Dr Pringsheim is working in collaboration with Dr Daniel Gorman from the Hospital for Sick Children to promote the use of the CAMESA guidelines among resident physicians training in pediatrics, family medicine and psychiatry. Dr Pringsheim and Dr Gorman received a grant from the Sick Kids Foundation to create a national educational curriculum on the assessment and management of disruptive behaviour disorders which examines the evidence for psychosocial and pharmacological therapies, and appropriate monitoring of antipsychotic safety in children.

Group Members

Josephine Ho: Pediatric Endocrinologist, University of Calgary
Dina Panagiotopoulos: Pediatric Endocrinologist, University of British Columbia
Scott Patten: Psychiatrist and Clinical Epidemiologist, University of Calgary
Jana Davison: Child Psychiatrist, University of British Columbia
Asif Doja: Pediatric Neurologist, University of Ottawa
Stacey Belanger: Pediatric Neurologist, University of Montreal
Rekha Jabbal: Pharmacist, Alberta Children’s Hospital Mental Health Program
Jonathan Ponesse: Developmental Pediatric Neurologist, University of Ottawa
Michelle Pearce: Child Psychiatrist, University of Toronto
Waqar Waheed: Child Psychiatrist, University of Calgary
Lisa Casselman: Consultant, Mental Health Commission of Canada
Silviu Grisaru: Pediatric Nephrologist, University of Calgary
Gail MacKean: Consultant, Mental Health Commission of Canada
Brian McCrindle: Pediatric Cardiologist, University of Toronto
John McLennan: Child Psychiatrist, University of Calgary
Valerie Palda: General Internist and Clinical Epidemiologist, University of Toronto
Roger Thomas: Family Physician, University of Calgary

Press & Publications

Press

CBC Homestretch Interview | November 9, 2011: Guest host Ken Lima-Coelho speaks with Dr. Tamara Pringsheim, a clinical Assistant Professor in the department of Clinical Neurosciences and Pediatrics at the University of Calgary.

Other Publications

Schizophr Res. 2005 Jul 15;76(2-3):247-65. Epub 2005 Apr 18.: Manual for the Extrapyramidal Symptom Rating Scale (ESRS).
Chouinard G, Margolese HC.
J Child Adolesc Psychopharmacol | 2011 Dec | 21(6):537-43.: The pharmacoepidemiology of antipsychotic medications for Canadian children and adolescents: 2005-2009.
Pringsheim T, Lam D, Patten SB.
Drug Saf. | 2011 Aug | 1;34(8):651-68.: Metabolic and neurological complications of second-generation antipsychotic use in children: a systematic review and meta-analysis of randomized controlled trials.
Pringsheim T, Lam D, Ching H, Patten S.