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

About the Guidelines

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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 Parents

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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 Doctors

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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.

Press & Other Publications

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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.