Mood stabilizer prescribing in a Christchurch adolescent sample: does it comply with guidelines?
OBJECTIVE
To determine the level of compliance with official guidelines for prescribing mood stabilizers among adolescents in Christchurch, New Zealand.


METHODS
A retrospective audit of clinical files of patients aged 13-19 years attending inpatient and outpatient services in the Child, Adolescent and Family Service in the Canterbury District catchment area was carried out against set criteria derived from the Ministry of Health Guidelines regarding the use of mood stabilizers (lithium and sodium valproate). A guideline compliance index was also created to measure overall compliance.


RESULTS
Over a period of 3 years beginning from January 2000, we identified 68 episodes of initiation among 58 adolescents. Of those, 91.2% were for indications set in the guidelines. More than half appeared to have been given no information about the medication, and only 61.8% had documented consent. Two-thirds had a full laboratory work-up before initiation. More than one-third had no evidence of communication with general practitioners about being initiated on a mood stabilizer. Overall, only 13.2% were 100% compliant and only 50% were 80% compliant.


CONCLUSIONS
In general, mood stabilizers were prescribed as indicated, but adherence to the guidelines beyond that appears to fall short of standards set by the guidelines.
Craig
Brian
B
Youth Inpatient Unit, Princess Margaret Hospital, Christchurch, New Zealand. brian.craig@cdhb.govt.nz
Olsen
Annalise
A
Swadi
Harith
H
Bobier
Candace
C
D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards*; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use*; D008297:Male; D008485:Medical Audit; D008605:Mental Health Services / Q000592:standards*; D019964:Mood Disorders / Q000175:diagnosis / Q000188:drug therapy*; D009520:New Zealand; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014635:Valproic Acid / Q000627:therapeutic use*
D000928:Antidepressive Agents; D018692:Antimanic Agents; D016651:Lithium Carbonate; D014635:Valproic Acid