title: Quality concerns in antipsychotic prescribing for youth: a review of treatment guidelines.
abstract: BACKGROUND
  Antipsychotic prescribing for youth has increased rapidly, is linked with serious health concerns, and lacks clear measures of quality for pediatric care. We reviewed treatment guidelines relevant to 7 quality concepts for appropriate use and management of youth on antipsychotics: 1) use in very young children, 2) multiple concurrent antipsychotics, 3) higher-than-recommended doses, 4) use without a primary indication, 5) access to psychosocial interventions, 6) metabolic screening, and 7) follow-up visits with a prescriber.
  
  
  METHODS
  We searched for clinical practice guidelines meeting the following criteria: developed or endorsed by a national body, published after 2000, and specific treatment recommendations made related to 1 or more of the 7 quality concepts. Sources included electronic databases, the American Academy of Child and Adolescent Psychiatry Web site, and stakeholder and expert advisory committee recommendations. Two raters reviewed the 11 guidelines identified, extracting treatment recommendations, including details that could support measure definitions, and ratings of strength of recommendation and evidence.
  
  
  RESULTS
  All 7 quality concepts were strongly endorsed by 1 or more guidelines, and 2 or more guidelines assigned their highest strength of recommendation ratings to 6 of the 7 concepts. Two guidelines rated evidence, providing high strength of evidence for 2 quality concepts: psychosocial interventions and metabolic monitoring.
  
  
  CONCLUSIONS
  Guidelines provide support for 7 quality concepts addressing antipsychotic prescribing for youth. However, guideline support is often based on strong clinical consensus rather than a robust evidence base.
authors.affiliation: New York State Office of Mental Health, New York, NY.
authors.forename: Edith
authors.initials: E
authors.lastname: Kealey
authors.affiliation: National Committee for Quality Assurance, Washington, DC.
authors.forename: Sarah Hudson
authors.initials: SH
authors.lastname: Scholle
authors.affiliation: National Committee for Quality Assurance, Washington, DC.
authors.forename: Sepheen C
authors.initials: SC
authors.lastname: Byron
authors.affiliation: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Hoagwood
authors.affiliation: New York State Office of Mental Health, New York, NY; New York State Office of Mental Health and School of Public Health, State University of New York-Albany, Albany, NY.
authors.forename: Emily
authors.initials: E
authors.lastname: Leckman-Westin
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Kelly
authors.initials: K
authors.lastname: Kelleher
authors.affiliation: New York State Office of Mental Health, New York, NY; Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY. Electronic address: molly.finnerty@omh.ny.gov.
authors.forename: Molly
authors.initials: M
authors.lastname: Finnerty
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D017410:Practice Guidelines as Topic; D011618:Psychotic Disorders / Q000188:drug therapy*; D011785:Quality Assurance, Health Care; D014481:United States
chemical_list: D014150:Antipsychotic Agents
keywords: adolescents; antipsychotic agents; children; practice guidelines as topic; quality indicators