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Side-effects Monitoring

  • Patients with bipolar disorder should be regularly monitored for iatrogenic adverse effects of antipsychotic medication including extrapyramidal symptoms (EPS). (1)
  • Studies indicate that tardive dyskinesia (TD) still occurs with atypical agents and that regular and specific examination for early signs of TD remains an appropriate monitoring plan. (2,3)
  • Treatment with certain antipsychotic medications is associated with metabolic adverse events that can increase the risk for metabolic syndrome and related conditions such as pre-diabetes, type 2 diabetes, and cardiovascular disease. (4)

Abnormal Involuntary Movement (AIMS):

  • The AIMS scale was designed to measure involuntary movements known as tardive dyskinesia. TD is a disorder that can develop as a side-effect of long term treatment with neuroleptic (antipsychotic) medication.

Texas Medication Algorithm Project Side-effects Checklists:

  • Medication side-effect self-report checklists, created by the Texas Medication Algorithm Project, lists common side-effects that should be reported to the clinician.
  • The two checklists include “Less Severe” and “More Severe” side-effects.

Antipsychotic Side-effects Checklist (ASC):

  • The ASC was originally developed for use with schizophrenia on antipsychotic medication. The checklists are also useful in monitoring the side-effects of antipsychotics in the bipolar population.
  • The ASC was not designed to screen for TD or acute dystonia.

Metabolic Monitoring Form:

  • The STABLE Metabolic Monitoring Form was designed as a tool to help clinicians organize the results of tests required for monitoring metabolic syndrome. The form includes tables for recording serial test results and provides normal and abnormal laboratory reference ranges.

References:

  1. Yatham LN, Kennedy SH, et al. Canadian Network for Mood and Anxiety Treatments of Bipolar Disorder (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies. Bipolar Disorders 2005: 7(Suppl 3): 5-69
  2. Suppes T, Dennehy E, Hirschfeld R, et al. The Texas Implementation of Medication Algorithms: Update to the Algorithms for Treatment of Bipolar I Disorder, J Clin Psychiatry 2005 ; 66 :870-886.
  3. Tarsy D, Baldessarini R, . Epidemiology of Tardive Dyskinesia: Is Risk Declining with Modern Antipsychotics? Movement Disorders Vol 21, No 5, 2006, 589-598
  4. Newcomer JW, Haupt DW, The Metabolic Effects of Antipsychotic Medications. Can J Psychiatry, Vol 51, No 8, July 2006; 480-491


Copyright 2007 by the Center for Quality Assessment and Improvement in Mental Health