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Quantum Units Education®

Antipsychotic Prescribing for Children and Adolescents

Executive Summary

1. Expert consensus strongly suggests that systems-level strategies are needed to support both the initial antipsychotic treatment decision and those decisions required after treatment is initiated.

A. True

B. False


Part A. Introduction

2. Antipsychotic medication use among youth in the United States is about equal to that in most other developed countries.

A. True

B. False


Part B. Background

3. Families that participated in a series of national focus groups conducted by FREDLA reported _____ as the most concerning side effect about giving antipsychotic medications to their children.

A. Weight gain

B. Drowsiness

C. Nausea / vomiting

D. Restlessness


4. Studies find rates of antipsychotic prescribing to be approximately equal among Medicaid-insured youth as compared to commercially insured youth.

A. True

B. False


5. Analyses found antipsychotic prescriptions for young children between one and five years of age occurred most frequently among children diagnosed with any of the following, except:

A. ADHD

B. Disruptive behavior disorders

C. Autism

D. Bipolar disorder


6. After controlling for diagnostic and sociodemographic factors, it was found that youth in foster care were prescribed antipsychotic medications at twice the rate of other Medicaid-insured youth.

A. True

B. False


7. From 2011 to 2015, the analytic report found decreases in the proportion of antipsychotic users who were:

A. Non-Hispanic Black

B. Non-Hispanic White

C. Hispanic

D. There was an increase in the proportion of antipsychotic users among all ethnicities


8. Second-generation antipsychotic medications are U.S. Food and Drug Administration approved for all of the following, except:

A. Schizophrenia

B. Bipolar disorder

C. ADHD

D. Tourette’s disorder


9. Antipsychotic medications are used widely for youth without FDA-approved indications often to manage “off-label” aggressive or challenging behaviors.

A. True

B. False


10. A study of the general pediatric population found _____ was the top target symptom for antipsychotic prescribing.

A. Irritability

B. Impulsivity

C. Hyperactivity

D. Aggression


11. A recent meta-analysis found youth treated with antipsychotics to hold more than a threefold increased risk for _____ vs. healthy controls.

A. Type 2 diabetes

B. Liver cancer

C. Renal failure

D. Cardiovascular disease


12. Members of the expert convening emphasized the goal of an antipsychotic monitoring program should be to restrict or inhibit antipsychotic prescribing.

A. True

B. False


Part E. Strategies to Promote Antipsychotic Medication Oversight and Best Practice Prescribing

13. Prior authorization is an administrative tool used by a health plan or prescription benefits management company that requires, under the terms of the pharmacy benefits plan, the prescribing clinician to receive approval prior to the medication being dispensed.

A. True

B. False


14. If the medication is dispensed without secondary peer review, there are all of the following risks, except for:

A. A potential for negative consequences from high start doses

B. Undetected drug interactions

C. Potential psychiatry decompensation

D. Dystonic reactions or marked sedation


15. Drug utilization reviews vary in all of the following ways, except for:

A. DURs vary in the notification provided to prescribing clinicians, ranging from written materials to telephone consultations and academic detailing.

B. DURs vary depending on the prescribing clinician.

C. DURs vary in the specific “red flag criteria” used. Generally, DURs employ metrics that are consistent with available practice parameters or consensus statements for antipsychotic medication treatment.

D. DURs range in the extent to which they are implemented on an ad hoc basis, or routinely conducted.


16. The implementation of telepsychiatry programs in Washington, Wyoming, and Massachusetts have been associated with reductions in psychotropic medication prescribing.

A. True

B. False


17. Based on comments provided by the participants in the expert convening and extant literature, all of the following practices were suggested in advancing retrospective review of antipsychotic medications with elective psychiatric consultations, except for:

A. Provide written consultations in every language commonly used by the patients.

B. Be consistent in messaging across consultants.

C. Make the consultation useful and create a bi-directional flow.

D. Provide consultations in real time to facilitate meaningful engagement.


18. Shared decision-making is the process by which the potential benefits, risks, and costs of being prescribed antipsychotic medications are discussed and considered collaboratively among the FDA, the prescribing providers, and the dispensing pharmacies.

A. True

B. False


19. Quality improvement initiatives optimally address:

A. The prescribing clinician’s knowledge of best practice.

B. Access to treatment alternatives.

C. Educational materials to provide information to youth-serving partners who might otherwise place pressure to maintain medication.

D. Quality improvement initiatives optimally address the prescribing clinician’s knowledge of best practice, access to treatment alternatives, and educational materials to provide information to youth-serving partners who might otherwise place pressure to maintain medication.


20. The reliance on antipsychotic medication treatments may, in some cases, be related to shortages in availability of non-pharmacological alternatives such as behavioral therapies, psychological therapies, and other psychosocial services.

A. True

B. False


21. The goal of the use of antipsychotic medication treatment for youth with complex mental and substance use treatment needs should be to reach the ability for psychotic symptoms to be controlled solely through antipsychotic medication.

A. True

B. False


22. Once the expert convening participants emphasized the availability of evidence-based psychosocial services as a first-line or concomitant treatment approach with antipsychotic medication, participants noted that these services were frequently being used as a first-line treatment alternative.

A. True

B. False


23. Which of the following should be instrumental in the process of treatment planning?

A. Reimbursement rates

B. Youth and family preferences

C. Individualized services

D. Community involvement


24. All of the following performance metrics were incorporated into the CMS 2017 Core Set of Children’s Health Care Quality Measures, except for:

A. Concurrent use of multiple antipsychotics.

B. Use of first-line psychosocial care for children on antipsychotic medications.

C. Use of metabolic screening for children who are prescribed antipsychotic medications.

D. All three performance metrics were incorporated into the CMS 2017 Core Set of Children’s Health Care Quality Measures.


25. Systematic evidence review of public reporting suggests that:

A. Health care providers engage in activities to improve quality when performance data are made public.

B. Public reporting significantly affects selection of health care providers by the patient or their caregiver.

C. Health care providers engage in activities to improve quality when performance data are made public and public reporting significantly affects selection of health care providers by the patient or their caregiver.

D. Health care providers do not engage in activities to improve quality when performance data are made public nor does public reporting significantly affects selection of health care providers by the patient or their caregiver.


26. Intensive care coordination across service systems is frequently cited as being important for the well-being of children and youth with significant mental health and substance use conditions.

A. True

B. False


27. Wraparound specifically refers to:

A. Supporting children and their families who are transitioning from higher levels of care such as residential treatment to community-based services.

B. An intensive family- and youth-driven care coordination process, which provides case management that is individualized and coordinated across youth-serving systems.

C. The oversight of developing an aftercare plan prior to discharge and ensuring necessary connections to psychosocial treatments are in place at the time of discharge, including in-home therapy and family peer support.

D. Offering transportation to facilitate successful linkage to services.


28. Enrollment in the CME for Medicaid-insured children was associated with significant:

A. Decreases in concomitant antipsychotic use and declines in monitoring for cardio-metabolic side effects.

B. Decreases in concomitant antipsychotic use and improvements in monitoring for cardio-metabolic side effects.

C. Increases in concomitant antipsychotic use and declines in monitoring for cardio-metabolic side effects.

D. Increases in concomitant antipsychotic use and improvements in monitoring for cardio-metabolic side effects.


29. High-quality wraparound includes all of the following phases, except:

A. Engagement

B. Plan development

C. Transition

D. Grant-funding


Part F. Implications for Research

30. Ensuring youth receive evidence-based strategies to promote safe and effective use of antipsychotic medications requires all of the following efforts, except:

A. Understanding the multifactorial nature of antipsychotic prescribing and effectiveness.

B. Extending the breadth and rigor of studies examining these strategies as “natural experiments.”

C. Increasing managed care, with mental and substance use service integration, by State Medicaid agencies.

D. Building additional infrastructure and public-academic partnerships to conduct and learn from local evaluation efforts.


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