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Attention to body mass index by child psychiatry providers when prescribing second-generation antipsychotic medication to children: a survey study using a clinical vignette


  • Work was carried out at Massachusetts General Hospital, Division of Postgraduate Education, Department of Psychiatry, One Bowdoin Square, 7th Floor, Boston, MA 02114.

Dr John A. Fromson, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA 02114, USA. Email:


Aim: We sought to determine whether weight and body mass index measurement were taken into consideration when prescribing second-generation antipsychotic (SGA) medication to a child.

Methods: Two hundred clinicians were surveyed using a hypothetical clinical case vignette at a child psychopharmacology, postgraduate medical education course. The vignette described an overweight 10-year-old boy who was about to be prescribed an SGA medication to control psychotic symptoms. The reference to the patient's being ‘overweight’ was purposefully included to determine if providers would assess the patient's risk of morbidity from the metabolic side effects of the SGAs at the time of prescribing.

Results: Only 7.0% of prescribers listed either ‘body mass index’ or a combination of ‘height’ and ‘weight’ as part of their next treatment steps for an overweight child before prescribing an SGA.

Conclusions: These results suggest the need for education as to the importance of body mass index monitoring when prescribing second-generation antipsychotic medications to children.