Table 5 Proposal for prescribing psychotropic medication for children and adolescents with eating disorders.

1. Adjunctive treatment in selected patients

a. In context of comprehensive medical and psychological assessment and treatment, including weight restoration

b. For relief of persistent distressing symptoms

c. For treatment of comorbid psychiatric disorders

2. Informed consent

a. Patient and family/carers

b. Discuss rationale, potential benefits, potential risks, alternative treatment options, data available

c. Choice of medication informed by individual characteristics

d. Documentation

3. Record baseline information

a. Identify target symptoms

b. Document level of baseline symptoms and social/occupational function

c. Use appropriate pre and post rating scales

d. Screen for suicidality and binge eating

e. Baseline investigations e.g. electrolytes, ECG, fasting lipids and fasting blood sugar prior to prescribing SGAs

4. Treat

a. Start at low doses, increase cautiously

b. Safe prescription and storage to reduce harm from intentional overdose

c. Enlist patient and family in adherence and monitoring

5. Monitor

a. Monitor treatment response clinically and using appropriate rating scales

b. Monitor for adverse effects

1. Screen for binge eating and suicidality

2. Examination for extrapyramidal adverse effects of SGAs

3. Monitor for SGAs with ECG, serum lipids, fasting blood sugar, weight, any other measures specific to the drug

6. Review

a. Regular review of balance of benefit and risk

b. Continue if effective and tolerated, cease if ineffective or poorly tolerated

c. Minimise polypharmacy

d. Maintain emphasis on non-pharmacological treatments

e. Review appropriateness as patient’s nutritional state changes

7. Audit

a. Collect and share data on prescription, effectiveness and adverse effects

b. Implement service-wide procedures that facilitate good prescribing and monitoring practices and allow data collection