Prescribing Practices of Quetiapine for Insomnia at a Tertiary Care Inpatient Child and Adolescent Psychiatry Unit: A Continuous Quality Improvement Project.
Bibliographic record
Abstract
OBJECTIVE: To examine the prescribing practices of quetiapine for insomnia at a tertiary care child and adolescent psychiatric inpatient unit. METHOD: A retrospective chart review was conducted on all admissions in 2013 involving night-time only prescription of quetiapine. We examined patient demographics, discharge diagnoses, physician's written indications for prescriptions, and maximum doses used. If used for insomnia only, we noted any documentation of past sedative trials, concurrent prescriptions of other sedative agents, whether quetiapine was started in hospital or continued as a part of a community regimen, and whether quetiapine was continued on discharge. RESULTS: Of 720 admissions, 83 (11.5%) involved the prescription of night-time only quetiapine, and 47 of the 83 (57%) were for insomnia only. Of patients prescribed quetiapine for insomnia only, most common discharge diagnoses were anxiety disorder (35%), depressive disorder (27%), eating disorder (27%), and Cluster B/borderline personality traits/disorder (25%). Mean age was 15.4 years; mean maximum dose was 41.2 mg. Quetiapine was often started during admission (89.5%) and continued on discharge (66%). About 40% of these cases involved concurrent prescription of other sedative agents. Most patients (81%) had no documented history of prior sedative trials. CONCLUSIONS: Quetiapine is used not infrequently for the management of insomnia in adolescents in tertiary mental health settings. We highlight the nuances associated with the prescription of quetiapine for the treatment of insomnia in the unique setting of the child and adolescent psychiatric inpatient unit, emphasizing the importance of weighing short-term use with potential long-term adverse consequences if continued in the community setting.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".