A Population-Based Study of Antipsychotic Prescription Trends in                     Children and Adolescents in British Columbia, from 1996 to 2011

Ronsley, Rebecca; Scott, David J.; Warburton, William; Hamdi, Ramsay D.; Louie, Dianna; Davidson, Jana; Panagiotopoulos, Constadina

doi:10.1177/070674371305800608

Cited by 71 publications

(63 citation statements)

References 19 publications

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“…The Canadian Psychiatric Association is currently developing its own list of recommendations for Choosing Wisely Canada. The list the APA submitted to Choosing Wisely reflects the disturbing trend of off-label use of APs, particularly among children and adolescents, 8,9 and an equally troubling trend of prescribing multiple APs in the absence of evidence for effectiveness and the potential for additive side effects. 10 The APA's participation and recommendations to Choosing Wisely are laudable and grounded in good evidence.…”

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confidence: 99%

Choosing Wisely? Let’s Start with Working Wisely

2016

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There is an increasing emphasis on quality and, relatedly, cost-effectiveness as it relates to the delivery of health care. Choosing Wisely is an initiative adopted by numerous specialties with the goal of starting a dialogue about efficient use of health care resources. People need to be able to access care to have an opportunity to choose wisely. There is a considerable amount of evidence that access to care is poor for specialty mental health care, particularly access to psychiatrists. Consequently, we suggest that psychiatrists and the broader mental health system need to consider working wisely, and in our paper outline key issues (for example, implementation of wait times and objective measures of need in a centralized referral management system; incorporation of performance indicators with longitudinal monitoring for continuous quality improvement) that need to be addressed to develop a mental health system that would allow people to access care to choose wisely. Abré géOn met de plus en plus l'accent sur la qualité et, corollairement, sur la rentabilité de la prestation des soins de santé. « Choisir avec soin » est une initiative adoptée par un certain nombre de spécialités dans le but d'amorcer un dialogue sur l'utilisation efficace des ressources de soins de santé. Les personnes doivent être capables d'accéder aux soins pour avoir la possibilité de « choisir avec soin ». Des données probantes en quantité considérable indiquent que l'accès aux soins est mauvais pour les soins de santé mentale de spécialité, particulièrement l'accès aux psychiatres. Par conséquent, nous suggérons que les psychiatres et le système de santé mentale en général devraient envisager de « Travailler avec soin », et nous présentons dans cet article les principaux enjeux (p. ex., la mise en oeuvre des temps d'attente et des mesures objectives des besoins dans un système de gestion d'aiguillage centralisé; l'incorporation des indicateurs de rendement avec la surveillance longitudinale de l'amélioration continue de la qualité) qui doivent être abordés afin de mettre au point un système de santé mentale qui permettrait aux gens d'accéder aux soins afin de « choisir avec soin ».Keywords access to care, health service delivery, evidence-based medicine, Choosing WiselyThere is an increasing emphasis on quality and, relatedly, cost-effectiveness as it relates to the delivery of health care.

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confidence: 99%

Choosing Wisely? Let’s Start with Working Wisely

2016

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“…In particular, there has been a significant increase in atypical APD prescription to adolescents and children, compared to adults, mainly due to lower rates of extrapyramidal side effects compared to typical APDs (Karanges et al 2014;Kaye et al 2003;Olfson et al 2012). The increase in APD prescribing to adolescents and children has been reported in the United States (US) (Olfson et al 2006;Patel et al 2002;Zito et al 2003), Australia (Hollingworth et al 2013;Karanges et al 2014), France (Verdoux et al 2015), the United Kingdom (UK) (Kaye et al 2003), the Netherlands (Kalverdijk et al 2008), Canada (Ronsley et al 2013),…”

Section: Adolescent Apd Prescription: a Brief Overview Of The Clinicamentioning

confidence: 99%

“…The aim of the current study was to test the hypothesis that chronic adolescent exposure to APDs, especially risperidone, the atypical APD most commonly prescribed to adolescents (Hollingworth et al 2013;Olfson et al 2012;Ronsley et al 2013), can induce long-lasting changes in brain structure, function and neurochemistry when compared with the same exposure in adults. I compared chronic APD treatment in adolescents and adults with regards to changes in (1) the behaviour in the CAR paradigm, (2) brain structures and (3) neurochemistry which may possibly underlie the behavioural change.…”

Section: Chapter 3 a Comparative Examination Of Apd-inducedmentioning

confidence: 99%

“…Over the last twenty years, prescription of APDs to children and adolescents has increased dramatically (as much as 5-6 fold) in several different countries (Kalverdijk et al 2008;Olfson et al 2006;Olfson et al 2012;Ronsley et al 2013;Song and Guo 2013). Consequently, the global increase in prescription of APDs to adolescents in clinical settings has raised concerns about its neurobiological consequences (Ben Amor 2012;Patel et al 2005;Ronsley et al 2015;Vitiello et al 2009).…”

Section: Introductionmentioning

confidence: 99%

“…The clinical reports are now revealing that APD prescription is increasing not only in adolescents but also in children (Olfson et al 2006;Olfson et al 2012;Rettew et al 2015;Ronsley et al 2013).…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

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Evaluating long-term consequences of adolescent antipsychotic exposure

Moe¹

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Antipsychotic drugs (APDs) are being used increasingly to treat a variety of conditions in adolescence. Accordingly there has been a dramatic increase in the prescription of APDs to adolescents over the past twenty years. Adolescence is an important postnatal developmental period in which major maturation changes occur in both brain structures and multiple neurotransmitter systems. Therefore, adolescence may represent a period of sensitivity to environmental perturbations including exposure to such pharmacological agents. The specific neurobiological consequences of APDs on the adolescent brain are however still poorly understood. The aim of the work presented in this thesis is to investigate how APD administration in adolescence can affect the immature adolescent brain, using a rodent model of adolescence.In this thesis, I examined chronic risperidone treatment (1.3 mg/kg/day for 21-22 days) in adolescent rats (postnatal day (PND) 36-PND56/57) with respect to short-and long-term neurobiological changes. Short-term alterations were measured either during or proximal to chronic treatment. Long-term effects were measured after a lengthy drug-free interval of 36 -60 days.Risperidone-induced neurobiological effects in adolescents were compared with those in adult rats (PND80-PND100/101) treated with the same risperidone regimen. Risperidone was chosen for detailed examination given this is the atypical APD that is most commonly prescribed to adolescents in the clinic. Behavioural effects were assessed using two well-validated tests for APD action, namely suppression of the conditioned avoidance response (CAR) and the horizontal bar test for catalepsy. Risperidone-induced changes in brain structures and metabolism of the nucleus accumbens (NAc) were examined with clinical comparable methods namely magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy ( 1 H MRS), respectively.Neurochemical alterations and gene expression in the NAc and the striatum were assessed with high performance liquid chromatography (HPLC) and real-time polymerase chain reaction respectively.My data reveal that, during chronic risperidone treatment, adolescent rats were less sensitive to risperidone-induced increases in catalepsy (when tested in horizontal bar test) and escape failures (when tested in CAR paradigm), both of which are striatum-dependent behaviours. By contrast, adult rats were observed to develop a progressive increase in these behaviours during chronic risperidone treatment. Accompanying these behavioural findings, increased levels of dopamine metabolites were observed selectively in the striatum of rats treated with risperidone in adolescence.Increased dopamine metabolites represent increased turnover of dopamine and/or increased dopamine availability, which both suggest increased dopaminergic signalling. Increased dopamine neurotransmission in adolescent-treated rats may overcome the behavioural effects of dopaminergic blockade by risperidone. When assessed after an equivalent drug-free interval o...

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Antipsychotic prescribing patterns in children and adolescents attending Australian general practice in 2011 and 2017

Klau,

Gonzalez‐Chica,

Raven

et al. 2023

JCPP Advances

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BackgroundAntipsychotics are increasingly prescribed to children and adolescents worldwide, but little is known about reasons for prescribing. We aimed to examine patterns of paediatric antipsychotic prescribing in Australian primary care services in 2011 and 2017, including diagnoses, sociodemographic characteristics, off‐label prescribing, and psychotropic co‐prescribing.MethodsRetrospective analysis of electronic health records (EHRs) using a large Australian general practice database (MedicineInsight). Diagnoses of mental disorders were extracted from EHRs and associated with antipsychotic prescriptions within the same calendar year for three age‐groups: 0–9, 10–14, and 15–18‐year‐olds.ResultsIn 2017, children/adolescents with mental health diagnoses were more likely to be prescribed antipsychotics (2.9% of 27,412 patients) than in 2011 (2.0% of 8418 patients; absolute difference +0.9, 95% CI + 0.5, +1.4). The likelihood was greater for patients with bipolar disorders (21.6% vs. 41.5%), eating disorders (1.1% vs. 7.2%), and autism without behavioural problems (3.7% vs. 6.1%). Depression/anxiety (adjusted 26.8% of patients 2011; 30.8% 2017) was the most common diagnosis associated with antipsychotics in both years. Most antipsychotics were prescribed off‐label (69.8% 2011; 79.7% 2017; absolute difference +9.8, 95% CI + 1.54, +18.4). Off‐label prescribing increased most among those aged 15–18‐years, females, and patients living in outer regional/remote/very remote communities and the most disadvantaged areas. The three most frequently prescribed antipsychotics in both years were risperidone, quetiapine, and olanzapine. Psychotropic co‐prescribing among patients receiving antipsychotic prescriptions was approximately 69% in both years.ConclusionsPrescribing antipsychotics for mental health diagnoses to children/adolescents attending Australian general practices was more frequent in 2017 than 2011, and most commonly associated with depression/anxiety diagnoses. In both years, most prescribing was off‐label. The majority of patients were co‐prescribed other classes of psychotropics along with antipsychotics.

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A Population-Based Study of Antipsychotic Prescription Trends in Children and Adolescents in British Columbia, from 1996 to 2011

Cited by 71 publications

References 19 publications

Choosing Wisely? Let’s Start with Working Wisely

Choosing Wisely? Let’s Start with Working Wisely

Evaluating long-term consequences of adolescent antipsychotic exposure

Antipsychotic prescribing patterns in children and adolescents attending Australian general practice in 2011 and 2017

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