A Review of Pharmacoepidemiologic Studies of Antipsychotic Use in Children and Adolescents

Abstract

Objective: In Canada, treatment of children and adolescents with antipsychotics is almost always off label. A single atypical agent, aripiprazole, only recently received regulatory authorization for use in the group aged 15 to 17 years. This regulatory approval was restricted to treatment of schizophrenia. The objective of this review was to summarize pharmacoepidemiologic reports examining the frequency of use of these medications. Methods:A literature search was used to identify English-language studies examining the pharmacoepidemiology of antipsychotics in children and adolescents. The results of identified studies were summarized using narrative review methods. Results:In countries where longitudinal data are available, increased antipsychotic use has been consistently observed. Generally, most or all of this increase can be attributed to second-generation antipsychotics (SGAs). Major international differences are evident in the literature. European studies describe lower overall frequencies of use than North American studies (most of which were conducted in the United States). SGAs in children and adolescents are used more often in boys than in girls, and are increasingly used for treatment of attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD). Conclusions:Determining the most appropriate frequency of SGA use in children and adolescents will ultimately depend on decisive clarification of risks and benefits. The currently available literature highlights large international differences in the frequency of use. These differences may reflect fundamental dissimilarities in the therapeutic stance adopted toward ADHD and CD by physicians practicing in different countries. W W WObjectif : Au Canada, le traitement des enfants et des adolescents par antipsychotiques est presque toujours non indiqué sur l'étiquette. Un seul agent atypique, l'aripiprazole, a reçu récemment l'autorisation réglementaire d'utilisation auprès du groupe des 15 à 17 ans. Cette approbation réglementaire se limitait au traitement de la schizophrénie. L'objectif de cette revue était de résumer les études pharmaco-épidémiologiques qui examinent la fréquence d'utilisation de ces médicaments.Méthodes : Une recherche de la littérature a servi à identifier les études en anglais qui examinent la pharmaco-épidémiologie des antipsychotiques chez les enfants et les adolescents. Les résultats des études identifiées ont été résumés à l'aide de méthodes de revue narrative. Résultats :Dans les pays qui disposent de données longitudinales, une utilisation accrue des antipsychotiques a été observée régulièrement. Généralement, une grande partie ou la totalité de cet accroissement peut être attribuée aux antipsychotiques de deuxième génération (ADG). Des différences majeures entre les pays sont manifestes dans la littérature. Les études européennes décrivent des fréquences d'utilisation globalement plus faibles que les études nord-américaines (dont la plupart ont été menées aux États-Unis). Les ADG chez les enfants et les adolescents so...

Developing Indicators for the Child and Youth Mental Health System in Ontario

“…The findings support other studies showing that the use of psychotropic medications among youth has increased in recent years. [31][32][33] The rates reported here are comparable to those reported in the U.S. 34,35 The overall prevalence of medication to treat a mood or anxiety disorder is still below the population prevalence of mood and anxiety disorders, which may illustrate under-treatment of these disorders. Unfortunately, these or other considerations cannot be determined with the data currently available.…”

Clinical use of second-generation antipsychotics in children

“…The increase appears to have been more extensive in the USA than in European countries, but the tendency is the same (3,6). However, after a peak, SGA use seems to have declined in the USA (7,8).…”

Epidemiologic and Clinical Perspectives on Antipsychotic Treatment of Children and Adolescents

“…In this issue of The Canadian Journal of Psychiatry, Dr Scott B Patten and colleagues 3 provide a timely review of trends in antipsychotic use among young people and Dr Tamara Pringsheim and Dr Daniel Gorman 4 assess clinical trials of SGAs for DBDs. Taken together, these 2 articles inform critical ongoing clinical, policy, and academic discussions over the appropriate role of SGAs in child and adolescent mental health care.…”

“…9 Antipsychotics have traditionally been the province of psychiatric practice. Dr Patten and colleagues 3 make the point that primary care physicians play a significant role in antipsychotic treatment of children and adolescents. While psychiatrists account for most (62%) antipsychotic prescriptions for Canadian youth, family physicians (17%) and general practitioners (17%) also make nontrivial contributions.…”

“…We learn from Dr Patten and colleagues 3 that antipsychotic use in young people has increased in Canada, the United States, the United Kingdom, Italy, and the Netherlands, with considerably lower absolute use rates in Europe than in North America. Adults in Europe and North America are also increasingly receiving antipsychotics.…”