Diagnosis and Use of Psychotherapy Among Children and Adolescents Prescribed Antipsychotics

Abstract

Objective: To examine the diagnoses, demographics, and prevalence of psychotherapy use among children and adolescents prescribed antipsychotics by psychiatric providers in a community setting. Methods: Medical records from 1127 children aged 0 to 17 years who were prescribed antipsychotics in 2014-2015 at Pine Rest Christian Mental Health Services (PRCMHS) outpatient network were analyzed. Antipsychotics, diagnosis codes, demographics, and number of psychotherapy sessions during this time frame were analyzed using χ2 and logistic regression analyses. Results: During this year, 50.8% of the patients attended psychotherapy, and 35.6% attended 5 or more sessions of psychotherapy. The most prevalent primary diagnosis was bipolar disorder (37.1%), followed by attention-deficit/hyperactivity disorder (19.7%). Females being treated with antipsychotics were significantly more likely to attend psychotherapy than their male peers (55.7% vs. 47.9%, P=0.01). In the fully adjusted models, patients with diagnoses of bipolar disorder or disorders first diagnosed in infancy, childhood, or adolescence were less than half as likely to attend psychotherapy as patients with depressive disorders, with adjusted odds ratios of 0.41 and 0.42, respectively. Conclusions: Approximately half of the child and adolescent patients prescribed antipsychotics in this community sample did not attend psychotherapy, and 39% of the patients did not have a diagnosis of bipolar disorder, psychotic disorder, or autistic disorder.

Attempting to discontinue antipsychotic medication: Withdrawal methods, relapse and success

“…Antipsychotic medication (AM) is commonly used by people diagnosed with schizophrenia spectrum disorders and bipolar disorder to manage symptoms of psychosis and mania (Castle et al, 2002, Fountoulakis et al, 2012. They are also commonly prescribed to people with a range of other off-label conditions including depression, dysthymia, obsessive-compulsive disorder, other anxiety disorders, or specific symptoms like insomnia or agitation, often at lower doses or alongside other psychiatric medications, despite limited evidence to support these practices (Maher et al, 2011, Monasterio and McKean, 2011, Carton et al, 2015, Walton et al, 2008, Albert et al, 2016, Vanbronkhorst et al, 2018. Most of the existing AM research focuses exclusively on people diagnosed with psychotic disorders (Landolt et al, 2016, Wunderink et al, 2013, Jung et al, 2016, Wils et al, 2017 and little is known about whether the experiences and outcomes of this group represents the experiences of those who take AMs for other reasons.…”

Left prefrontal transcranial magnetic stimulation for treatment-resistant depression in adolescents: a double-blind, randomized, sham-controlled trial

“…However, few additional studies are available to guide next-step interventions. Adolescents with TRD frequently receive multiple psychotropic medications (eg, dopamine-serotonin receptor antagonists, dopamine-serotonin reuptake inhibitors, and mood stabilizers) [7][8][9], yet remission rates are low and many youth experience adverse effects [7,[10][11][12]. Although electroconvulsive therapy (ECT) has been studied for TRD, access for adolescents is limited [13].…”