National time trend changes in psychotropic medication of child and adolescent psychiatric inpatients across Finland

Abstract

Background: There have been no comprehensive studies on trends in psychotropic medication use in child and adolescent inpatient settings. The aim of this nationwide study was to report changes in the psychotropic medication given to child and adolescent psychiatric inpatients across Finland and the factors associated with those changes. Methods: We asked the psychiatrist responsible for each inpatient to complete a questionnaire that included questions about the pharmacological treatment and background information. The data were collected on all inpatients on one selected study day in 2000 and 2011. Changes in the use of regular psychotropic medication were studied by comparing the data on 504 patients in 2000 and 412 patients in 2011. Results: The study showed that there had been a significant increase in the use of psychotropic medication from 2000 to 2011. According to the multivariate analysis, the increase in psychotropic medication was associated with the study year (in 2000 39%, in 2011 58%), but could not be explained by changes in diagnostic profiles, age distribution, suicidality, violence or the Children 0 s Global Assessment Scale scores. The use of combined psychotropic medication increased from 9% in 2000 to 25% in 2011. The increase in the use of antipsychotics among child inpatients was particularly noteworthy, with an increase from 10% to 32%. Conclusions: There is a need for evidence-based studies to clarify recommendations for indications and treatment practices when using psychotropic medication in children and adolescents. Cross-cultural studies of the use of psychotropic medication are warranted. Key Practitioner Message• There is very little information about trends over time in psychotropic medication use in child and adolescent inpatient settings. This is the first comprehensive, nationwide study on the topic.• The study showed that there has been a significant increase in the use of psychotropic medication from 2000 to 2011 in Finland. The increase in the use of antipsychotics among child inpatients more than trebled.• The increase could not be explained by the changes of diagnostic profile of the inpatients.

Current follow‐up practices often fail to detect metabolic and neurological adverse reactions in children treated with second‐generation antipsychotics

“…The identification, follow up and management of SGA-related adverse reactions are important activities for patient safety and all treating physicians are responsible for carrying these out. 4 14 melatonin 63 1 F00-F99 mental and behavioural disorders. 2 Co-occurence was possible.…”

“…3 At least a trial during the study period. 4 As requisite medication. 1 Standardised body mass index, adjusted for sex and age (BMI z-score) 2 BMI z-score corresponding to BMI > 25.…”

“…The use of psychotropic medication and polypharmacy has increased among paediatric patients (1)(2)(3)(4). The use of second-generation antipsychotics (SGAs) has particularly emerged, as has the use of stimulants, other medication for attention deficit and hyperactivity disorder (ADHD) and melatonin (4,5).…”

“…The use of psychotropic medication and polypharmacy has increased among paediatric patients (1)(2)(3)(4). The use of second-generation antipsychotics (SGAs) has particularly emerged, as has the use of stimulants, other medication for attention deficit and hyperactivity disorder (ADHD) and melatonin (4,5). Paediatric patients have been reported to be especially vulnerable to SGA-induced metabolic adverse reactions, such as weight gain, glucose and lipid abnormalities and elevated blood pressure (2,3,(6)(7)(8).…”

Ten-year changes in the psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence of 18-year-old males: a Finnish population-based time-trend study

“…The use of services for several psychiatric disorders has increased and the reasons for this are probably partly related to broader diagnostic definitions and increased awareness and recognition by professionals [3][4][5][6][7][8][9]. Increases in mental health care and the use of psychotropic medication have been reported among children and adolescents [4,6,[10][11][12][13][14].…”