National Trends in Child and Adolescent Psychotropic Polypharmacy in Office-Based Practice, 1996-2007

Abstract

Objective To examine patterns and recent trends in multi-class psychotropic treatment among youth visits to office-based physicians in the United States. Method Annual data from the 1996–2007 National Ambulatory Medical Care Surveys were analyzed to examine patterns and trends in multi-class psychotropic treatment within a nationally representative sample of 3466 child and adolescent visits to office-based physicians in which a psychotropic medication was prescribed. Results There was an increase in the percentage of child visits in which psychotropic medications were prescribed that included at least two psychotropic classes. Across the twelve year period, multi-class psychotropic treatment rose from 14.3% of child psychotropic visits (1996–1999) to 20.2% (2004–2007) (AOR: 1.89; 95% CI: 1.22–2.94, p<.01). Among medical visits in which a current mental disorder was diagnosed, the percentage with multi-class psychotropic treatment increased from 22.2% (1996–1999) to 32.2% (2004–2007) (AOR: 2.23, 95% CI: 1.42–3.52, p<.001). Over time, there were significant increases in multi-class psychotropic visits in which ADHD medications, antidepressants, or antipsychotics were prescribed, and a decrease in those visits in which mood stabilizers were prescribed. There were also specific increases in co-prescription of ADHD medications and antipsychotic medications (AOR: 6.22, 95% CI: 2.82–13.70, p<.001) and co-prescription of antidepressant and antipsychotic medications (AOR: 5.77, 95% CI: 2.88–11.60, p<.001). Conclusions Although little is known about the safety and efficacy of regimens that involve concomitant use of two or more psychotropic agents for children and adolescents, multi-class psychotropic pharmacy is becoming increasingly common in outpatient practice.

Use of Psychotropic Medication in Children and Adolescents With Autism Spectrum Disorders

“…However, studies have shown that a high proportion of prescriptions for psychotropic medications such as anxiety medications fail to have a corroborating diagnosis in the medical record. [15][16][17] Our data do not allow confirmation via medical records or other sources.…”

Evaluation and Management of Children With Acute Mental Health or Behavioral Problems. Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting With Medical or Uncertain Symptoms

“…36,37 Antipsychotic use, in particular, has shown large increases. 38 Especially notable is their burgeoning off-label use, [39][40][41] including in preschool-aged children.…”

Does Patient Race/Ethnicity Influence Physician Decision-Making for Diagnosis and Treatment of Childhood Disruptive Behavior Problems?

“…A variety of psychoactive medications are also used frequently for these patients. In fact, a national study indicates that the most common problem category for children receiving psychoactive medications in the USA is DBPs (including ADHD) [31] and national "best practice" recommendations include prescription of psychoactive medications for these youths [32]. Efficacy research data offer promising support for the use of psychoactive medications for children with DBPs, particularly stimulant medication for children with attention and hyperactivity symptoms, which often occur concurrently with other DBPs [33].…”

“…There is significant national attention to the increased use of psychoactive medications for children [10,36] with public controversy about rising rates of use of psychoactive medications for children, including increasing rates of polypharmacy [31] and potential health risks. Several medications are recommended as "best practices," but there is considerable debate about potential over-and/or under-use and concern about unintended effects of several different psychoactive medications used to treat DBPs in childhood.…”

“…Several medications are recommended as "best practices," but there is considerable debate about potential over-and/or under-use and concern about unintended effects of several different psychoactive medications used to treat DBPs in childhood. There are specific concerns also about the dramatically rising rates of the use of atypical antipsychotics for children with a variety of behavioral problems and the physical health risks associated with these medications (including weight and metabolic effects) [31]. Within this debate, there has been limited attention to the role of racial/ethnic disparities in medication use, but such attention is highly relevant as it addresses potential factors other than clinical need that may be influencing utilization.…”