National Trends in the Office-Based Treatment of Children, Adolescents, and Adults With Antipsychotics

Abstract

CONTEXT Although antipsychotic treatment has recently increased, little is known about how this development has differentially affected the office-based care of adults and young people in the United States. OBJECTIVE To compare national trends and patterns in antipsychotic treatment of adults and youths in office-based medical practice. DESIGN Trends between 1993 and 2009 in visits with antipsychotics for children (0-13 years), adolescents (14-20 years), and adults (≥21 years) are described on a per population basis and as a proportion of total medical office visits. Background and clinical characteristics of recent (2005-2009) antipsychotic visits are also compared by patient age. SETTING Outpatient visits to physicians in office-based practice. PARTICIPANTS Visits from the 1993-2009 National Ambulatory Medical Care Surveys (N = 484 889). MAIN OUTCOME MEASURES Visits with a prescription of antipsychotic medications. RESULTS Between 1993-1998 and 2005-2009, visits with a prescription of antipsychotic medications per 100 persons increased from 0.24 to 1.83 for children, 0.78 to 3.76 for adolescents, and 3.25 to 6.18 for adults. The proportion of total visits that included a prescription of antipsychotics increased during this period from 0.16% to 1.07% for youths and from 0.88% to 1.73% for adults. From 2005 to 2009, disruptive behavior disorders were the most common diagnoses in child and adolescent antipsychotic visits, accounting for 63.0% and 33.7%, respectively, while depression (21.2%) and bipolar disorder (20.2%) were the 2 most common diagnoses in adult antipsychotic visits. Psychiatrists provided a larger proportion of the antipsychotic visits for children (67.7%) and adolescents (71.6%) than to adults (50.3%) (P < .001). From 2005 to 2009, antipsychotics were included in 28.8% of adult visits and 31.1% of youth visits to psychiatrists. CONCLUSIONS On a population basis, adults make considerably more medical visits with a prescription of antipsychotics than do adolescents or children. Yet antipsychotic treatment has increased especially rapidly among young people, and recently antipsychotics have been prescribed in approximately the same proportion of youth and adult visits to psychiatrists.

Clinical use of second-generation antipsychotics in children

“…In this study, the data were collected from a geographically restricted area in Finland. However, the findings are in line with previous studies (2,10,11). SGA use was mostly off-label, since none of the patients fulfilled all of the official indication criteria.…”

“…The official indications for SGA medication for children younger than 13 years are few. Nevertheless, these medications are frequently used for varying indications in this age group (1,2,8,10,14). In this study, the data were collected from a geographically restricted area in Finland.…”

“…The use of second-generation antipsychotic (SGA) medication among child and adolescent psychiatric patients has increased worldwide in recent years (1)(2)(3)(4)(5). The increase appears to have been more extensive in the USA than in European countries, but the tendency is the same (3,6).…”

“…At the same time, the duration of SGA use in children has lengthened, indications have broadened, and offlabel use has increased (3,9,10). The use of SGAs in children and adolescents seems to be increasing from the age of 7 to 8 years onwards, predominantly in male patients (2)(3)(4)(5).…”

Identifying the gaps between science, policies, services, and the needs of youths affected by mental disorders

“…Only 6 % of children and 12.7 % of adolescents' antipsychotic visits included a FDA clinical indication, and disruptive behavior disorders were the diagnosis for 63 and 33.7 % of visits for children and adolescents, respectively, despite the limited evidence for this indication and the urgent need of short-and long-term studies assessing its efficacy and safety, as addressed by the article from the Paediatric European Risperidone Studies Consortium in this issue [16]. Noteworthy, mean duration of antipsychotic visits was approximately 25 min and only approximately 30 % of them included psychotherapy [8], despite solid evidence on the efficacy of psychosocial interventions for several mental disorders, such as disruptive behavior disorders, for example in [15]. Children aged 2-5 years have also been Mental disorders are estimated to affect 10-20 % of children and adolescents around the world and are major causes of morbidity among youth [10].…”