New Users of Antipsychotic Medications Among Children Enrolled in TennCare

Cooper, William O.; Hickson, Gerald B.; Fuchs, Cathérine; Arbogast, Patrick G.; Ray, Wayne A.

doi:10.1001/archpedi.158.8.753

Cited by 154 publications

(135 citation statements)

References 31 publications

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“…This was driven by a large increase in the prescription of secondgeneration antipsychotics, whereas the prescription of first-generation antipsychotics began to fall during the latter five years of this time period. The increase in antipsychotic prescribing among children and adolescents is even more dramatic in the United States (US) where two to six-fold increases have been observed during similar time periods, with similar trends to those in the UK noted in the use of first-and second-generation preparations (Cooper et al, 2004;Aparasu et al, 2005;Cooper et al, 2006;Olfson et al, 2006).…”

Section: Introductionmentioning

confidence: 77%

Psychotropic prescribing patterns among adolescents in Northern Ireland presenting with psychotic symptoms during a 5-year period

Woods¹,

Shannon²,

Davidson³

et al. 2015

Ir. j. psychol. Med.

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Objective: to report new prescriptions of psychotropic medications among adolescents presenting with new onset psychotic symptoms during a five-year period. Results: A total of 100 patients (88.5%) were prescribed some form of psychotropic medication.Over three-quarters of patients received an antipsychotic as their first medication. Risperidone (45.8%), olanzapine (24.0%) and chlorpromazine (12.5%) were the most commonly prescribed first-line antipsychotic medications. Of a total of 160 antipsychotic prescriptions, 81 (50.6%) were off-label. Prescriptions were most likely to have been deemed off-label due to medications not being licensed in under-18s (71.6% of off-label prescriptions) but other reasons were medications being used outside licensed age ranges (23.5%) and outside licensed indications (4.9%).Conclusions: This is the first study examining psychotropic prescribing patterns in a complete sample of all children and adolescents presenting with early onset psychotic episodes in a single geographical area. The observation of risperidone as the most commonly-prescribed antipsychotic was in keeping with previous studies in child and adolescent populations. Rates of off-label prescribing were lower than previously observed although our study was the first to investigate offlabel prescribing solely in children and adolescents presenting with psychotic symptoms.2

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Section: Introductionmentioning

confidence: 77%

Psychotropic prescribing patterns among adolescents in Northern Ireland presenting with psychotic symptoms during a 5-year period

Woods¹,

Shannon²,

Davidson³

et al. 2015

Ir. j. psychol. Med.

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“…[19][20][21] However, children are being prescribed antipsychotics to control behavioral symptoms of ADHD or comorbid aggression and for other nonapproved indications. 6,22,23 In addition, psychiatric polypharmacy involving antipsychotics and stimulants has increased in recent years. Cooper et al (2004) found over a 3-fold increase in the proportion of children who were prescribed antipsychotics for ADHD or conduct disorders from 1996-2001 in the TennCare program.…”

Section: ■■ Methods Study Design and Data Sourcementioning

confidence: 99%

“…6,22,23 In addition, psychiatric polypharmacy involving antipsychotics and stimulants has increased in recent years. Cooper et al (2004) found over a 3-fold increase in the proportion of children who were prescribed antipsychotics for ADHD or conduct disorders from 1996-2001 in the TennCare program. 22 Fullerton et al (2012) found that the percentage of ADHD youths taking antipsychotics increased from 8% in 1996 to 18% in 2005, which was primarily driven by the increased use of atypical antipsychotics (AAPs).…”

Section: ■■ Methods Study Design and Data Sourcementioning

confidence: 99%

“…Cooper et al (2004) found over a 3-fold increase in the proportion of children who were prescribed antipsychotics for ADHD or conduct disorders from 1996-2001 in the TennCare program. 22 Fullerton et al (2012) found that the percentage of ADHD youths taking antipsychotics increased from 8% in 1996 to 18% in 2005, which was primarily driven by the increased use of atypical antipsychotics (AAPs). 24 An analysis of physician visits made by children and adolescents from 1996-2007 revealed significant increase in concomitant prescription of ADHD and antipsychotic medications (adjusted odds ratio = 6.22, 95% confidence interval [CI] = 2.82-13.70).…”

Section: ■■ Methods Study Design and Data Sourcementioning

confidence: 99%

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Predictors of Concomitant Use of Antipsychotics and Stimulants and Its Impact on Stimulant Persistence in Pediatric Attention Deficit Hyperactivity Disorder

Bali

Kamble²,

Aparasu³

2015

JMCP

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“…22 Although the evidence strongly suggests that atypicals are effective, it is by no means definitive, yet the use of atypicals as combination therapy with antidepressants in unipolar patients is apparently common, at least as I have understood recent utilization data. 23 It may be because this particular combination is a new approach or because clinicians are seeing a robust response, but concerns about side effects and long-term adverse outcome may complicate matters. Of course, the costs of these agents can also be prohibitive.…”

Section: Dr Trivedimentioning

confidence: 99%

Use of Treatment Algorithms for Depression

Trivedi¹,

Fava

Marangell³

et al. 2006

J. Clin. Psychiatry

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The effectiveness of treatment algorithms rests on 3 principles. The 3 broad categories requiring special attention are (1) the determination of the need for sequential treatment algorithms; (2) what should be the placement of various treatment interventions in treatment algorithms with sequenced treatments, e.g., at what point should combination treatments and somatic treatments be included; and finally, (3) what the process or procedure is to implement algorithms in the clinical setting, e.g., the use of recently developed measurement-based care. 1 Dr. Osser: It is clear to me that there are significant differences between the likely outcome of people receiving treatment as usual (TAU) as opposed to algorithm-driven treatment. In the Texas Medication Algorithm Project (TMAP), 2 that difference was seen primarily in the first 3 months. An important factor in that difference was that the care coordinator identified patients who were not doing well and needed to move to the next step in the algorithm. For the next 9 months of the TMAP study, there was no widening of the difference between the algorithm group and the TAU group, suggesting that, from that point on, both groups did reasonably well (Figure 1). Dr. Trivedi: There is also evidence in primary care from Katon and colleagues, 3 which showed that guideline-driven care produces better outcome than TAU. Unützer and coworkers 4 found similar results. All of these studies have used care coordinators in the algorithm-driven treatment groups. The question becomes whether the better outcomes are related to the use of the care coordinator.Dr. Shelton: Dr. Trivedi, according to your TMAP article from 2004, 2 I agree that the first quarter is where the majority of change happens, but if you look at the end of a year of treatment, there still is a substantial difference between the TAU and the algorithm treatment patients. TAU patients did not catch up by the end of a year (see Figure 1), but the differences that are achieved are achieved primarily up front and then maintained throughout the year. Dr. Marangell: The data are fairly consistent in showing that algorithms result in not just better response rates, but improved patient satisfaction as well. Katon et al. 3 found that response rates were 74% with the algorithm versus 44% with TAU and that patients who received algorithmdriven treatment were more likely than patients who received TAU to rate their quality of care as good or excellent (93% vs. 75%).Dr. Fava: If you ask me whether there is a need for treatment algorithms in depression, I would say absolutely, but I question if we truly

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New Users of Antipsychotic Medications Among Children Enrolled in TennCare

Abstract: The proportion of TennCare children who became new users of antipsychotics nearly doubled from 1996 to 2001, with a substantial increase in use of antipsychotics for attention-deficit/hyperactivity disorder, conduct disorder, and affective disorders.

Cited by 154 publications

References 31 publications

Psychotropic prescribing patterns among adolescents in Northern Ireland presenting with psychotic symptoms during a 5-year period

Psychotropic prescribing patterns among adolescents in Northern Ireland presenting with psychotic symptoms during a 5-year period

Predictors of Concomitant Use of Antipsychotics and Stimulants and Its Impact on Stimulant Persistence in Pediatric Attention Deficit Hyperactivity Disorder

Use of Treatment Algorithms for Depression

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