Prevalence and correlates of antipsychotic polypharmacy in children and adolescents receiving antipsychotic treatment

Abstract

Antipsychotic polypharmacy (APP), which is common in adults with psychotic disorders, is of unproven efficacy and raises safety concerns. Although youth are increasingly prescribed antipsychotics, little is known about APP in this population. We performed a systematic PubMed search (last update 26 January 2013) of studies reporting the prevalence of APP in antipsychotic-treated youth. Summary statistics and statistical tests were calculated at the study level and not weighted by sample size. Fifteen studies (n=58 041, range 68–23 183) reported on APP in youth [mean age=13.4±1.7 yr, 67.1±10.2% male, 77.9±27.4% treated with second-generation antipsychotics (SGAs)]. Data collected in these studies covered 1993–2008. The most common diagnoses were attention-deficit hyperactivity disorder (ADHD; 39.9±23.5%) and conduct disorder/oppositional defiant disorder (CD/ODD; 33.6±24.8). In studies including predominantly children (mean age=<13 yr, N=5), the most common diagnosis were ADHD (50.6±25.4%) and CD/ODD (39.5±27.5%); while in studies with predominantly adolescents (mean age =≥13 yr, N=7) the most common diagnoses were schizophrenia-spectrum disorders (28.6±23.8%), anxiety disorders (26.9±14.9%) and bipolar-spectrum disorders (26.6±7.0%), followed closely by CD/ODD (25.8±17.7). The prevalence of APP among antipsychotic-treated youth was 9.6±7.2% (5.9±4.5% in child studies, 12.0±7.9% in adolescent studies, p=0.15). Higher prevalence of APP was correlated with a bipolar disorder or schizophrenia diagnosis (p=0.019) and APP involving SGA+SGA combinations (p=0.0027). No correlation was found with APP definition [≥1 d (N=10) vs. >30–≥90 d (N=5), p=0.88]. Despite lacking safety and efficacy data, APP in youth is not uncommon, even in samples predominantly consisting of non-psychotic patients. The duration, clinical motivations and effectiveness of this practice require further study.

Polypharmacy among children and adolescents with psychiatric disorders in a mental referral hospital in Botswana

“…An initial analysis did not find significant association with gender and diagnosis in keeping with previous studies [10, 11]. Our data showed that age group, psychiatrist care, psychiatric co-morbidity and psychotropic side effects influenced the rate of polypharmacy in our series.…”

Antipsychotic Use in Children and Adolescents

“…The patients with psychotic disorders were more likely to be on polypharmacy than those with bipolar I disorder; the most frequent combination of AP prescribed was 2 SGAs, with quetiapine, aripiprazole, and risperidone being the most used in the combinations. However, a rate of 9.6% T 7.2% of AP polypharmacy in children and adolescents has been found, 42 with higher rates in patients with ADHD and conduct disorder/ODD, whereas studies focusing on adolescents have found SSD, anxiety disorders, and BD to be the most common diagnoses. Moreover, higher prevalence of AP polypharmacy was correlated with BD and SSD, which is similar to our results.…”

Mortality in individuals with disruptive behavior disorders diagnosed by specialist services – A nationwide cohort study

“…We were also unable to assess if the provision of pharmacological or non-pharmacological intervention influenced the MRR associated with DBDs. Atypical antipsychotics are increasingly used for the treatment of these disorders (Toteja et al, 2014) and are associated with increased risk of metabolic and cardiovascular events in children and adolescents (McIntyre and Jerrell, 2008). However, it is unknown if there is an excess mortality associated with atypical antipsychotics in children and young people which would be of interest in future studies.…”