Prevalence and Patterns of Antipsychotic Use in Youth at the Time of Admission and Discharge From an Inpatient Psychiatric Facility

Abstract

The objective of this study was to examine the prevalence and patterns of antipsychotic use in children and adolescents at the time of admission and discharge from a tertiary care inpatient psychiatric facility. This retrospective analysis included all patients 18 years and younger, who were admitted and discharged from a child and adolescent tertiary care inpatient psychiatric facility between May 1, 2008 and December 31, 2009. Data for medications at admission were obtained using a province-wide network that links all pharmacies in British Columbia, Canada to a central set of data systems, whereas data for medications at discharge were obtained using the Department of Pharmacy's (British Columbia Children's Hospital, Vancouver, British Columbia, Canada) inpatient computer database. Apart from antipsychotics, overall drug use included antidepressants, mood stabilizers, benzodiazepines, anticholinergics, stimulants, and sleep medications. Referral and discharge diagnoses were also examined. During the study period, 335 patients were admitted and discharged from the tertiary care inpatient psychiatric facility. Significantly, more patients were prescribed with an antipsychotic at the time of discharge from hospital compared with that of the time when they were admitted to hospital (51.6% vs 30.7%; P < 0.0001). Antidepressants were most often coprescribed with an antipsychotic at admission and discharge (32.0% vs 42.2%, respectively) followed by attention-deficit/hyperactivity disorder medications (22.3% vs 24.9% at admission and discharge, respectively) and anticonvulsants (19.4% vs 19.1% at admission and discharge, respectively). Whether the significant increase in antipsychotic use seen from the time of admission to discharge is solely attributed to clinical worsening or other variables requires further investigation.

Improving Metabolic and Cardiovascular Health at an Early Psychosis Intervention Program in Vancouver, Canada

“…First, this may be the period of most rapid physical change, particularly as patients are starting from a healthier baseline and some may have not yet reached full sexual maturity (33). Second, patients have less of a “history” with previous antipsychotic medications, and are less likely to be treated with multiple antipsychotic drugs or additional classes of psychotherapeutic medications (20), meaning that observed physical changes can be interpreted with greater clarity. Finally, the greater receptivity of patients and family during this phase of the illness (6) is conducive to engaging the patients in the type of longitudinal research studies that will ultimately be necessary for progress to be made in understanding these issues.…”

“…However, an additional factor that has been the focus of considerable research over the past decade is the direct cardiometabolic effects of the antipsychotic drugs themselves (16–19). Antipsychotic drugs can be given for a wide range of different psychiatric indications, in both adults and youth (20–23). …”

Psychotropic Drug Prescription in Adolescents: A Retrospective Study in a Swiss Psychiatric University Hospital

“…The problem is more pronounced for hospitalized patients who received a higher number of psychotropic medications than in the community. Several studies conducted since 1976 have evaluated the prescription of these drugs in children and/or adolescents in psychiatric wards in the USA (Zito et al 1994;Kaplan and Busner 1997;Safer 1997;Pappadopulos et al 2002;Kelly et al 2004;Lekhwani et al 2004;Najjar et al 2004;Pathak et al 2004;Pogge et al 2007;Meagher et al 2013;Saldana et al 2014), Canada (Ahsanuddin et al 1983;Procyshyn et al 2014), Finland (Sourander et al 2002;Haapasalo-Pesu et al 2004), France (Winterfeld et al 2008;Consoli et al 2009), United Kingdom (Akram 2015), Serbia (Pejovic-Milovancevic et al 2011), Israel (Gilat et al 2011), Australia (Dean et al 2006) and China (Song and Guo 2013). The proportion of patients treated with psychotropic medication was high, ranging from 30% to 100%.…”

“…Despite the relative important number of studies, the majority have some limitations such as the evaluation of a single prevalence period (Ahsanuddin et al 1983;Zito et al 1994;Kaplan and Busner 1997;Pappadopulos et al 2002;Sourander et al 2002;Kelly et al 2004;Lekhwani et al 2004;Pathak et al 2004;Dean et al 2006;Pogge et al 2007;Winterfeld et al 2008;Consoli et al 2009;Pejovic-Milovancevic et al 2011;Procyshyn et al 2014;Saldana et al 2014;Akram 2015), the analysis of prescriptions at a single point during hospitalization (Sourander et al 2002;Haapasalo-Pesu et al 2004) or at admission and/or discharge only (Safer 1997;Lekhwani et al 2004;Gilat et al 2011;Meagher et al 2013;Procyshyn et al 2014;Saldana et al 2014;Akram 2015), the study of antipsychotics only (Pappadopulos et al 2002;Kelly et al 2004;Pogge et al 2007;Procyshyn et al 2014;Saldana et al 2014), or the inclusion of children only (Lekhwani et al 2004;Pathak et al 2004;Akram 5/23 2015). The rate of off-label prescriptions was evaluated in only three of these studies, at a single prevalence period (Winterfeld et al 2008;Procyshyn et al 2014;Akram 2015), at admission and discharge for antipsychotics (Procyshyn et al 2014), and at discharge for ch...…”

Managing ADHD and disruptive behaviour disorders with combination psychostimulant and antipsychotic treatment

“…1 Our group has also reported that 25% of children discharged on an antipsychotic from the Child and Adolescent Mental Health Inpatient Program at BC Children's Hospital were coprescribed a psychostimulant. 2 As monotherapy, both psychostimulants and antipsychotics are supported by a reasonable amount of evidence for the treatment of ADHD and disruptive behaviour disorders. On first impression, the combination of a psychostimulant and antipsychotic, with their opposing effects on dopamine (DA) neurotransmission, (i.e., indirect agonist v. antag onist) seems contradictory and illogic al.…”