Treatment of Young People With Antipsychotic Medications in the United States

Abstract

IMPORTANCE Despite concerns about rising treatment of young people with antipsychotic medications, little is known about trends and patterns of their use in the United States.OBJECTIVE To describe antipsychotic prescription patterns among young people in the United States, focusing on age and sex. DESIGN, SETTING, AND PARTICIPANTSA retrospective descriptive analysis of antipsychotic prescriptions among patients aged 1 to 24 years was performed with data from calendar years 2006 (n = 765 829), 2008 (n = 858 216), and 2010 (n = 851 874), including a subset from calendar year 2009 with service claims data (n = 53 896). Data were retrieved from the IMS LifeLink LRx Longitudinal Prescription database, which includes approximately 60% of all retail pharmacies in the United States. Denominators were adjusted to generalize estimates to the US population. MAIN OUTCOMES AND MEASURESThe percentage of young people filling 1 or more antipsychotic prescriptions during the study year by sex and age group (younger children, 1-6 years; older children, 7-12 years; adolescents, 13-18 years; and young adults, 19-24 years) was calculated. Among young people with antipsychotic use, percentages with specific clinical psychiatric diagnoses and 1 or more antipsychotic prescriptions from a psychiatrist and from a child and adolescent psychiatrist were also determined. RESULTSThe percentages of young people using antipsychotics in 2006 and 2010, respectively, were 0.14% and 0.11% for younger children, 0.85% and 0.80% for older children, 1.10% and 1.19% for adolescents, and 0.69% and 0.84% for young adults. In 2010, males were more likely than females to use antipsychotics, especially during childhood and adolescence: 0.16% vs 0.06% for younger children, 1.20% vs 0.44% for older children, 1.42% vs 0.95% for adolescents, and 0.88% vs 0.81% for young adults. Among young people treated with antipsychotics in 2010, receiving a prescription from a psychiatrist was less common among younger children (57.9%) than among other age groups (range, 70.4%-77.9%). Approximately 29.3% of younger children treated with antipsychotics in 2010 received 1 or more antipsychotic prescriptions from a child and adolescent psychiatrist. Among young people with claims for mental disorders in 2009 who were treated with antipsychotics, the most common diagnoses were attention-deficit/hyperactivity disorder in younger children (52.5%), older children (60.1%), and adolescents (34.9%) and depression in young adults (34.5%). CONCLUSIONS AND RELEVANCEAntipsychotic use increased from 2006 to 2010 for adolescents and young adults but not for children aged 12 years or younger. Peak antipsychotic use in adolescence, especially among boys, and clinical diagnosis patterns are consistent with management of developmentally limited impulsive and aggressive behaviors rather than psychotic symptoms.

Clinical use of second-generation antipsychotics in children

“…SGA treatment for children is often associated with the symptomatic treatment of developmental or other disorders with a long duration (1,2,8,14,21,22,25). The average duration of the SGA medication was long in this study as well: the median duration was almost two years.…”

“…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 increase appears to have been more extensive in the USA than in European countries, but the tendency is the same (3,6). However, after a peak, SGA use seems to have declined in the USA (7,8). At the same time, the duration of SGA use in children has lengthened, indications have broadened, and offlabel use has increased (3,9,10).…”

“…SGA use is also common among children with attention deficit hyperactivity disorder or disruptive behaviour disorders (2,3). SGA medication is also used for children and adolescents with various other diagnoses -such as psychosis, mood and tic disorders, and obsessive compulsive disorder -and in symptomatic treatment for aggressive behaviour despite the primary diagnosis (1,2,8,10,14).…”

Serum Ferritin, Weight Gain, Disruptive Behavior, and Extrapyramidal Symptoms in Risperidone-Treated Youth

“…Antipsychotic medications, particularly second-generation antipsychotics (SGAs), are widely used in children and adolescents (Olfson et al 2015). They can cause significant weight gain (Calarge et al 2012).…”