Trends in Antipsychotic Medication Use in Young Privately Insured Children

Abstract

Objective: To estimate trends of annual antipsychotic medication use by privately insured young children (aged 2-7 years) in the United States, and to describe the clinical and treatment characteristics of these children. Method: The study population included young children from a nationwide commercial claims database (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017). We estimated annual antipsychotic use by age and sex, defined as the number of children dispensed an antipsychotic per year divided by the number enrolled. We described clinical diagnoses and mental health service use in those with prescription antipsychotic use in 2009 and 2017. Results: Annual antipsychotic use in young children was 0.27% in 2007, peaked at 0.29% in 2009, and statistically significantly declined to 0.17% by 2017 (linear trend: À0.017% per year, 95% CI: À0.018 to À0.016). Antipsychotic use was higher in boys than in girls. A greater proportion of antipsychotic users received a mental disorder diagnosis in 2017 (89%) than in 2009 (86%, p < .01). The most common clinical diagnoses in antipsychotic users, under a hierarchical classification, were pervasive developmental disorder ( 2009

Psychotropic Polypharmacy in the US Pediatric Population: A Methodologic Critique and Commentary

“…Opportunities from federal survey data are limited to point prevalence data ( 16 ). For polypharmacy, comparisons are difficult partly because of limited access except broadly from separate studies of data sources ( 7 , 54 ). In general, greater polypharmacy patterns are expected in publicly insured than privately insured youth.…”

“…The problem is particularly acute with respect to children where widespread adoption of second-generation antipsychotics for non-psychotic youth in complex regimens is evidenced in the tables above. While adoption of SGA antipsychotics has been trending downward) in publicly insured youth ( 7 , 13 , 14 ), oversight of inter-class polypharmacy and research on it is far less prominent.…”

“…Outcome measures include two types of polypharmacy: within class, e.g., 2 concomitant antipsychotics, and inter-class (multi-class), e.g., concomitant antipsychotic and antidepressant. Within class antipsychotic polypharmacy has been featured in many pediatric studies ( 6 , 7 ) presumably because it raises concerns with respect to treatment emergent risk, especially for metabolic adverse effects ( 8 , 9 ). For simplicity of presentation, the most commonly used definition of psychotropic polypharmacy is the use of 2 or more psychiatric medications in the same patient ( 10 ).…”

Atypical antipsychotics: Managing adverse effects

“…In the United States, antipsychotic use is estimated at 40 per 1000 persons 1 . In children and adolescents, rates of antipsychotic use exceed 2% of the youth population 2,3 . In pregnant individuals, antipsychotics are prescribed at an estimated rate of 1.3% 4 …”

Editors’ Best of 2021

“…In the second article, Bushnell and colleagues 7 estimated trends and patterns in annual use of so-called antipsychotic medications in a national sample of privately insured (MarketScan Commercial Claims and Encounters) young children in the United States aged 2 to 7 years from 2007 to 2017 overall, as well as separately for boys and girls, respectively. They also analyzed the clinical characteristics of young children prescribed antipsychotic medications.…”