Trends in the Use of Typical and Atypical Antipsychotics in Children and Adolescents

Patel, Nick C.; Crismon, M. Lynn; Johnsrud, Michael; Rascati, Karen L.; Wilson, James P.; Jensen, Peter S.

doi:10.1097/01.chi.0000157543.74509.c8

Cited by 169 publications

(108 citation statements)

References 33 publications

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“…Patel et al 3 subsequently examined these results by evaluating similar data in additional Medicaid programs, and one managed care organization for the period between 1996 and 2001. This study 3 demonstrated increases in prescription rates over time, with boys having higher rates than girls and increased use with age, peaking in 3 of these 4 populations in the group aged 10 to 14 years. Consistent results were also found using data from an expanded Medicare program in Tennessee, called TennCare.…”

Section: Us Studiesmentioning

confidence: 97%

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A Review of Pharmacoepidemiologic Studies of Antipsychotic Use in Children and Adolescents

2012

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Objective: In Canada, treatment of children and adolescents with antipsychotics is almost always off label. A single atypical agent, aripiprazole, only recently received regulatory authorization for use in the group aged 15 to 17 years. This regulatory approval was restricted to treatment of schizophrenia. The objective of this review was to summarize pharmacoepidemiologic reports examining the frequency of use of these medications. Methods:A literature search was used to identify English-language studies examining the pharmacoepidemiology of antipsychotics in children and adolescents. The results of identified studies were summarized using narrative review methods. Results:In countries where longitudinal data are available, increased antipsychotic use has been consistently observed. Generally, most or all of this increase can be attributed to second-generation antipsychotics (SGAs). Major international differences are evident in the literature. European studies describe lower overall frequencies of use than North American studies (most of which were conducted in the United States). SGAs in children and adolescents are used more often in boys than in girls, and are increasingly used for treatment of attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD). Conclusions:Determining the most appropriate frequency of SGA use in children and adolescents will ultimately depend on decisive clarification of risks and benefits. The currently available literature highlights large international differences in the frequency of use. These differences may reflect fundamental dissimilarities in the therapeutic stance adopted toward ADHD and CD by physicians practicing in different countries. W W WObjectif : Au Canada, le traitement des enfants et des adolescents par antipsychotiques est presque toujours non indiqué sur l'étiquette. Un seul agent atypique, l'aripiprazole, a reçu récemment l'autorisation réglementaire d'utilisation auprès du groupe des 15 à 17 ans. Cette approbation réglementaire se limitait au traitement de la schizophrénie. L'objectif de cette revue était de résumer les études pharmaco-épidémiologiques qui examinent la fréquence d'utilisation de ces médicaments.Méthodes : Une recherche de la littérature a servi à identifier les études en anglais qui examinent la pharmaco-épidémiologie des antipsychotiques chez les enfants et les adolescents. Les résultats des études identifiées ont été résumés à l'aide de méthodes de revue narrative. Résultats :Dans les pays qui disposent de données longitudinales, une utilisation accrue des antipsychotiques a été observée régulièrement. Généralement, une grande partie ou la totalité de cet accroissement peut être attribuée aux antipsychotiques de deuxième génération (ADG). Des différences majeures entre les pays sont manifestes dans la littérature. Les études européennes décrivent des fréquences d'utilisation globalement plus faibles que les études nord-américaines (dont la plupart ont été menées aux États-Unis). Les ADG chez les enfants et les adolescents so...

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Section: Us Studiesmentioning

confidence: 97%

“…Additional papers were identified because they were cited in the identified sources or in widely cited articles. 2,3 The MEDLINE search used 3 sets of key words linked by "or" and these searches were later combined using "and". The first set of key words included "antipsychotic.…”

Section: Methodsmentioning

confidence: 99%

A Review of Pharmacoepidemiologic Studies of Antipsychotic Use in Children and Adolescents

2012

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“…Several studies have demonstrated sharp rises in antipsychotic treatment among Medicaid-insured and privately insured children. [1][2][3][4][5] The prevalence of antipsychotic medication use among youth is estimated at 1% to 3% among Medicaid-insured youth, which is about double the rate of those with private insurance. [6][7][8] Concern that the increase represents an overuse of this class of medications has come from evidence that antipsychotic agents are frequently prescribed outside of indications approved by the US Food and Drug Administration (FDA) and before other types of treatments have been attempted.…”

Section: What This Study Addsmentioning

confidence: 99%

Antipsychotic Medication Prescribing in Children Enrolled in Medicaid

et al. 2015

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BACKGROUND: Although the increase in treatment of children and adolescents with antipsychotic medications has been well documented, much less is known about the factors related to the use of these agents and how closely the treatment follows best practice recommendations.METHODS: Prescribers of each antipsychotic medication prescription issued for a Medicaidinsured child in Vermont aged ,18 years were sent a prior authorization survey that assessed several domains including the clinical indication, other treatments, metabolic monitoring, prescriber specialty, and prescription origin. These variables were combined to categorize prescriptions as following indications approved by the US Food and Drug Administration (FDA) and best practice guidelines. RESULTS:The response rate of the survey was 80%, with 677 surveys from 147 prescribers available for analysis; more than one-half of the respondents were primary care clinicians. Overall, the clinical indication for an antipsychotic prescription followed best practice guidelines 91.7% of the time, with overall best practice guidelines followed at a rate of 50.1%. An FDA indication was followed in 27.2% of cases. Psychiatrists were significantly more likely to follow best practice guidelines than nonpsychiatrists. Antipsychotic medications were typically used only after other pharmacologic and nonpharmacologic treatments were ineffective, although previous treatment with cognitive-behavioral therapy was uncommon (15.5%). Metabolic monitoring that included serial laboratory tests was reported in 57.2% of cases.CONCLUSIONS: Current prescribing patterns of antipsychotic medications for children and adolescents follow best practice guidelines approximately one-half of the time, with nonadherence often related to lack of metabolic monitoring. WHAT'S KNOWN ON THIS SUBJECT:Although the rates of antipsychotic medication treatment are rising for children and adolescents, little is known about the factors associated with this practice. WHAT THIS STUDY ADDS:This study provides some of the first data regarding when and why clinicians decide to use antipsychotic medications. It reveals clues as to how prescribing might better follow best practice guidelines.

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“…Most previous studies of preschool psychotropic use have been demographically limited, focusing on Medicaid samples, region-specific managed-care health maintenance organization (HMO) populations, or privately insured children, 3,4,12,13 whereas others have concentrated on a single medication class (eg, stimulants 14,15 or atypical antipyschotics 16 ). There is a need to understand better the sociodemographic trends in psychotropic use among very young children.…”

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confidence: 99%

National Trends in Psychotropic Medication Use in Young Children: 1994–2009

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Studies of psychotropic use in very young US children in the last decade have been limited by the regions, insurance types, or medication classes examined. There is a paucity of recent, nationally representative investigations of US preschool psychotropic use. WHAT THIS STUDY ADDS:In a national sample of 2 to 5 year olds, the likelihood of psychotropic prescription peaked in the mid2000s, then stabilized in the late 2000s. Increased psychotropic use in boys, white children, and those lacking private health insurance was documented.abstract OBJECTIVE: To examine recent national trends in psychotropic use for very young children at US outpatient medical visits. METHODS:Data for 2-to 5-year-old children (N = 43 598) from the 1994-2009 National Ambulatory and National Hospital Ambulatory Medical Care Surveys were used to estimate the weighted percentage of visits with psychotropic prescriptions. Multivariable logistic regression was used to identify factors associated with psychotropic use. Time effects were examined in 4-year blocks (1994-1997, 1998-2001, 2002-2005, and 2006-2009).RESULTS: Psychotropic prescription rates were 0.98% from 1994-1997, 0.83% from 1998-2001 , white children (AOR versus other race: 1.42), older children (AOR for 4 to 5 vs 2 to 3 year olds: 3.87), and those lacking private insurance (AOR versus privately insured: 2.38) were more likely than children from other groups to receive psychotropic prescriptions. CONCLUSIONS:

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Trends in the Use of Typical and Atypical Antipsychotics in Children and Adolescents

Cited by 169 publications

References 33 publications

A Review of Pharmacoepidemiologic Studies of Antipsychotic Use in Children and Adolescents

A Review of Pharmacoepidemiologic Studies of Antipsychotic Use in Children and Adolescents

Antipsychotic Medication Prescribing in Children Enrolled in Medicaid

National Trends in Psychotropic Medication Use in Young Children: 1994–2009

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