Who Are the New Users of Antipsychotic Medications?

Domino, Marisa Elena; Swartz, Marvin S.

doi:10.1176/appi.ps.59.5.507

Cited by 86 publications

(57 citation statements)

References 36 publications

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“…Others have reported that increases in antipsychotic use have not corresponded with increases in daily doses. 12 Antipsychotic duration is not a measure of compliance or consumption. Finally, the lack of information on illness severity, treatment decisions, and clinical outcomes prohibits conclusions about the appropriateness of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…6 Among youths with autism who were in foster care, 21% received Ն3 medications from different classes concomitantly for at least 30 days, compared with 10% among youths with autism and eligible for Medicaid through a disability status. 7 Finally, the increase has been primarily the second-generation antipsychotics (SGAs), [8][9][10][11][12][13][14] which carry a greater risk of metabolic adverse effects among children. 15 Concerning is the expanded use of antipsychotics for attention-deficit/hyperactivity disorder (ADHD) in the absence of schizophrenia, autism, or bipolar disorder for which these medications are typically prescribed.…”

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confidence: 99%

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Antipsychotic Treatment Among Youth in Foster Care

et al. 2011

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WHAT'S KNOWN ON THIS SUBJECT:Youths in foster care have higher rates of psychotropic use, singly and concomitantly, than do youths who are eligible for Medicaid through income or disability qualifications. However, concomitant antipsychotic use among youth in foster care has not been assessed. WHAT THIS STUDY ADDS:Compared with youths who qualify for Medicaid because of a disability or low income, youths in foster care are more likely to receive antipsychotics concomitantly and for longer periods of time despite the lack of evidence to support such regimens. abstract OBJECTIVE: Despite national concerns over high rates of antipsychotic medication use among youth in foster care, concomitant antipsychotic use has not been examined. In this study, concomitant antipsychotic use among Medicaid-enrolled youth in foster care was compared with disabled or low-income Medicaid-enrolled youth. PATIENTS AND METHODS:The sample included 16 969 youths younger than 20 years who were continuously enrolled in a Mid-Atlantic state Medicaid program and had Ն1 claim with a psychiatric diagnosis and Ն1 antipsychotic claim in 2003. Antipsychotic treatment was characterized by days of any use and concomitant use with Ն2 overlapping antipsychotics for Ͼ30 days. Medicaid program categories were foster care, disabled (Supplemental Security Income), and Temporary Assistance for Needy Families (TANF). Multicategory involvement for youths in foster care was classified as foster care/Supplemental Security Income, foster care/TANF, and foster care/adoption. We used multivariate analyses, adjusting for demographics, psychiatric comorbidities, and other psychotropic use, to assess associations between Medicaid program category and concomitant antipsychotic use. RESULTS:Average antipsychotic use ranged from 222 Ϯ 110 days in foster care to only 135 Ϯ 101 days in TANF (P Ͻ .001). Concomitant use for Ն180 days was 19% in foster care only and 24% in foster care/ adoption compared with Ͻ15% in the other categories. Conduct disorder and antidepressant or mood-stabilizer use was associated with a higher likelihood of concomitant antipsychotic use (P Ͻ .0001). CONCLUSIONS:Additional study is needed to assess the clinical rationale, safety, and outcomes of concomitant antipsychotic use and to inform statewide policies for monitoring and oversight of antipsychotic use among youths in the foster care system. Pediatrics 2011;128: e1459-e1466

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Section: Discussionmentioning

confidence: 99%

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Antipsychotic Treatment Among Youth in Foster Care

et al. 2011

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“…Nevertheless, increasing rates of antipsychotic treatment of young people 49 and common adverse metabolic effects 50 contribute to concerns over antipsychotic prescribing patterns to young people. 42,49,51 This study advances knowledge on the patterns of psychotropic medication use in a nationally representative sample of adolescents with well-characterized DSM-IV mental disorders and clinical correlates. Previous estimates of psychotropic medication use from pharmacy and insurance statistics are not based on representative samples of the population nor do they include comprehensive assessment of current mental disorders.…”

Section: Commentmentioning

confidence: 99%

Medication Use in US Youth With Mental Disorders

Merikangas¹,

He²,

Rapoport³

et al. 2013

JAMA Pediatr

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“…The use of atypicals has accelerated rapidly since their introduction into the market. Domino and Swartz (Domino & Swartz, 2008) …”

Section: The Rise In the Use Of Atypical Antipsychoticsmentioning

confidence: 99%

Can a Diagnosis Be Epidemic, With Therapeutic Efforts the Catastrophe?

Littrell

2012

Ethical Hum Psychol Psychiatry

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The diagnosis of Bipolar Spectrum Disorders (BSD) given for office visits has risen 40 fold for children and has risen dramatically for adults as well. Some of the growth may have been fueled by re-categorization of individuals who would previously have received diagnoses of major depression along with the widening of diagnostic criteria for BSD. Concomitant with the rise in BSD diagnoses, the number of adults and children receiving atypical antipsychotics has increased dramatically. Recent evidence finds that atypical antipsychotics cause considerable reduction in brain volume. It is thus imperative to ensure that those with diagnoses comprising BSD-Bipolar I, Bipolar II, and Bipolar Not Otherwise specified (NOS)-actually share a common etiology and are being appropriately treated. This paper reviews the history, evidentiary support, and implications associated with the expansion of the Bipolar Spectrum. Can a Diagnosis Be Epidemic, with Therapeutic Efforts the Catastrophe?In the years from 1999 to 2003, the diagnosis of bipolar given in office visits has increased 40 fold for children. Bipolar Disorder diagnoses have increased during the same time period for adults as well rising from 4.77% of office visits to 6.28% of office visits (Moreno et al., 2007).Allen Frances (2009), the Chairperson of the DSM-IV, has suggested that the sharp rise in bipolar diagnoses is attributable to the manner in which criteria for the disorders were written-that it was an issue of taxonomy rather than epidemiology. Obviously, diagnostic criteria have profound implications for who is diagnosed, at what age, and whether they are treated with psychotropic medications. Because psychotropic medications carry substantial risks-if not guarantees-of side effects, those decisions must be judicious, and ever cognizant of Hippocrates' admonishment: First, do no harm. This review constitutes an audit of psychiatry's books, asking if they balance when the substantial risk of harm from such diagnoses and the regimen of medication they entail is taken fully into account. Creation of the Bipolar SpectrumOver the years, those behaviors categorized under the bipolar label have expanded greatly. In the DSM-II (Association, 1968), manic-depression, listed under the heading "affective psychoses", was the only bipolar type diagnosis. With subsequent editions of the DSM, new categories of affect perturbations were included in manuals. The DSM-III (Association, 1980) provided descriptions of the behaviors required to meet criteria for mixed and manic episodes. The DSM-III-R (Association, 1987) added criteria for hypomania (specified in the next paragraph). The literature recognized that some persons who had experienced an episode of depression did have periods when they were enthusiastic, energetic, and animated to the extent that they met criteria for hypomania. Kupfer, Carpenter, and Frank (1988) had argued that such individuals, who were labeled Bipolar II, should be viewed as experiencing a variant of major depression. Dunner (1993) disagr...

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Who Are the New Users of Antipsychotic Medications?

Cited by 86 publications

References 36 publications

Antipsychotic Treatment Among Youth in Foster Care

Antipsychotic Treatment Among Youth in Foster Care

Medication Use in US Youth With Mental Disorders

Can a Diagnosis Be Epidemic, With Therapeutic Efforts the Catastrophe?

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