Current Psychiatry Reports

, 15:426 | Cite as

Use of Antipsychotic Medications in Pediatric Populations: What do the Data Say?

  • Robert B. Penfold
  • Christine Stewart
  • Enid M. Hunkeler
  • Jeanne M. Madden
  • Janet R. Cummings
  • Ashli A. Owen-Smith
  • Rebecca C. Rossom
  • Christine Y. Lu
  • Frances L. Lynch
  • Beth E. Waitzfelder
  • Karen A. Coleman
  • Brian K. Ahmedani
  • Arne L. Beck
  • John E. Zeber
  • Gregory E. Simon
Schizophrenia and Other Psychotic Disorders (SJ Siegel, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Schizophrenia and Other Psychotic Disorders

Abstract

Recent reports of antipsychotic medication use in pediatric populations describe large increases in rates of use. Much interest in the increasing use has focused on potentially inappropriate prescribing for non-Food and Drug Administration-approved uses and use amongst youth with no mental health diagnosis. Different studies of antipsychotic use have used different time periods, geographic and insurance populations of youth, and aggregations of diagnoses. We review recent estimates of use and comment on the similarities and dissimilarities in rates of use. We also report new data obtained on 11 health maintenance organizations that are members of the Mental Health Research Network in order to update and extend the knowledge base on use by diagnostic indication. Results indicate that most use in pediatric populations is for disruptive behaviors and not psychotic disorders. Differences in estimates are likely a function of differences in methodology; however, there is remarkable consistency in estimates of use by diagnosis.

Keywords

Antipsychotics Children Adolescents Medicaid Mental Health Research Network Off-label MarketScan IMS Health NAMCS NDTI NCS-A 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Olfson M, Crystal S, Huang C, Gerhard T. Trends in antipsychotic drug use by very young, privately insured children. J Am Acad Child Adolesc Psychiatry. 2010;49:13–23.PubMedGoogle Scholar
  2. 2.
    • Olfson M, Blanco C, Liu SM, Wang S, Correll CU. National trends in the office-based treatment of children, adolescents, and adults with antipsychotics. Arch Gen Psychiatry. 2012;69:1247–56. The article presents antipsychotic utilization estimates between 1993 and 2009 using nationally representative NAMCS data. Estimates are based on visits where a prescription occurred. Excellent discussion of reasons for practice variation in prescribing and increasing use over time.PubMedCrossRefGoogle Scholar
  3. 3.
    • Andrade SE, Lo JC, Roblin D, Fouayzi H, Connor DF, Penfold RB, et al. Antipsychotic medication use among children and risk of diabetes mellitus. Pediatrics. 2011;128:1135–41. Study reports an almost fourfold increase in the rate of diabetes among youth using antipsychotic medications compared to youth using no psychotropic medications.PubMedCrossRefGoogle Scholar
  4. 4.
    • Correll CU. Safety and tolerability of antipsychotic treatment in young patients with schizophrenia. J Clin Psychiatry. 2011;72:e26. Seminal study on the side effects of antipsychotic medications in youth.PubMedCrossRefGoogle Scholar
  5. 5.
    • Maayan L, Correll CU. Weight gain and metabolic risks associated with antipsychotic medications in children and adolescents. J Child Adolesc Psychopharmacol. 2011;21:517–35. Review of 34 published head-to-head and placebo-controlled studies in youth with psychotic and bipolar disorders of the effects of antipsychotic medications on weight and metabolic disorders. Describes metabolic effects and number-needed-to-harm for individual agents.PubMedCrossRefGoogle Scholar
  6. 6.
    Cohen D, Bonnot O, Bodeau N, Consoli A, Laurent C. Adverse effects of second-generation antipsychotics in children and adolescents: a Bayesian meta-analysis. J Clin Psychopharmacol. 2012;32:309–16.PubMedCrossRefGoogle Scholar
  7. 7.
    • Seida JC, Schouten JR, Boylan K, Newton AS, Mousavi SS, Beaith A, et al. Antipsychotics for children and young adults: a comparative effectiveness review. Pediatrics. 2012;129:e771–84. Reviews the comparative effectiveness of individual agents for youth across 64 trials and 17 cohort studies.PubMedCrossRefGoogle Scholar
  8. 8.
    Loy JH, Merry SN, Hetrick SE, Stasiak K. Atypical antipsychotics for disruptive behaviour disorders in children and youths. Cochrane Database Syst Rev. 2012;9, CD008559.PubMedGoogle Scholar
  9. 9.
    • McKinney C, Renk K. Atypical antipsychotic medications in the management of disruptive behaviors in children: safety guidelines and recommendations. Clin Psychol Rev. 2011;31:465–71. Discusses mechanisms of action and long-term outcomes for young people using antipsychotics. Good discussion of use for sedation rather than core reasons for disruptive behavior.PubMedCrossRefGoogle Scholar
  10. 10.
    Harrison JN, Cluxton-Keller F, Gross D. Antipsychotic medication prescribing trends in children and adolescents. J Pediatr Health Care. 2012;26:139–45.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Maher AR, Maglione M, Bagley S, Suttorp M, Hu JH, Ewing B, et al. Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis. JAMA. 2011;306:1359–69.PubMedCrossRefGoogle Scholar
  12. 12.
    Penfold RB, Kelleher KJ, Wang W, Strange B, Pajer K. Pediatric uptake of a newly available antipsychotic medication. Pediatrics. 2010;125:475–82.PubMedCrossRefGoogle Scholar
  13. 13.
    • Alexander GC, Gallagher SA, Mascola A, Moloney RM, Stafford RS. Increasing off-label use of antipsychotic medications in the United States, 1995–2008. Pharmacoepidemiol Drug Saf. 2011;20:177–84. Only recent study estimating use from physician-reported prescribing. Categorizes the volume of off-label use by level of evidence.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Hassler F, Reis O. Pharmacotherapy of disruptive behavior in mentally retarded subjects: a review of the current literature. Dev Disabil Res Rev. 2010;16:265–72.PubMedCrossRefGoogle Scholar
  15. 15.
    Aman MG, Gharabawi GM, Special Topic Advisory Panel on Transitioning to Risperidone Therapy in Patients With Mental R, Developmental D. Treatment of behavior disorders in mental retardation: report on transitioning to atypical antipsychotics, with an emphasis on risperidone. J Clin Psychiatry. 2004;65:1197–210.PubMedCrossRefGoogle Scholar
  16. 16.
    McDougle CJ, Stigler KA, Erickson CA, Posey DJ. Atypical antipsychotics in children and adolescents with autistic and other pervasive developmental disorders. J Clin Psychiatry. 2008;69 Suppl 4:15–20.PubMedGoogle Scholar
  17. 17.
    Capone GT, Goyal P, Grados M, Smith B, Kammann H. Risperidone use in children with Down syndrome, severe intellectual disability, and comorbid autistic spectrum disorders: a naturalistic study. J Dev Behav Pediatr. 2008;29:106–16.PubMedCrossRefGoogle Scholar
  18. 18.
    • Crystal S, Olfson M, Huang C, Pincus H, Gerhard T. Broadened use of atypical antipsychotics: safety, effectiveness, and policy challenges. Health Aff (Millwood). 2009;28:w770–81. Compares antipsychotic utilization in both Medicaid (public) and MarketScan (commercial) data.CrossRefGoogle Scholar
  19. 19.
    • dos Reis S, Yoon Y, Rubin DM, Riddle MA, Noll E, Rothbard A. Antipsychotic treatment among youth in foster care. Pediatrics. 2011;128(6):e1459–66. Compares utilization among youth eligible for Medicaid on the basis of disability or low income to youth in foster care.CrossRefGoogle Scholar
  20. 20.
    •• Matone M, Localio R, Huang YS, Dosreis S, Feudtner C, Rubin D. The relationship between mental health diagnosis and treatment with second-generation antipsychotics over time: a national study of U.S. medicaid-enrolled children. Health Serv Res. 2012;47:1836–60. Comprehensive presentation of utilization rates in youth across 50 states and 6 years. Detailed rates available for young people aged 0–5, 6–11, and 12–18 years.PubMedCrossRefGoogle Scholar
  21. 21.
    Ellis WR, Huebner C, Vander Stoep A, Williams MA. Washington State exhibits wide regional variation in proportion of Medicaid-eligible children who get needed mental health care. Health Aff (Millwood). 2012;31:990–9.CrossRefGoogle Scholar
  22. 22.
    Cummings JR, Wen H, Ko M, Druss BG. Geography and the Medicaid mental health care infrastructure: implications for health care reform. JAMA Psychiatry. 2013;70:1084–90.PubMedCrossRefGoogle Scholar
  23. 23.
    Harris E, Sorbero M, Kogan JN, Schuster J, Stein BD. Concurrent mental health therapy among medicaid-enrolled youths starting antipsychotic medications. Psychiatr Serv. 2012;63:351–6.PubMedGoogle Scholar
  24. 24.
    Sturm R, Ringel JS, Andreyeva T. Geographic disparities in children's mental health care. Pediatrics. 2003;112:e308.PubMedCrossRefGoogle Scholar
  25. 25.
    Merikangas KR, He JP, Rapoport J, Vitiello B, Olfson M. Medication use in US youth with mental disorders. JAMA Pediatr. 2013;167:141–8.PubMedCrossRefGoogle Scholar
  26. 26.
    • Olfson M, He JP, Merikangas KR. Psychotropic medication treatment of adolescents: results from the national comorbidity survey-adolescent supplement. J Am Acad Child Adolesc Psychiatry. 2013;52:378–88. Estimates rates of antipsychotic use in youth across socio-demographic groups. Diagnoses were obtained using a validated instrument rather than administrative codes.PubMedCrossRefGoogle Scholar
  27. 27.
    Simon GE, Rutter CM, Stewart C, Pabiniak C, Wehnes L. Response to past depression treatments is not accurately recalled: comparison of structured recall and patient health questionnaire scores in medical records. J Clin Psychiatry. 2012;73:1503–8.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Solomon DH, Stedman M, Licari A, Weinblatt ME, Maher N, Shadick N. Agreement between patient report and medical record review for medications used for rheumatoid arthritis: the accuracy of self-reported medication information in patient registries. Arthritis Rheum. 2007;57:234–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Boudreau DM, Daling JR, Malone KE, Gardner JS, Blough DK, Heckbert SR. A validation study of patient interview data and pharmacy records for antihypertensive, statin, and antidepressant medication use among older women. Am J Epidemiol. 2004;159:308–17.PubMedCrossRefGoogle Scholar
  30. 30.
    van Gelder MM, van Rooij IA, de Walle HE, Roeleveld N, Bakker MK. Maternal recall of prescription medication use during pregnancy using a paper-based questionnaire: a validation study in the Netherlands. Drug Saf. 2013;36:43–54.PubMedCrossRefGoogle Scholar
  31. 31.
    West SL, Savitz DA, Koch G, Strom BL, Guess HA, Hartzema A. Recall accuracy for prescription medications: self-report compared with database information. Am J Epidemiol. 1995;142:1103–12.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Robert B. Penfold
    • 1
    • 2
  • Christine Stewart
    • 1
  • Enid M. Hunkeler
    • 3
  • Jeanne M. Madden
    • 4
    • 5
  • Janet R. Cummings
    • 6
  • Ashli A. Owen-Smith
    • 7
  • Rebecca C. Rossom
    • 8
    • 9
  • Christine Y. Lu
    • 4
    • 5
  • Frances L. Lynch
    • 10
  • Beth E. Waitzfelder
    • 11
  • Karen A. Coleman
    • 12
  • Brian K. Ahmedani
    • 13
  • Arne L. Beck
    • 14
  • John E. Zeber
    • 15
  • Gregory E. Simon
    • 1
    • 16
  1. 1.Group Health Research InstituteSeattleUSA
  2. 2.Department of Health Services ResearchUniversity of WashingtonSeattleUSA
  3. 3.Kaiser Permanente Division of Research, Northern CaliforniaOaklandUSA
  4. 4.Harvard Pilgrim Health Care Research InstituteBostonUSA
  5. 5.Department of Population MedicineHarvard Medical SchoolBostonUSA
  6. 6.Department of Health Policy and Management, Rollins School of Public HealthEmory UniversityAtlantaUSA
  7. 7.Kaiser Permanente Center for Health Research SoutheastAtlantaUSA
  8. 8.Health Partners Institute for Education and ResearchBloomingtonUSA
  9. 9.Department of PsychiatryUniversity of MinnesotaMinneapolisUSA
  10. 10.Kaiser Permanente Center for Health Research, NorthwestPortlandUSA
  11. 11.Kaiser Permanente Center for Health Research, HawaiiHonoluluUSA
  12. 12.Kaiser Permanente Center for Health Research, Southern CaliforniaPasadenaUSA
  13. 13.Henry Ford Health SystemDetroitUSA
  14. 14.Kaiser Permanente Institute for Health Research, ColoradoDenverUSA
  15. 15.Center for Applied Health Research, Scott and White Healthcare and Central Texas VATempleUSA
  16. 16.Department of PsychiatryUniversity of WashingtonSeattleUSA

Personalised recommendations