Regional variation and clinical indicators of antipsychotic use in residential treatment: A four-state comparison

  • Purva H. Rawal
  • John S. Lyons
  • James C. MacIntyreII
  • John C. Hunter
Regular Articles


The last decade saw an increase in psychotropic use with pediatric populations. Antipsychotic prescriptions are used frequently in residential treatment settings, with many youth receiving antipsychotics for off-label indications. Residential treatment data from 4 states were examined to determine if regional variation exists in off-label prescription and what clinical factors predict use. The study used clinical and pharmacological data collected via retrospective chart reviews (N = 732). The Child and Adolescent Needs and Strengths Assessment — Mental Health Version was used to measure symptom and risk severity. Of youth receiving antipsychotics, 42.9% had no history of or current psychosis. Statistical analyses resulted in significant regional variation in use across states and yielded attention deficit/impulsivity, physical aggression, elopement, sexually abusive behavior, and criminal behavior as factors associated with antipsychotic prescription in nonpsychotic youth. Antipsychotic prescription is inconsistent across states. Off-label prescription is frequent and likelihood of use increases with behavior problems.


Behavior Problem Regional Variation Clinical Indicator Physical Aggression Criminal Behavior 
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Copyright information

© National Council for Community Behavioral Healthcare 2004

Authors and Affiliations

  • Purva H. Rawal
    • 1
    • 2
  • John S. Lyons
    • 3
  • James C. MacIntyreII
    • 4
    • 5
  • John C. Hunter
    • 6
  1. 1.Institute for Health Services Research and Policy StudiesUSA
  2. 2.Northwestern University Feinberg Medical SchoolChicago
  3. 3.the Mental Health Services and Policy Program the Division of Psychology at the Northwestern University Feinberg Medical SchoolChicago
  4. 4.Psychiatry at Albany Medical CollegeUSA
  5. 5.Psychiatry for the Bureau of Children and Families in the New York State Office of Mental HealthAlbany
  6. 6.the Division of Health Services Research and Outcomes Evaluation in the Department of Health Evaluation Sciencesthe University of VirginiaCharlottesville

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