Advertisement

European Child & Adolescent Psychiatry

, Volume 24, Issue 2, pp 199–207 | Cite as

Trends in psychopharmacologic treatment of tic disorders in children and adolescents in Germany

  • Christian J. Bachmann
  • Veit Roessner
  • Gerd Glaeske
  • Falk Hoffmann
Original Contribution

Abstract

Data on medical treatment of children and adolescents with tic disorders are scarce. This study examined the administrative prevalence of psychopharmacological prescriptions in this patient group in Germany. Data of the largest German health insurance fund were analysed. In outpatients aged 0–19 years with diagnosed tic disorder, psychotropic prescriptions were evaluated for the years 2006 and 2011. In 2011, the percentage of psychotropic prescriptions was slightly higher than in 2006 (21.2 vs. 18.6 %). The highest prescription prevalence was found in Tourette syndrome (51.5 and 53.0 %, respectively). ADHD drugs were most frequently prescribed, followed by antipsychotics. In 2011, prescriptions of second generation antipsychotics (SGA) were higher and prescriptions of first generation antipsychotics (FGA) lower than in 2006. Concerning prescribed antipsychotic substances, in 2011 risperidone prescriptions were higher and tiapride prescriptions lower. Paediatricians issued 37.4 %, and child and adolescent psychiatrists issued 37.1 % of psychotropic prescriptions. The FGA/SGA ratio was highest in GPs (1.25) and lowest in child and adolescent psychiatrists (0.96). From 2006 to 2011, there was only a slight increase in psychotropic prescriptions for children and adolescents with a diagnosis of tic disorder in Germany, which stands in contrast towards the significant increase in psychotropic prescriptions in other child and adolescent psychiatric disorders (e.g. ADHD). There were marked differences in treatment patterns by tic disorder subgroups, with Tourette syndrome patients receiving most frequently psychopharmacotherapy. Risperidone prescriptions increased, probably reflecting a switch in prescribing practice towards up-to-date treatment guidelines. In primary care physicians, dissemination of current tic disorder treatment guidelines might constitute an important educational goal.

Keywords

Children Health services research Pharmacoepidemiology Psychopharmacology Tic disorders 

Notes

Acknowledgments

The data presented in this manuscript was partially obtained during a study funded by the BARMER GEK. The funders have no involvement with the research. The authors and the research are completely independent of the funders. The corresponding author had full access to all data in the study and had final responsibility for submitting the article for publication.

Conflict of interest

CB has received speaker honoraria from Actelion, Medice, Ferring and Novartis, and author honoraria from BARMER GEK health insurance fund. He has worked as an investigator in clinical trials sponsored by Novartis and Shire. VR has acted as a consultant or member of advisory board for Lilly, Novartis and Shire. He has received honoraria for lectures from Lilly, Medice, Novartis and Shire, and has worked as an investigator in clinical trials sponsored by Novartis, Otsuka and Shire. GG is on the advisory board of the DAK health insurance fund. He has received honoraria from the BKK, BARMER GEK, DAK and TK health insurance funds. FH has received speaker and author honoraria from Apothekerkammer Westfalen-Lippe and BARMER GEK.

References

  1. 1.
    Knight T, Steeves T, Day L et al (2012) Prevalence of tic disorders: a systematic review and meta-analysis. Pediatr Neurol 47:77–90PubMedCrossRefGoogle Scholar
  2. 2.
    Khalifa N, von Knorring A-L (2006) Psychopathology in a Swedish population of school children with tic disorders. J Am Acad Child Adolesc Psychiatry 45:1346–1353PubMedCrossRefGoogle Scholar
  3. 3.
    Scharf JM, Miller LL, Mathews CA, Ben-Shlomo Y (2012) Prevalence of Tourette syndrome and chronic tics in the population-based Avon longitudinal study of parents and children cohort. J Am Acad Child Adolesc Psychiatry 51(192–201):e5PubMedGoogle Scholar
  4. 4.
    Freeman RD, Fast DK, Burd L et al (2000) An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries. Dev Med Child Neurol 42:436–447PubMedCrossRefGoogle Scholar
  5. 5.
    Ludolph AG, Roessner V, Münchau A, Müller-Vahl K (2012) Tourette syndrome and other tic disorders in childhood, adolescence and adulthood. Dtsch Arztebl Int 109(48):821–828. doi: 10.3238/arztebl.2012.0821 PubMedCentralPubMedGoogle Scholar
  6. 6.
    Roessner V, Plessen KJ, Rothenberger A et al (2011) European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment. Eur Child Adolesc Psychiatry 20:173–196PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Wile DJ, Pringsheim TM (2013) Behavior therapy for Tourette syndrome: a systematic review and meta-analysis. Curr Treat Options Neurol 15:385–395PubMedCrossRefGoogle Scholar
  8. 8.
    Verdellen C, van de Griendt J, Hartmann A, Murphy T (2011) European clinical guidelines for Tourette syndrome and other tic disorders. Part III: behavioural and psychosocial interventions. Eur Child Adolesc Psychiatry 20:197–207. doi: 10.1007/s00787-011-0167-3 PubMedCrossRefGoogle Scholar
  9. 9.
    Scahill L, Woods DW, Himle MB et al (2013) Current controversies on the role of behavior therapy in Tourette syndrome. Mov Disord 28:1179–1183PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie und Psychotherapie (2007) Ticstörungen (F95). Leitlinien zur Diagnostik und Therapie von psychischen Störungen im Säuglings-, Kindes- und Jugendalter. Deutscher Ärzte Verlag, pp 319–325Google Scholar
  11. 11.
    Debes NM, Hjalgrim H, Skov L (2009) The presence of comorbidity in Tourette syndrome increases the need for pharmacological treatment. J Child Neurol 24:1504–1512PubMedCrossRefGoogle Scholar
  12. 12.
    Olfson M, Crystal S, Gerhard T et al (2011) Patterns and correlates of tic disorder diagnoses in privately and publicly insured youth. J Am Acad Child Adolesc Psychiatry 50:119–131. doi: 10.1016/j.jaac.2010.11.009 PubMedCrossRefGoogle Scholar
  13. 13.
    Bitsko RH, Danielson M, King M et al (2013) Health care needs of children with Tourette syndrome. J Child Neurol 28:1626–1636PubMedCrossRefGoogle Scholar
  14. 14.
    Zito JM, Safer DJ, de Jong-van den Berg LTW et al. (2008) A three-country comparison of psychotropic medication prevalence in youth. Child Adolesc Psychiatry Ment Health 2:26Google Scholar
  15. 15.
    Arbeitsgruppe Erhebung und Nutzung von Sekundärdaten (AGENS) (2012) Gute Praxis Sekundärdatenanalyse (GPS) Leitlinien und Empfehlungen (3. Fassung). http://dgepi.de/fileadmin/pdf/leitlinien/GPS_fassung3.pdf
  16. 16.
    Kalverdijk LJ, Tobi H, van den Berg PB et al (2008) Use of antipsychotic drugs among Dutch youths between 1997 and 2005. Psychiatr Serv 59:554–560PubMedCrossRefGoogle Scholar
  17. 17.
    Schubert I, Lehmkuhl G (2009) Increased antipsychotic prescribing to youths in Germany. Psychiatr Serv 60:269PubMedGoogle Scholar
  18. 18.
    Bachmann CJ, Lempp T, Glaeske G, Hoffmann F (2014) Antipsychotic prescription in children and adolescents: an analysis of data from a german statutory health insurance company from 2005 to 2012. Dtsch Arztebl Int 111:25–34PubMedCentralPubMedGoogle Scholar
  19. 19.
    Bachmann CJ, Manthey T, Kamp-Becker I et al (2013) Psychopharmacological treatment in children and adolescents with autism spectrum disorders in Germany. Res Dev Disabil 34:2551–2563PubMedCrossRefGoogle Scholar
  20. 20.
    Schlander M, Schwarz O, Rothenberger A, Roessner V (2011) Tic disorders: administrative prevalence and co-occurrence with attention-deficit/hyperactivity disorder in a German community sample. Eur Psychiatry 26:370–374PubMedCrossRefGoogle Scholar
  21. 21.
    Hoffmann F, Bachmann CJ (2014) Unterschiede in den soziodemografischen Merkmalen, der Gesundheit und Inanspruchnahme bei Kindern und Jugendlichen nach ihrer Krankenkassenzugehörigkeit (Differences in sociodemographic characteristics, health, and health service use of children and adolescents according to their health insurance funds). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 57:455–463Google Scholar
  22. 22.
    Paszek J, Pollok B, Biermann-Ruben K et al (2010) Is it a tic?—Twenty seconds to make a diagnosis. Mov Disord 25:1106–1108PubMedCrossRefGoogle Scholar
  23. 23.
    Roessner V, Hoekstra PJ, Rothenberger A (2011) Tourette’s disorder and other tic disorders in DSM-5: a comment. Eur Child Adolesc Psychiatry 20:71–74PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Robertson MM (2008) The prevalence and epidemiology of Gilles de la Tourette syndrome. Part 2: tentative explanations for differing prevalence figures in GTS, including the possible effects of psychopathology, aetiology, cultural differences, and differing phenotypes. J Psychosom Res 65:473–486PubMedCrossRefGoogle Scholar
  25. 25.
    Lewin AB, Murphy TK, Storch EA et al (2012) A phenomenological investigation of women with Tourette or other chronic tic disorders. Compr Psychiatry 53:525–534PubMedCrossRefGoogle Scholar
  26. 26.
    Roessner V, Becker A, Banaschewski T, Rothenberger A (2007) Psychopathological profile in children with chronic tic disorder and co-existing ADHD: additive effects. J Abnorm Child Psychol 35:79–85PubMedCrossRefGoogle Scholar
  27. 27.
    Roessner V, Becker A, Banaschewski T, Rothenberger A (2007) Executive functions in children with chronic tic disorders with/without ADHD: new insights. Eur Child Adolesc Psychiatry 16(Suppl 1):36–44PubMedCrossRefGoogle Scholar
  28. 28.
    Gadow KD, Sverd J, Sprafkin J et al (1999) Long-term methylphenidate therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder. Arch Gen Psychiatry 56:330–336PubMedCrossRefGoogle Scholar
  29. 29.
    Roessner V, Robatzek M, Knapp G et al (2006) First-onset tics in patients with attention-deficit-hyperactivity disorder: impact of stimulants. Dev Med Child Neurol 48:616–621PubMedCrossRefGoogle Scholar
  30. 30.
    Hinshaw SP, Scheffler RM, Fulton BD et al (2011) International variation in treatment procedures for ADHD: social context and recent trends. Psychiatr Serv 62:459–464PubMedCrossRefGoogle Scholar
  31. 31.
    Zoëga H, Baldursson G, Hrafnkelsson B et al (2009) Psychotropic drug use among Icelandic children: a nationwide population-based study. J Child Adolesc Psychopharmacol 19:757–764PubMedCrossRefGoogle Scholar
  32. 32.
    Olfson M, Blanco C, Liu S-M et al (2012) National trends in the office-based treatment of children, adolescents, and adults with antipsychotics. Arch Gen Psychiatry 69:1247–1256PubMedCrossRefGoogle Scholar
  33. 33.
    Dion Y, Annable L, Sandor P, Chouinard G (2002) Risperidone in the treatment of Tourette syndrome: a double-blind, placebo-controlled trial. J Clin Psychopharmacol 22:31–39PubMedCrossRefGoogle Scholar
  34. 34.
    Roessner V, Schoenefeld K, Buse J et al. (2012) Therapy of tic disorders. Z Kinder Jugendpsychiatr Psychother 40:217–236Google Scholar
  35. 35.
    Scahill L, Leckman JF, Schultz RT et al (2003) A placebo-controlled trial of risperidone in Tourette syndrome. Neurology 60:1130–1135PubMedCrossRefGoogle Scholar
  36. 36.
    Rickards H, Cavanna AE, Worrall R (2012) Treatment practices in Tourette syndrome: the European perspective. Eur J Paediatr Neurol 16:361–364PubMedCrossRefGoogle Scholar
  37. 37.
    Hoffmann F, Glaeske G, Petermann F, Bachmann CJ (2012) Outpatient treatment in German adolescents with depression: an analysis of nationwide health insurance data. Pharmacoepidemiol Drug Saf 21:972–979PubMedCrossRefGoogle Scholar
  38. 38.
    Jaite C, Hoffmann F, Glaeske G, Bachmann CJ (2013) Prevalence, comorbidities and outpatient treatment of anorexia and bulimia nervosa in German children and adolescents. Eat Weight Disord 18:157–165PubMedCrossRefGoogle Scholar
  39. 39.
    Schneeweiss S, Avorn J (2005) A review of uses of health care utilization databases for epidemiologic research on therapeutics. J Clin Epidemiol 58:323–337PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Christian J. Bachmann
    • 1
  • Veit Roessner
    • 2
  • Gerd Glaeske
    • 3
  • Falk Hoffmann
    • 3
  1. 1.Department of Child and Adolescent Psychiatry, Faculty of MedicinePhilipps-University MarburgMarburgGermany
  2. 2.Department of Child and Adolescent PsychiatryTechnical University DresdenDresdenGermany
  3. 3.Division of Health Economics, Health Policy and Health Services Research, Centre for Social Policy ResearchUniversity of BremenBremenGermany

Personalised recommendations