Skip to main content

Advertisement

SpringerLink
Log in

Outpatient antipsychotic drug use in children and adolescents in Germany between 2004 and 2011

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Studies from different countries showed increasing use of antipsychotics in pediatric patients. However, these studies were methodologically limited and could not assess underlying diagnoses and off-label use sufficiently. This is the first study to examine antipsychotic prescriptions in a representative sample of minors over a long period, looking at changes regarding substances and drug classes, underlying diagnoses, and the rate of off-label use. Claims data of about two million pediatric subjects were used to calculate annual prevalences and incidence rates of antipsychotic prescriptions for the years 2004–2011. Analyses were stratified by sex, age, and drug type. Numbers of prescriptions, frequencies of diseases/disorders, the prescribing physicians’ specialties, and the share of off-label prescriptions were examined. During the study period, the prevalence of antipsychotic prescriptions ranged between 2.0 and 2.6 per 1000 minors. Antipsychotic prescriptions in children younger than 6 years decreased from 2.42 per 1000 subjects in 2004 to 0.48 in 2011. Among antipsychotic users, 47.0 % had only one prescription and hyperkinetic disorder was, by far, the most frequent diagnosis. The annual share of off-label prescriptions varied between 61.0 and 69.5 %. Antipsychotics were mainly prescribed to manage aggressive and impulsive behaviors in hyperkinetic disorder patients. This explains the high share of off-label prescriptions but raises concerns, since efficacy and safety of antipsychotics in this indication have not been sufficiently investigated. The decreasing antipsychotic use in younger children and the high proportion of antipsychotic users with one-time prescriptions are striking and should be further investigated in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Preston JD, O’Neal JH, Talaga MC (2013) Handbook of clinical psychopharmacology for therapists. New Harbinger Publications, Oakland

    Google Scholar 

  2. Correll CU, Blader JC (2015) Antipsychotic use in youth without psychosis: a double-edged sword. JAMA Psychiatry 72:859–860

    Article  PubMed  Google Scholar 

  3. Ben Amor L (2012) Antipsychotics in pediatric and adolescent patients: a review of comparative safety data. J Affect Disord 138(Suppl):S22–S30

    Article  CAS  PubMed  Google Scholar 

  4. Seida JC, Schouten JR, Boylan K, Newton AS, Mousavi SS, Beaith A, Vandermeer B, Dryden DM, Carrey N (2012) Antipsychotics for children and young adults: a comparative effectiveness review. Pediatrics 129:e771–e784

    Article  PubMed  Google Scholar 

  5. Vitiello B, Correll C, van Zwieten-Boot B, Zuddas A, Parellada M, Arango C (2009) Antipsychotics in children and adolescents: increasing use, evidence for efficacy and safety concerns. Eur Neuropsychopharmacol 19:629–635

    Article  CAS  PubMed  Google Scholar 

  6. 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 111:25–34

    PubMed  PubMed Central  Google Scholar 

  7. Schubert I, Lehmkuhl G (2009) Increased antipsychotic prescribing to youths in Germany. Psychiatr Serv 60:269

    Article  PubMed  Google Scholar 

  8. Steinhausen HC, Bisgaard C (2014) Nationwide time trends in dispensed prescriptions of psychotropic medication for children and adolescents in Denmark. Acta Psychiatr Scand 129:221–231

    Article  PubMed  Google Scholar 

  9. Ronsley R, Scott D, Warburton WP, Hamdi RD, Louie DC, Davidson J, Panagiotopoulos C (2013) A population-based study of antipsychotic prescription trends in children and adolescents in British Columbia, from 1996 to 2011. Can J Psychiatry 58:361–369

    Article  PubMed  Google Scholar 

  10. Alessi-Severini S, Biscontri RG, Collins DM, Sareen J, Enns MW (2012) Ten years of antipsychotic prescribing to children: a Canadian population-based study. Can J Psychiatry 57:52–58

    Article  PubMed  Google Scholar 

  11. Olfson M, Blanco C, Liu SM, Wang S, Correll CU (2012) National trends in the office-based treatment of children, adolescents, and adults with antipsychotics. Arch Gen Psychiatry 69:1247–1256

    Article  PubMed  Google Scholar 

  12. Olfson M, King M, Schoenbaum M (2015) Treatment of young people with antipsychotic medications in the United States. JAMA Psychiatry 72:867–874

    Article  PubMed  Google Scholar 

  13. Pringsheim T, Lam D, Patten SB (2011) The pharmacoepidemiology of antipsychotic medications for Canadian children and adolescents: 2005–2009. J Child Adolesc Psychopharmacol 21:537–543

    Article  PubMed  Google Scholar 

  14. Alexander GC, Gallagher SA, Mascola A, Moloney RM, Stafford RS (2011) Increasing off-label use of antipsychotic medications in the United States, 1995–2008. Pharmacoepidemiol Drug Saf 20:177–184

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Zoega H, Baldursson G, Hrafnkelsson B, Almarsdottir AB, Valdimarsdottir U, Halldorsson M (2009) Psychotropic drug use among Icelandic children: a nationwide population-based study. J Child Adolesc Psychopharmacol 19:757–764

    Article  PubMed  Google Scholar 

  16. Koelch M, Prestel A, Singer H, Keller F, Fegert JM, Schlack R, Hoelling H, Knopf H (2009) Psychotropic medication in children and adolescents in Germany: prevalence, indications, and psychopathological patterns. J Child Adolesc Psychopharmacol 19:765–770

    Article  CAS  PubMed  Google Scholar 

  17. Hoffmann F, Bachmann CJ (2014) Differences in sociodemographic characteristics, health, and health service use of children and adolescents according to their health insurance funds. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 57:455–463

    Article  CAS  PubMed  Google Scholar 

  18. European Medicines Agency (2007) The European paediatric initiative: history of the paediatric regulation. www.ema.europa.eu/docs/en_GB/document_library/Other/2009/09/WC500003693.pdf. Accessed 13 May 2016

  19. Turner S, Nunn AJ, Fielding K, Choonara I (1999) Adverse drug reactions to unlicensed and off-label drugs on paediatric wards: a prospective study. Acta Paediatr 88:965–968

    Article  CAS  PubMed  Google Scholar 

  20. Carton L, Cottencin O, Lapeyre-Mestre M, Geoffroy PA, Favre J, Simon N, Bordet R, Rolland B (2015) Off-label prescribing of antipsychotics in adults, children and elderly individuals: a systematic review of recent prescription trends. Curr Pharm Des 21:3280–3297

    Article  CAS  PubMed  Google Scholar 

  21. Pigeot I, Ahrens W (2008) Establishment of a pharmacoepidemiological database in Germany: methodological potential, scientific value and practical limitations. Pharmacoepidemiol Drug Saf 17:215–223

    Article  PubMed  Google Scholar 

  22. Schink T, Garbe E (2010) Assessment of the representativity of in-patient hospital diagnoses in the German pharmacoepidemiological research database. Gesundheitswesen 72:P10

    Article  Google Scholar 

  23. Schink T, Garbe E (2010) Representativity of dispensations of non-steroidal anti-inflammatory drugs (NSAIDs) in the German pharmacoepidemiological research database. Gesundheitswesen 72:V111

    Google Scholar 

  24. Verdoux H, Pambrun E, Cortaredona S, Tournier M, Verger P (2015) Antipsychotic prescribing in youths: a French community-based study from 2006 to 2013. Eur Child Adolesc Psychiatry 24:1181–1191

    Article  PubMed  Google Scholar 

  25. Ucok A, Gaebel W (2008) Side effects of atypical antipsychotics: a brief overview. World Psychiatry 7:58–62

    Article  PubMed  PubMed Central  Google Scholar 

  26. Schlack R, Holling H, Kurth BM, Huss M (2007) The prevalence of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany. Initial results from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50:827–835

    Article  CAS  PubMed  Google Scholar 

  27. Lindemann C, Langner I, Kraut AA, Banaschewski T, Schad-Hansjosten T, Petermann U, Petermann F, Schreyer-Mehlhop I, Garbe E, Mikolajczyk RT (2012) Age-specific prevalence, incidence of new diagnoses, and drug treatment of attention-deficit/hyperactivity disorder in Germany. J Child Adolesc Psychopharmacol 22:307–314

    Article  CAS  PubMed  Google Scholar 

  28. Grobe TG, Bitzer EM, Schwartz FW (2013) BARMER GEK Arztreport 2013. http://presse.barmer-gek.de/barmer/web/Portale/Presseportal/Subportal/Presseinformationen/Archiv/2013/130129-Arztreport-2013/PDF-Arztreport-2013.pdf. Accessed 4 August 2016

  29. Kalverdijk LJ, Tobi H, van den Berg PB, Buiskool J, Wagenaar L, Minderaa RB, de Jong-van den Berg LT (2008) Use of antipsychotic drugs among Dutch youths between 1997 and 2005. Psychiatr Serv 59:554–560

    Article  PubMed  Google Scholar 

  30. Rani F, Murray ML, Byrne PJ, Wong IC (2008) Epidemiologic features of antipsychotic prescribing to children and adolescents in primary care in the United Kingdom. Pediatrics 121:1002–1009

    Article  PubMed  Google Scholar 

  31. Linton D, Barr AM, Honer WG, Procyshyn RM (2013) Antipsychotic and psychostimulant drug combination therapy in attention deficit/hyperactivity and disruptive behavior disorders: a systematic review of efficacy and tolerability. Curr Psychiatry Rep 15:355

    Article  PubMed  Google Scholar 

  32. German Society of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy (2007) [Guideline hyperkinetic disorders (F90)]. http://www.awmf.org/en/awmf-online-portal-for-scientific-medicine/awmf-news.html. Accessed 13 May 2016

  33. Schneeweiss S, Avorn J (2005) A review of uses of health care utilization databases for epidemiologic research on therapeutics. J Clin Epidemiol 58:323–337

    Article  PubMed  Google Scholar 

  34. Hoffmann F, Pfannkuche MS, Glaeske G (2008) Validity of information relevant to research in routine medication claims data from 2000 to 2006. Dtsch Med Wochenschr 133:945–949

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Funding for this study was provided by the German Federal Institute for Drugs and Medical Devices (BfArM). BfArM reviewed the study protocol and commented on the study report, but had no further role in the conduct of the study, the collection, management, analysis, and interpretation of data, and the preparation, review, and approval of the manuscript. The authors would like to thank all statutory health insurance providers which provided data for this study, namely the AOK Bremen/Bremerhaven, the DAK-Gesundheit, and the Techniker Krankenkasse (TK). The authors would also like to thank Dr. Heike Gerds for proofreading the final manuscript.

Author information

Authors and Affiliations

  1. Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstr. 30, 28359, Bremen, Germany

    Carsten Schröder, Tilo Blenk, Edeltraut Garbe & Oliver Riedel

  2. Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 140, 26111, Oldenburg, Germany

    Michael Dörks

  3. Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstr. 30, 28359, Bremen, Germany

    Bianca Kollhorst

  4. Paediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, J 5, 68159, Mannheim, Germany

    Ralf W. Dittmann

Authors
  1. Carsten Schröder
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Dörks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bianca Kollhorst
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tilo Blenk
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ralf W. Dittmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Edeltraut Garbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Oliver Riedel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Oliver Riedel.

Ethics declarations

Informed consent

In Germany, the Code of Social Law (SGB X) regulates the use of SHI data for scientific research. All involved SHIs and their governing authorities approved the use of the data for this study. Informed consent and approval by an ethics committee were not needed.

Conflict of interest

C.S., B.K., T.B., and O.R. are working in departments that occasionally perform studies for pharmaceutical industries as indicated below. Until October 2014, M.D. worked at the same institute, and until August 2015, E.G. was head of a department there. The pharmaceutical companies include Bayer, Celgene, GSK, Mundipharma, Novartis, Sanofi, Sanofi Pasteur MSD, and STADA. E.G. has been a consultant to Bayer, Nycomed, Teva, GSK, Schwabe, Astellas, Takeda, and Novartis on issues unrelated to the subject of the study. R.W.D. has received compensation for serving as a consultant or speaker, or he or the institution he works for has received research support or royalties from the companies or organizations indicated: EU (FP7 Programme), US National Institute of Mental Health (NIMH), German Federal Ministry of Health/Regulatory Agency (BMG/BfArM), German Federal Ministry of Education and Research (BMBF), German Research Foundation (DFG), Volkswagen Foundation, Boehringer Ingelheim, Ferring, Janssen-Cilag, Lilly, Lundbeck, Otsuka, Servier, Shire, Sunovion/Takeda, and Theravance. R.W.D. owns Eli Lilly stock.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schröder, C., Dörks, M., Kollhorst, B. et al. Outpatient antipsychotic drug use in children and adolescents in Germany between 2004 and 2011. Eur Child Adolesc Psychiatry 26, 413–420 (2017). https://doi.org/10.1007/s00787-016-0905-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-016-0905-7

Keywords

Search

Navigation