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Antipsychotic Prescriptions Rise Among Children and Teens

The number of patients under age 20 years who receive prescriptions for antipsychotic medications rose steadily between 1993 and 2002, according to a report published in the June issue of Archives of General Psychiatry.

Antipsychotics are a class of drugs used to treat schizophrenia, mania and other mental disorders characterized by loss of contact with reality.

Concern about the increasing use of antipsychotics has arisen from several studies that indicate that doctors are increasingly prescribing these drugs for children and adolescents. Most such prescriptions are for second-generation antipsychotics, which are not approved by the US Food and Drug Administration (FDA) for pediatric use.

No national data on the incidence of these prescriptions has previously been available, according to background information in the article by Mark Olfson, MD, MPH, College of Physicians and Surgeons, Columbia University, New York, et al.

Data Analysis

Dr Olfson and colleagues analyzed data from a national annual survey of office-based physicians conducted by federal researchers.

These physicians collected the following information: whether or not the child or adolescent received a prescription for antipsychotics; the patient's age, sex and race/ethnicity; the length of the office-visit; the physician's specialty; whether or not the patient received psychotherapy.

The results showed:

  • A six-fold increase occurred from 1993 to 2002 in the annual number of outpatient health-care visits in which patients aged of 0-20 years received antipsychotic medications (from 201,000 to 1,224,000).
  • A similar jump occurred in office visits: in 1993-95, a total of 274.7 visits occurred annually per 100,000 individuals under age 21 years, compared with 1,341 visits annually in 2000-02.
  • Overall, 9.2% of mental health visits and 18.3% of visits to psychiatrists included treatment with antipsychotic drugs.
  • The diagnoses among patients receiving antipsychotic medications included disruptive behavior disorder (37.8%), mood disorders (31.8%), pervasive developmental disorders or mental retardation (17.3%) and psychotic disorders (14.2%).
  • Male patients and Caucasian patients were most likely to receive antipsychotic prescriptions.

The authors speculated that the availability of new antipsychotics that have fewer adverse effects in adults may have contributed to the increase in prescriptions for younger people.

Additionally, because fewer inpatient care options exist for children with mental illnesses, physicians may be more inclined to treat more seriously mentally ill children in an outpatient setting -and these severely ill children are likelier to require more powerful medications, such as antipsychotics.

The authors note that, although such antipsychotic drugs may be safe and effective for some mental disorders in children and adolescents patients, further research is required to confirm safety and effectiveness, and to provide more detailed information about benefits and risks of treatment.

"In recent years, second-generation antipsychotic medications have become common in the office-based mental health treatment of young people," the authors conclude.

"These medications are used to treat children and adolescents with different mental disorders. Results of clinical trials provide a limited base of support for the short-term safety and efficacy of some second-generation antipsychotic medications for psychosis and disruptive behavior disorders.

"In light of the widespread and growing use of these medications, there is a pressing need to increase and extend the experimental evaluation of these medications in children and adolescents."

Source: National Trends in the Outpatient Treatment of Children and Adolescents With Antipsychotic Drugs. Mark Olfson et al. Archives of General Psychiatry, volume 63, pages 679-685, June 2006.

Posted: June 2006