Thursday, June 26, 2014

Use of Antipsychotics Concurrent With Other Psychotropic Meds Has Increased in Medicaid-Insured Youth, Study Finds

Use of second-generation antipsychotics (SGAs) concurrently with other psychotropic medications in children in the Medicaid program has increased over the last few years, according to a report published online in the Journal of American Academy of Child and Adolescent Psychiatry.

Researchers at Children’s Hospital of Philadelphia used data from the Medicaid program to estimate the probability and duration of concurrent SGA use with different psychotropic medication classes over time and to examine concurrent SGAs in relation to clinical and demographic characteristics. Their analysis showed that while SGA use overall increased by 22%, about 85% of such use occurred concurrently with use of other psychotropic medications. By 2008, the probability of concurrent SGA use ranged from 0.22 for stimulant users to 0.52 for mood stabilizer users. The concurrent SGA use occurred for long durations (69%-89% of annual medication days).

"We knew that antipsychotic use was increasing among youth, but were surprised to learn just how often a child with ADHD or depression receives an antipsychotic as part of their treatment, and when they do, it is for sustained periods of time," said senior author David Rubin, M.D., co-director of the Policy Lab at Children's Hospital of Philadelphia. “In all likelihood, the use of the antipsychotics illustrates the great challenge clinicians are having when responding to disruptive and challenging behaviors in youth that don't neatly fit common diagnostic categories. In a society that often doesn't offer other services to respond to these behaviors, we should not be surprised how quickly the use of antipsychotics has grown.”

For more information on antipsychotic use in children and adolescents, see the Psychiatric News article, "Increase in Off-Label Antipsychotic Use Seen in Canadian Youth." A comprehensive review of psychotropic medication use in this age group can be found in American Psychiatric Publishing's Clinical Manual of Child and Adolescent Psychopharmacology, Second Edition.

(Image: Luis Rego/


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