Mark Olfson, M.D., M.P.H., a professor of clinical psychiatry at Columbia University, and colleagues retrieved data on antipsychotic prescriptions filled by or for young people (aged 1 to 24 years) in 2006, 2008, and 2010 from the IMS LifeLink LRx Longitudinal Prescription database, which includes about 60 percent of all retail pharmacies in the United States. The researchers then calculated the percentage of young people for whom one or more antipsychotic prescriptions were filled during the study year by sex and age group, and generalized the IMS prevalence to the entire U.S. population of young people, including those who did not fill a prescription.
The percentages of young people whose antipsychotic prescriptions were filled in 2006 and 2010, respectively, were 0.14% and 0.11% for younger children (1 to 6 years), 0.85% and 0.80% for older children (7 to 12 years), 1.10% and 1.19% for adolescents (13 to 18 years), and 0.69% and 0.84% for young adults (19 to 24 years). Further analysis of the 2010 data revealed that across all age groups, males were more likely than females to have filled their antipsychotic prescriptions; among young people treated with antipsychotics in 2010, receiving a prescription from a psychiatrist was less common among younger children (57.9%) than among other age groups (range, 70.4%-77.9%).
“In view of evidence of widespread antipsychotic prescribing outside of U.S. Food and Drug Administration–labeled indications and concerns regarding the adverse metabolic effects of second-generation antipsychotics, this decline [in the rate of antipsychotic use among children 12 and under] is a welcome development,” the authors wrote. “Nevertheless, age and sex antipsychotic use patterns suggest that much of the antipsychotic treatment of children and younger adolescents targets age-limited behavioral problems.”
When evaluating treatment options for the youngest children with disruptive behaviors, practice guidelines recommend that “consideration of antipsychotic medications should be limited to those who have severe, sustained, and intractable impairment in multiple settings or who pose safety risks,” the authors noted. They added that if such therapy is initiated, young patients should be continually reassessed to minimize treatment duration. However, as the authors pointed out, children treated with antipsychotics most commonly receive prescriptions from physicians who are not psychiatrists.
“Given the paucity of high-quality empirical evidence supporting the efficacy and safety of antipsychotic treatment in this age group, these treatment patterns raise potential safety concerns and underscore the importance of improving access for young children with severe mental health problems to high-quality, specialized child and adolescent mental health services,” they concluded.
For more on antipsychotic use among children and adolescents and practice guidelines, see the Psychiatric News article “Recent Rise in Youth on Antipsychotics Raises Concerns Among Experts.”
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