Current Pattern of Psychiatric Comorbidity and Psychotropic Drug Prescription in Child and Adolescent Patients (original) (raw)
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Recent international trends in psychotropic medication prescriptions for children and adolescents
European child & adolescent psychiatry, 2014
Prescriptions of psychotropic medications have become an important intervention for many children and adolescents with mental disorders, and the rise of these prescriptions is debated intensively both among experts and the public. This review reports some recent international findings on point prevalence rates, cross-country comparisons, and time trends in psychotropic medication prescriptions for children and adolescents. Besides the total prescription rates, figures for antidepressants, antipsychotics, stimulants, and anxiolytics prescriptions are provided. The overall prescription rates of psychotropics in general and the major medication subgroups prescribed to children and adolescents vary substantially between countries with the US consumption being markedly higher than the use in European countries. However, even among the latter there are marked variations in findings. Studies reporting on time trends clearly indicate that there was a marked increase in the use of psychotrop...
BMC Psychiatry, 2016
Background: Time-trend studies on psychotropic drugs among children and adolescents are scarce, and most of them are outdated. The purpose of this study was to study prevalences of psychotropic drug use during 2004-2014 among Norwegians aged <18 years, overall and in psychotropic subgroups. Methods: Data were obtained from the Norwegian Prescription Database, which covers all dispensed prescription drugs in Norway from 2004 and onwards. Psychotropic drugs included: antipsychotics (ATC-group N05A), anxiolytics (N05B), hypnotic/sedatives (N05C), antidepressants (N06A), stimulants (N06BA), and alimemazine (R06AD01). Period (1-year) prevalence of use, overall and in subgroups of psychotropic drugs, was estimated by identifying individuals <18 years who had at least one psychotropic drug dispensed during each year. Results: Psychotropic drug use increased in 0-17 year olds over an 11-year period, in which the main contributing drugs were stimulants (boys overall; 15.0 to 20.8/1000, girls overall; 3.8 to 8.5/1000), hypnotic/sedative drugs in adolescents (boys overall; 4.2 to 10.8/1000, girls overall; 2.6 to 8.8/1000) and to some extent antidepressants among adolescent girls (girls overall from 3.1 to 4.0/1000). Psychotropic drug use was, however, reduced by half in the youngest children, attributed to reduction of alimemazine only (1-year olds: boys; from 36.6 to 10.2/1000, girls; 26.9 to 7.2/1000). A higher level of psychotropic drug use was observed among younger boys, but there is a shift towards girls using more psychotropic drugs than boys during adolescence for all psychotropic drugs except for stimulants. Conclusion: Different trends in psychotropic drug use exist in age and gender subgroups. Psychotropic drug use has decreased among the youngest children, attributed to alimemazine, and increased in older children and adolescents, attributed mainly to stimulants and hypnotics/sedatives.
Psychotropic Medication Utilization in a Child and Adolescent Mental Health Service
JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY, 2006
Objectives: This study aimed to identify rates and correlates of psychotropic drug utilization in children and adolescents in inpatient and outpatient settings. Methods: A retrospective chart review examined 122 inpatient and 126 outpatient charts from a metropolitan child and youth mental health service in Brisbane, Australia. Results: Inpatients received more psychotropic medication than outpatients (71% vs. 25%; p < 0.01). Patients receiving medication were older, had longer hospital admissions, and more complex presentations, including history of abuse or suicide attempts and more diagnoses (all p < 0.01). Selective serotonin reuptake inhibitors (SSRIs) were the most frequently used drug class (44% inpatients; 14% outpatients), primarily indicated for mood disorders (31%). SSRIs and newer antidepressants (ADs) were used more frequently in patients with a high suicide risk (p < 0.01). Atypical antipsychotics (APs) were also used (inpatients 23%; outpatients 3%), primarily for behavioral disturbances. Half of those receiving medication (51%) received polypharmacy (>1 concurrent drug), with up to four drugs used at one time. Rates of polypharmacy were highest among patients receiving antipsychotics. Conclusions: Use of psychotropic medication is frequent in this population. Future research should initially focus on inpatients and intensive treatment settings and examine both safety and efficacy of interventions for depression in young people, atypical antipsychotics for behavioral disturbances, and polypharmacy.
Psychotropic Drug Use in Preschool and Toddler Age Groups: An Evaluation of Hospital Admissions
Psychiatry and Behavioral Sciences, 2019
Objective: This study is aimed to evaluate the frequency of psychotropic drug use in children under age 6, and determine the predictive variables of psychotropic drug use. Methods: For six months, data of children aged up to 6 admitted to Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Child Psychiatry Department was evaluated. Statistical analyses were performed using SPSS version 17 for Windows. A value of p<0.05 was accepted as significant. Results: Total of 953 children under age 6 were recruited. Mean age was 3.5 years and 67.7% were male. 83.4% of all had at least one psychiatric disorder. The most common diagnosis was communication disorders (33.5%). Comorbid psychiatric disorder was found in 5.9% of all and the most comorbid diagnosis was an oppositional defiant disorder (3.3%). Psychotropic drug use was found in 7.3%. The most commonly used drug was risperidone (4%). Predictors of treatment were found as aged in 4-5 (p=0.002); male gender (p=0.049); anxiety (p<0.001); attention-deficit/ hyperactivity disorder (ADHD) (p<0.001), and pervasive developmental disorder (p<0.001). Conclusions: Our results could be useful for preferences of clinicians in treatment of children under age 6, and predictions of scientists working on these age groups in pharmaceutical industry. Multi-centered, large clinic-based studies are needed to constitute a systematic approach for psychopharmacological treatment in these age groups.
Prevalence Variations in Psychotropic Treatment of Children
Journal of Child and Adolescent Psychopharmacology, 1998
This study was undertaken to clarify several aspects of the estimation of prevalence of three commonly use pédiatrie psychotropic agents, namely, methylphenidate, desipramine, and imipramine. The study aims are threefold: (1) to show the variability of drug prevalence by comparing estimates from three data sources; (2) to show the misleading impression that can be created by reporting drug prevalence estimates based on counts of prescriptions rather than persons; (3) to show the utility of gender-by-age-specific prevalence of drug use as a marker for diagnosis. Two data sources that yield population-based prescription estimates were available: 1991 Medicaid administrative claims data for prescriptions from a mid-Atlantic state and 1991 prescription records of the northwest region of Kaiser Permanente, a staff-model health maintenance organization (HMO). Another source of data consists of the 1991 National Ambulatory Medical Care Survey, which records medication information reported during physician office visits. Data analysis consists of quantitative estimates of (1) drug prevalence from each source; (2) the ratio of prescription claims to persons; and (3) the proportion of drug use according to age and gender. Methylphenidate and desipramine prevalence had a twofold greater use among state Medicaid enrólleos compared with HMO enrollees. Average claims-to-person ratios of 5:1 suggest better accuracy using persons with medication rather than prescription counts. Gender-by-age-specific prevalence rates showed that 75% of the drug use for desipramine among those less than 15 years old was found among males, whereas 75% of the desipramine use among those 15 or older was found among females, suggesting its use for the treatment of attention deficithyperactivity disorder among young males and for depression among older females. The
Multiple Psychotropic Medication Use for Youths: A Two-State Comparison
Journal of Child and Adolescent Psychopharmacology, 2005
Objective: The aim of this study was to compare multiple psychotropic use among youths enrolled in two U.S. mid-Atlantic state Medicaid and state Children's Health Insurance Programs (SCHIP). Methods: Administrative data were used to examine multiple psychotropic use among youths less than 20 years of age and who were continuously enrolled in Medicaid or SCHIP programs in two states during 1999. Multiple psychotropic use referred to multidass combinations and was defined by the number of months of multiple use. Main outcome measures were the prevalence of multiple psychotropic use and months of multiple use. Demographic and clinical characteristics, mental health visits, and common combinations were examined according to months of multiple use. Results: Among continuously enrolled youths, 21%-22% had at least one mental health-related visit, 8%-10% received a psychotropic medication, and 2%-3% received multiple psychotropic medications. Nearly one third (28%-30%) of youths with any psychotropic use received multiple medications, of which almost half was for 5-12 months. Multiclass use was more common in male, white, aged 10-14, disabled, and foster-care youths. Stimulants with antidepressants, antipsychotics, or alpha-agonists were the most common combinations. Conclusions: Multiple use occurred in nearly one third of youths with any psychotropic treatment. Additional research is needed to investigate switching patterns and the effectiveness of combined pharmacotherapy.
State of the Evidence for Use of Psychotropic Medications in School-Age Youth
Children
Psychotropic medications are commonly prescribed to school-aged youth for the management of mental health concerns. This paper describes the current state of evidence for psychotropic medications in school-aged youth. More specifically, the following sections summarize relevant medication research trials and practice parameters pertaining to psychotropic medication prescribing as well as the specific medications indicated for a range of commonly presenting disorders and symptom clusters in school-aged youth. For each of these disorders and symptom clusters, key findings pertaining to the current state of science and practice are highlighted for the purpose of offering patients, clinicians, researchers, and policymakers with nuanced considerations for the role of psychopharmacology within the context of a larger “whole-child” approach to care that relies on the collaboration of providers and services across systems of care to promote optimal child and family health and wellness. The ...
Psychiatric services (Washington, D.C.), 2004
This study estimated the overall rate of use of psychotropic medications among youths (less than 18 years of age) in the U.S. mental health service system and compared rates of use for youths with a single diagnosis and those with co-occurring diagnoses. Results were based on nationally representative client data from the 1997 Client/Patient Sample Survey. On any given day, about one-third (32.5 percent) of the 559,769 youths in the service system received psychotropic medication. Youths with co-occurring diagnoses were significantly more likely to receive medication than youths with a single diagnosis. Future research on best practices may be most effective if the role of medication in the treatment of single and co-occurring disorders among youths is evaluated.
National trends in psychotropic medication use in young children: 1994-2009
Child: Care, Health and Development, 2013
WHAT'S KNOWN ON THIS SUBJECT: Studies of psychotropic use in very young US children in the last decade have been limited by the regions, insurance types, or medication classes examined. There is a paucity of recent, nationally representative investigations of US preschool psychotropic use. WHAT THIS STUDY ADDS: In a national sample of 2 to 5 year olds, the likelihood of psychotropic prescription peaked in the mid-2000s, then stabilized in the late 2000s. Increased psychotropic use in boys, white children, and those lacking private health insurance was documented.