Antipsychotics for Children and Young Adults: A Comparative Effectiveness Review

Seida, Jennifer C; Schouten, Janine R; Boylan, Khrista; Newton, Amanda S; Mousavi, Shima S; Beaith, Amy; Vandermeer, Ben; Dryden, Donna M; Carrey, Normand

doi:10.1542/peds.2011-2158

Cited by 109 publications

(98 citation statements)

References 98 publications

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“…SGA treatment for children is often associated with the symptomatic treatment of developmental or other disorders with a long duration (1,2,8,14,21,22,25). The average duration of the SGA medication was long in this study as well: the median duration was almost two years.…”

Section: Discussionmentioning

confidence: 62%

Clinical use of second-generation antipsychotics in children

Kakko

Pihlakoski

Salmelin

et al. 2017

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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Background: The use of second-generation antipsychotic (SGA) medication among child and adolescent psychiatric patients has increased worldwide in recent years. The increase appears to have been more extensive in the USA than in European countries, but the tendency is similar. However, after a peak the use seems to have declined in the USA. Simultaneously with the increasing numbers, the duration of SGA use has lengthened, indications have broadened, and off-label use has increased. Despite existing follow-up recommendations and evidence for the metabolic adverse effects of SGAs in children, research evidence has not translated into clinical practice. Objective: The aim of this study was to assess the clinical use and follow-up practices of SGA medication among child psychiatric patients of one university hospital in Finland. Method: This retrospective patient report-based study was conducted at the Child Psychiatric Clinic of Tampere University Hospital, Finland. The study sample consisted of 133 patients who were younger than 13 years when initiating SGA treatment and had an ongoing SGA medication during the study period. The study sample was divided into two groups according to diagnosis to examine whether there were differences between patients with an autistic or a developmental disorder (F83-84) and patients with other psychiatric diagnoses. Results: This study showed that SGA use in children younger than 13 years was mainly off-label. Irrespective of diagnosis, the most common indication was aggression. Especially children with psychiatric diagnoses other than developmental disorders had multiple socio-demographic risk factors and adverse life experiences in their background. The follow-up practices were diverse and partly irregular. Conclusions: A need for systematic SGA monitoring practices and dialogue between the medical specialities treating children and their families is evident.

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Section: Discussionmentioning

confidence: 62%

Clinical use of second-generation antipsychotics in children

Kakko

Pihlakoski

Salmelin

et al. 2017

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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“…13,15 These increases have been mirrored by a dramatic rise in the use of neuropsychiatric drugs in children. [16][17][18] Antipsychotic use increased from 8.6 per 1000 children to 39.4 per 1000 children from 1995 to 2002, for example, and antidepressant use increased from 9.4 per 1000 to 21.3 per 1000 children between 1994 and 2003. [19][20][21] The lack of clinical evidence to support the use of these agents in children has resulted in a number of controversies, including concerns over increased suicidality among adolescents treated with selective serotonin reuptake inhibitors and of antipsychotic side effects in young children.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Pediatric Clinical Drug Trials for Neuropsychiatric Conditions

2013

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BACKGROUND AND OBJECTIVE: Neuropsychiatric conditions represent a large and increasing disease burden in children. A number of drugs are available for the treatment of these conditions, but most drugs have not been adequately tested in children, and off-label drug use remains widespread. We sought to define and quantify recent and ongoing clinical research on the use of neuropsychiatric drugs in children. METHODS: Drug trials registered in ClinicalTrials.gov between 2006 and 2011 and studying neuropsychiatric conditions were selected and classified based on the drug’s Food and Drug Administration (FDA) approval status in children. We measured the proportion of trials seeking to expand the use of a drug to pediatric patients and the proportion of available drugs studied in children. RESULTS: Only 10% of neuropsychiatric trials focused on children. Of 303 drugs studied in both pediatric and adult populations, 90% lacked FDA approval in children and 97% were not approved in children for the indication studied. However, only 19% of all neuropsychiatric drugs were under study in pediatric populations, with as few as 8% of either antidepressant or antipsychotic drugs. Overall, 76% of pediatric drug trials examined a drug previously unapproved in children and 26% explored the use of a drug for a new indication. CONCLUSIONS: Despite the rising prevalence of neuropsychiatric disease and the paucity of FDA-approved pediatric drugs, only a small proportion of trials focus on pediatric populations and these trials cover only a fraction of available drugs. This deficiency is most pronounced for depression and schizophrenia.

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“…6,[26][27][28][29] A recent literature review by the Agency for Healthcare Research and Quality found limited evidence for the effectiveness of secondgeneration antipsychotics in the treatment of ADHD. 30 Although concomitant use of LAS and AAPs is common in pediatric settings, little is known about the prevalence of and factors associated with concomitant use of LAS and AAPs in youth with ADHD. Recently, Betts et al (2014) examined the prevalence of concomitant psychotropic medication use in commercially insured children and adolescents with ADHD in the United States to find that AAPs were one of the most commonly prescribed concomitant medications (5.8%-6.8%).…”

Section: ■■ Methods Study Design and Data Sourcementioning

confidence: 99%