Child and Adolescent Psychiatrists' Attitudes and Practices Prescribing Second Generation Antipsychotics

Abstract

Psychiatrists' attitudes about prescribing SGAs to children exhibiting aggressive symptoms were associated with off-label SGA use. Research is needed to understand the construct of aggression, potential interaction effects of aggression with diagnostic criteria, and their impact on SGA use.

Examining predictors of initial outpatient psychiatric treatment for conduct problems in youth: A records review

“…Parent perceptions of the severity of aggression symptoms significantly increased the likelihood that a participant received an initial treatment recommendation involving psychotropic medication. This finding corroborates Rodday et al.’s results that showed aggression to be a psychiatric symptom that significantly predicted psychiatrist willingness to use off‐label psychotropic medication with youth. Current findings also align with other research pointing toward specific clinician motivations that may drive this pattern of psychotropic medication use such as (a) the diminishing effect that youth's aggressive behavior can have on psychosocial intervention adherence and effectiveness and (b) the ability of psychotropic medication to mitigate risk of harm associated with aggressiveness more quickly…”

“…Etiology, psychosocial intervention, and implementation research identify numerous patient‐level factors that may increase the odds that psychotropic medication are included within initial treatment recommendations for CP, including age of onset, severity of aggression symptoms, severity of internalizing symptoms, suicidal ideation, previous out‐of‐home placements, maternal age, parent marital satisfaction, race, and gender . Furthermore, psychosocial intervention implementation research highlights clinician , organizational , and systemic factors that limit patient access to evidence‐based psychosocial intervention, which may also affect the likelihood that initial treatment recommendations include psychotropic medication.…”

Monitoring of Patients on Second-Generation Antipsychotics: A National Survey of Child Psychiatrists

“…Those who had completed training recently were more likely to monitor lab values and BMI, which may reflect different views of managing psychotropic medications based on training era. Similarly, in another small survey sample of child psychiatrists, those practicing for longer periods were less likely to monitor fasting glucose and lipids (10). Thus interventions to improve monitoring should target physicians in nonacademic practices and physicians who have been out of training longer.…”

A multi-national comparison of antipsychotic drug use in children and adolescents, 2005–2012

“…For example: the attitude of physicians that SGA should be used to treat aggressive behavior can contribute to higher AP prescription rates [32] and the acceptance of psychiatric medication for children by the general public may be a factor [33]. Several studies indicate a broadening of indications, for example in ADHD and other disruptive behaviour disorders [13, 16, 34, 35].…”