Evidence-Based Use of Second-Generation Antipsychotics in a State Medicaid Pediatric Population, 2001–2005

Antipsychotic Use in Children and Adolescents

“…Previous studies in outpatients are mainly prescription studies (using prescription claims records), which stated that APs are mainly used off-label in attention-deficit and hyperactivity disorder (ADHD), behavioral disorders (such as oppositional defiant disorder [ODD] and unspecified disturbance of conduct 6,7 ), and depressive disorder. 8 In inpatients, Winterfeld et al 9 reported, in 2 children and adolescent inpatient units in France, that 90% of the AP prescriptions were off-label for diagnoses such as schizophrenia, anxiety disorders, and ADHD/DBDs.…”

“…14 A total of 5% to 8% of AP polypharmacy has been found in child and adolescent prevalence studies. 6,7 In the Child and Adolescent First Episode of Psychosis Study, 6.3% to 14.5% were on combined AP in at least 1 assessment. 15 To the best of our knowledge, there are no prospective published studies about the use of AP in the clinical practice in children and adolescents with different psychiatric disorders.…”

Period Prevalence of Concomitant Psychotropic Medication Usage Among Children and Adolescents with Attention-Deficit/Hyperactivity Disorder During 2009

“…Especially among noncomorbid ADHD patients, the off-label use of medications observed in this study, although controversial, is, perhaps, explained by the relative paucity of clinical evidence regarding the efficacy and safety for concomitant therapy (Pappadopulos et al 2002;Cooper et al 2004Cooper et al , 2006Weiss et al 2009;Pathak et al 2010a;Alexander et al 2011;Bussing and Winterstein 2012). The American Academy of Pediatrics notes that only guanfacine XR and clonidine XR have clinical evidence to support their use as adjunctive therapy in children and adolescents who partially respond to stimulants (Wolraich et al 2011).…”

“…Such practice-based information about concomitant psychotropic medication usage is particularly important, given that the use of off-label therapies for ADHD is controversial (Pappadopulos et al 2002;Cooper et al 2004Cooper et al , 2006Zito et al 2008;Weiss et al 2009;Wilens 2009;Alexander et al 2011;Pathak et al 2010a;Matone et al 2012;Sikirica et al 2012b). Furthermore, recent studies have also questioned the possible negative effects of polypharmacy on ADHD patients, citing concerns of potentially opposing effects on dopamine regulation and potential risks, including inducing metabolic syndrome and its sequelae (Findling et al 2005;Penzner et al 2009;Weiss et al 2009;Wilens 2009;Yanofski 2010;Maglione et al 2011;Bussing and Winterstein 2012).…”

DSM‐5 and the ‘Psychosis Risk Syndrome’: Whose best interests would it serve?

“…This is especially so given the probability that this would result in further increases in prescription of antipsychotics for young people . For example a recent U.S.A. study revealed that prescriptions of anti-psychotics to under 18 year olds has doubled over five years, and that 41% had no diagnosis for which such treatment was supported by a published study (Pathak, West, Martin, Helm, & Henderson, 2010). These drugs have considerable risks for young people with developing brains (Bentall & Morrison, 2002).…”