Patterns and determinants of antipsychotic prescribing in children and adolescents, 2003–2004

Abstract

Although the findings were based on cross-sectional analyses of outpatient visit data, the study revealed that atypical antipsychotic medications are being commonly and extensively prescribed to children and adolescents despite the relatively limited scientific evidence to support their pediatric use. Well-designed studies are urgently needed in children and adolescents to address atypical antipsychotic use for a variety of psychiatric disorders.

Psychotropic prescribing patterns among adolescents in Northern Ireland presenting with psychotic symptoms during a 5-year period

“…Risperidone has repeatedly been demonstrated to be the most commonly prescribed antipsychotic among child and adolescent populations (Pappadopulos et al, 2002;Doerry and Kent, 2003;Sivaprasad et al, 2006;Aparasu and Bhatara, 2007;Castro-Fornieles et al, 2008;Haw and Stubbs, 2010) and our finding of risperidone as the most commonly prescribed of both the first-and secondline antipsychotics was consistent with such studies. The frequency of risperidone prescribing would appear to be attributable to the fact that it was the only one of the more commonly used second-generation antipsychotics to be licensed in the under-18s (possessing a licence for use between 15-18 years), with both olanzapine and quetiapine not licensed at all among this age group.…”

“…The age profile of our study group was almost identical to that observed in a similar study of 110 adolescents with early onset psychosis by the CAFEPS group in Spain(Castro-Fornieles et al, 2008). The 2:1 male to female ratio we observed had previously been seen in a study of children and adolescents presenting to outpatients and being prescribed antipsychotics in a large cross-sectional analysis in the US (Aparasu and Bhatara, 2007). It has been demonstrated elsewhere that adolescent males are more than twice as likely to be prescribed antipsychotics as their female counterparts (Olfson et al, 2006).…”

“…Haloperidol was the only first-generation antipsychotic prescribed at baseline in the CAFEPS group, where it was used in only 1.8% of persons (Castro-Fornieles et al, 2008). A cross-sectional analysis of outpatient child and adolescent antipsychotic prescriptions in the US showed rates of first-generation antipsychotic prescribing of only 1.0% (Aparasu and Bhatara, 2007), although an earlier analysis between 2000-2002 demonstrated a rate of 7.7% (Olfson et al, 2006). We considered whether the chlorpromazine use in our study was clustered in one particular centre and reflective of individual rather than collective practice but were unable to determine this retrospectively from analysis of the anonymised data.…”

Antipsychotic drugs upregulate lipogenic gene expression by disrupting intracellular trafficking of lipoprotein-derived cholesterol

“…Of course, NPC is a genetic disorder (with defects in NPC1 or NPC2) and hence operates during crucial stages of development. In this context, it is noteworthy that APDs are increasingly being prescribed in childhood, 1 when extensive brain development and remodeling occur, which is a potential concern in light of our results. Of course, transferring results from cultured cells to a clinical setting is a big step, and our findings first need confirmation in animal studies and eventually in patients.…”

“…Mostly prescribed for schizophrenia and bipolar disorder, they are also increasingly being used as therapies in pediatric and geriatric psychiatry. 1,2 Their mechanism of action is believed to be largely because of modulation of particular receptors in the brain. The older, typical APDs predominately block D2 dopamine receptors.…”