"Real World" Atypical Antipsychotic Prescribing Practices in Public Child and Adolescent Inpatient Settings

Abstract

This article examines the factors that influence antipsychotic use among youth treated in public inpatient facilities. By combining data from 11 focus groups, a survey of 43 researchers and clinicians, and a chart review of 100 closed patient charts, we investigated the interplay between physicians' and staff members' perceptions of problems related to antipsychotic prescribing, their beliefs concerning optimal approaches, their actual recorded prescribing behaviors, and the discrepancies between their beliefs and their recorded practices. We discovered that antipsychotics are prescribed broadly to treat a variety of conditions, including nonpsychotic disorders among children in public inpatient facilities. Despite overall expert consensus regarding "best practices," physicians described systemic obstacles that prevent the application of these practices, and our data confirmed that best practices are not always followed. Future research should be done with this patient population and should investigate the factors that influence antipsychotic use among inpatient youth.

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.…”

Antipsychotic prescribing practice among child psychiatrists and community paediatricians

“…[3][4][5][6] Despite their tolerability, atypical antipsychotic drugs are associated with serious adverse effects such as agranulocytosis and with metabolic and cardiovascular risks. 7,8 These adverse effects may be more prevalent and more severe in children and adolescents than in adults.…”

“…Rai & Kerr Antidepressant use in adults with intellectual disability Antipsychotic prescribing practice among child psychiatrists and community paediatricians John Otasowie, 1 Rachel Duffy, 2 Jenny Freeman, 3 Chris Hollis Aims and method All child and adolescent psychiatrists and community paediatricians in the former Trent Region were surveyed about their antipsychotic prescribing practice during 1 year, including monitoring, and whether they would like consensus guidelines on prescribing and monitoring of antipsychotics in children and adolescents.…”

“…Otasowie et al Antipsychotic prescribing in children Table 1 Type of antipsychotic prescribed, indications and need for guidance 1,3,11 Aripiprazole was the second favoured atypical, possibly because of its low perceived potential for causing weight gain and hyperprolactinaemia and its availability in liquid form.…”

Atypical and typical antipsychotics in the schools

“…Nevertheless, TAs still have been used (Riddle, Kastelic, & Frosch, 2001), despite concerns about their tolerability and long-term effects in this age group. However, with the introduction of the AAs, there have been studies to suggest that these agents could be replacing the older antipsychotics for treating psychotic and nonpsychotic childhood disorders (Andres & Douglas, 2003;Pappadopulos et al, 2002).…”