The Pharmacoepidemiology of Antipsychotic Medications for Canadian Children and Adolescents: 2005–2009

Pringsheim, Tamara; Lam, Darren; Patten, Scott B.

doi:10.1089/cap.2010.0145

Cited by 75 publications

(70 citation statements)

References 21 publications

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“…In 2008, the proportion of prescriptions written by GPs in Manitoba was 73%. 17 The third study, by Pringsheim et al, 30 used IMS Health data (Canadian Disease and Therapeutic Index) to estimate the number of prescription recommendations for antipsychotics in the group aged 17 years and younger. Increases both for SGAs and FGAs were observed, but increases were much more rapid for SGAs.…”

Section: Canadamentioning

confidence: 99%

A Review of Pharmacoepidemiologic Studies of Antipsychotic Use in Children and Adolescents

2012

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Objective: In Canada, treatment of children and adolescents with antipsychotics is almost always off label. A single atypical agent, aripiprazole, only recently received regulatory authorization for use in the group aged 15 to 17 years. This regulatory approval was restricted to treatment of schizophrenia. The objective of this review was to summarize pharmacoepidemiologic reports examining the frequency of use of these medications. Methods:A literature search was used to identify English-language studies examining the pharmacoepidemiology of antipsychotics in children and adolescents. The results of identified studies were summarized using narrative review methods. Results:In countries where longitudinal data are available, increased antipsychotic use has been consistently observed. Generally, most or all of this increase can be attributed to second-generation antipsychotics (SGAs). Major international differences are evident in the literature. European studies describe lower overall frequencies of use than North American studies (most of which were conducted in the United States). SGAs in children and adolescents are used more often in boys than in girls, and are increasingly used for treatment of attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD). Conclusions:Determining the most appropriate frequency of SGA use in children and adolescents will ultimately depend on decisive clarification of risks and benefits. The currently available literature highlights large international differences in the frequency of use. These differences may reflect fundamental dissimilarities in the therapeutic stance adopted toward ADHD and CD by physicians practicing in different countries. W W WObjectif : Au Canada, le traitement des enfants et des adolescents par antipsychotiques est presque toujours non indiqué sur l'étiquette. Un seul agent atypique, l'aripiprazole, a reçu récemment l'autorisation réglementaire d'utilisation auprès du groupe des 15 à 17 ans. Cette approbation réglementaire se limitait au traitement de la schizophrénie. L'objectif de cette revue était de résumer les études pharmaco-épidémiologiques qui examinent la fréquence d'utilisation de ces médicaments.Méthodes : Une recherche de la littérature a servi à identifier les études en anglais qui examinent la pharmaco-épidémiologie des antipsychotiques chez les enfants et les adolescents. Les résultats des études identifiées ont été résumés à l'aide de méthodes de revue narrative. Résultats :Dans les pays qui disposent de données longitudinales, une utilisation accrue des antipsychotiques a été observée régulièrement. Généralement, une grande partie ou la totalité de cet accroissement peut être attribuée aux antipsychotiques de deuxième génération (ADG). Des différences majeures entre les pays sont manifestes dans la littérature. Les études européennes décrivent des fréquences d'utilisation globalement plus faibles que les études nord-américaines (dont la plupart ont été menées aux États-Unis). Les ADG chez les enfants et les adolescents so...

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Section: Canadamentioning

confidence: 99%

A Review of Pharmacoepidemiologic Studies of Antipsychotic Use in Children and Adolescents

2012

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“…36,37 Antipsychotic use, in particular, has shown large increases. 38 Especially notable is their burgeoning off-label use, [39][40][41] including in preschool-aged children. 42 -44 Given the frequency and multiple medication regimens with which psychotropic agents are being prescribed, 36 ED clinicians are likely to encounter children and adolescents taking 1 or many of these medications.…”

Section: Adverse Effects Of Psychiatric Medicationsmentioning

confidence: 99%

Evaluation and Management of Children With Acute Mental Health or Behavioral Problems. Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting With Medical or Uncertain Symptoms

Chun¹,

Mace²,

Katz³

2016

Pediatrics

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“…In Canada, rates of antipsychotic indication for children also increased, by 114 % from 2005 to 2009, while indications for stimulants and antidepressants increased by 36 and 44 %, respectively. Attention-deficit/hyperactivity disorder was the most common indication for antipsychotic use [14]. In Denmark, data on filled selective serotonin reuptake inhibitors obtained for all children aged 5-17 during 1995-2011 demonstrated that prevalence proportion rose from 0.1 per 1,000 children in 1995 to 3.3 in 2011.…”

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confidence: 99%

Identifying the gaps between science, policies, services, and the needs of youths affected by mental disorders

Polanczyk

2014

Eur Child Adolesc Psychiatry

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Second, there is a lack of solid empirical evidence for the treatment of a variety of conditions, and frequently the available evidence is not incorporated by the health systems [10]. The gap between interventions that are available in community settings and interventions that are evidence-based is even larger in low-resource settings [11]. Pharmacological interventions are commonly preferred because they are more easily delivered, with high fidelity if adherence is good. However, attributes of medications and patients' and families' preferences are usually not addressed by clinicians and have important implications on adherence [7]. On the other hand, psychotherapeutic approaches available in the health system usually lack consistency and are directed by the professional's theoretical affiliation, not by patient needs. Also, treatments are frequently delivered by professionals with limited training in inadequate formats. For example, nationally representative survey data from visits to office-based physicians in the US revealed that visits with a prescription of antipsychotic medications per 100 persons increased from 0.24 to 1.83 for children and 0.78-3.76 for adolescents between 1993-1998 and 2005-2009 [8]. Only 6 % of children and 12.7 % of adolescents' antipsychotic visits included a FDA clinical indication, and disruptive behavior disorders were the diagnosis for 63 and 33.7 % of visits for children and adolescents, respectively, despite the limited evidence for this indication and the urgent need of short-and long-term studies assessing its efficacy and safety, as addressed by the article from the Paediatric European Risperidone Studies Consortium in this issue [16]. Noteworthy, mean duration of antipsychotic visits was approximately 25 min and only approximately 30 % of them included psychotherapy [8], despite solid evidence on the efficacy of psychosocial interventions for several mental disorders, such as disruptive behavior disorders, for example in [15]. Children aged 2-5 years have also been Mental disorders are estimated to affect 10-20 % of children and adolescents around the world and are major causes of morbidity among youth [10]. Evidence from different countries suggests that the number of youths with reported diagnoses of mental disorders in the community has increased substantially during the past decades [1,17], although there is no evidence to indicate that the actual prevalence of disorders has increased [12]. Surprisingly, despite the fact that mental disorders have been increasingly recognized by professionals and the community, associated morbidity and mortality have remained stable [3].There are several possible explanations to explain why increasing rates of diagnoses do not translate into broad benefits to the health of the population. First, although rates of diagnoses have increased over time, the absolute number of youths affected by disorders who did not receive a diagnosis or treatment is still large. This is the case in the National Comorbidity Survey Adolescent Supplement (N...

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The Pharmacoepidemiology of Antipsychotic Medications for Canadian Children and Adolescents: 2005–2009

Cited by 75 publications

References 21 publications

A Review of Pharmacoepidemiologic Studies of Antipsychotic Use in Children and Adolescents

A Review of Pharmacoepidemiologic Studies of Antipsychotic Use in Children and Adolescents

Evaluation and Management of Children With Acute Mental Health or Behavioral Problems. Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting With Medical or Uncertain Symptoms

Identifying the gaps between science, policies, services, and the needs of youths affected by mental disorders

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