The Relationship between Mental Health Diagnosis and Treatment with Second‐Generation Antipsychotics over Time: A National Study of U.S. Medicaid‐Enrolled Children

Abstract

Objective To describe the relationship between mental health diagnosis and treatment with antipsychotics among U.S. Medicaid‐enrolled children over time. Data Sources/Study Setting Medicaid Analytic Extract (MAX) files for 50 states and the District of Columbia from 2002 to 2007. Study Design Repeated cross‐sectional design. Using logistic regression, outcomes of mental health diagnosis and filled prescriptions for antipsychotics were standardized across demographic and service use characteristics and reported as probabilities across age groups over time. Data Collection Center for Medicaid Services data extracted by means of age, ICD‐9 codes, service use intensity, and National Drug Classification codes. Principal Findings Antipsychotic use increased by 62 percent, reaching 354,000 youth by 2007 (2.4 percent). Although youth with bipolar disorder, schizophrenia, and autism proportionally were more likely to receive antipsychotics, youth with attention deficit hyperactivity disorder (ADHD) and those with three or more mental health diagnoses were the largest consumers of antipsychotics over time; by 2007, youth with ADHD accounted for 50 percent of total antipsychotic use; 1 in 7 antipsychotic users were youth with ADHD as their only diagnosis. Conclusions In the context of safety concerns, disproportionate antipsychotic use among youth with nonapproved indications illustrates the need for more generalized efficacy data in pediatric populations.

Risk for Incident Diabetes Mellitus Following Initiation of Second-Generation Antipsychotics Among Medicaid-Enrolled Youths

“…[1][2][3][4] Between 2002 and 2007, SGA use among Medicaidenrolled youths increased by 62%, exceeding rates among commercially insured youths, with nearly 350 000 youths having filled prescriptions in 2007. [4][5][6][7] There are certain conditions for which SGAs have regulatory approval in youths such as schizophrenia, bipolar disorder, and irritability associated with autism 8,9 ; however, the growth in SGA prescribing is attributable mostly to shifts in the management of disruptive behaviors among youths without psychotic disorders. 4,5,[10][11][12] By the mid-2000s, half of all youths prescribed SGAs had a diagnosis of attention-deficit/hyperactivity disorder, the most prevalent externalizing disorder, and 1 in 7 had a diagnosis of attention-deficit/hyperactivity disorder in the absence of comorbidity.…”

“…[4][5][6][7] There are certain conditions for which SGAs have regulatory approval in youths such as schizophrenia, bipolar disorder, and irritability associated with autism 8,9 ; however, the growth in SGA prescribing is attributable mostly to shifts in the management of disruptive behaviors among youths without psychotic disorders. 4,5,[10][11][12] By the mid-2000s, half of all youths prescribed SGAs had a diagnosis of attention-deficit/hyperactivity disorder, the most prevalent externalizing disorder, and 1 in 7 had a diagnosis of attention-deficit/hyperactivity disorder in the absence of comorbidity. 4 Prescribing behavior to youths in foster care, who have higher rates of disruptive behaviors than other youths, included SGAs in most cases.…”

“…4,5,[10][11][12] By the mid-2000s, half of all youths prescribed SGAs had a diagnosis of attention-deficit/hyperactivity disorder, the most prevalent externalizing disorder, and 1 in 7 had a diagnosis of attention-deficit/hyperactivity disorder in the absence of comorbidity. 4 Prescribing behavior to youths in foster care, who have higher rates of disruptive behaviors than other youths, included SGAs in most cases. 13 The use of SGAs has also reflected a shift toward more complicated treatment regimens; 85% of youths receiving SGAs between 2004 and 2008 were concurrently receiving other psychotropic medications.…”

Management of Adverse Effects of Second-generation Antipsychotics in Youth

“…In the U.S., the number of children treated with SGAs increased 22 % from 2004 to 2008, with an average of 250,000 prescriptions per year for children under 6 years of age and numerous prescriptions for non-psychotic disorders and off-label indications [8]. In the 50 U.S. states and the District of Columbia, antipsychotic use increased 62 % from 2002 to 2007, reaching a total of 354,000 child and adolescent psychiatric patients by 2007, most of them presenting bipolar disorders, schizophrenia, and autism, comorbid with ADHD in 50 % of the cases [9]. Similarly, in France, SGAs are prescribed primarily for bipolar disorders, schizophrenia, and autism.…”

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

“…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.…”