Trends in Antipsychotic Drug Use by Very Young, Privately Insured Children

Olfson, Mark; Crystal, Stephen; Huang, Cecilia; Gerhard, Tobias

doi:10.1097/00004583-201001000-00005

Cited by 105 publications

(121 citation statements)

References 41 publications

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“…Several studies have demonstrated sharp rises in antipsychotic treatment among Medicaid-insured and privately insured children. [1][2][3][4][5] The prevalence of antipsychotic medication use among youth is estimated at 1% to 3% among Medicaid-insured youth, which is about double the rate of those with private insurance. [6][7][8] Concern that the increase represents an overuse of this class of medications has come from evidence that antipsychotic agents are frequently prescribed outside of indications approved by the US Food and Drug Administration (FDA) and before other types of treatments have been attempted.…”

Section: What This Study Addsmentioning

confidence: 99%

Antipsychotic Medication Prescribing in Children Enrolled in Medicaid

et al. 2015

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BACKGROUND: Although the increase in treatment of children and adolescents with antipsychotic medications has been well documented, much less is known about the factors related to the use of these agents and how closely the treatment follows best practice recommendations.METHODS: Prescribers of each antipsychotic medication prescription issued for a Medicaidinsured child in Vermont aged ,18 years were sent a prior authorization survey that assessed several domains including the clinical indication, other treatments, metabolic monitoring, prescriber specialty, and prescription origin. These variables were combined to categorize prescriptions as following indications approved by the US Food and Drug Administration (FDA) and best practice guidelines. RESULTS:The response rate of the survey was 80%, with 677 surveys from 147 prescribers available for analysis; more than one-half of the respondents were primary care clinicians. Overall, the clinical indication for an antipsychotic prescription followed best practice guidelines 91.7% of the time, with overall best practice guidelines followed at a rate of 50.1%. An FDA indication was followed in 27.2% of cases. Psychiatrists were significantly more likely to follow best practice guidelines than nonpsychiatrists. Antipsychotic medications were typically used only after other pharmacologic and nonpharmacologic treatments were ineffective, although previous treatment with cognitive-behavioral therapy was uncommon (15.5%). Metabolic monitoring that included serial laboratory tests was reported in 57.2% of cases.CONCLUSIONS: Current prescribing patterns of antipsychotic medications for children and adolescents follow best practice guidelines approximately one-half of the time, with nonadherence often related to lack of metabolic monitoring. WHAT'S KNOWN ON THIS SUBJECT:Although the rates of antipsychotic medication treatment are rising for children and adolescents, little is known about the factors associated with this practice. WHAT THIS STUDY ADDS:This study provides some of the first data regarding when and why clinicians decide to use antipsychotic medications. It reveals clues as to how prescribing might better follow best practice guidelines.

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Section: What This Study Addsmentioning

confidence: 99%

Antipsychotic Medication Prescribing in Children Enrolled in Medicaid

et al. 2015

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“…Risperidone is the most commonly prescribed antipsychotic drug in paediatric patients [4,12,13]. It has been repeatedly reported that risperidone is associated with much higher weight gain in children and adolescents than those in adults [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Risperidone-induced weight gain and reduced locomotor activity in juvenile female rats: The role of histaminergic and NPY pathways

Lian

Santis

et al. 2015

Pharmacological Research

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. (2015). Risperidone-induced weight gain and reduced locomotor activity in juvenile female rats: the role of histaminergic and NPY pathways. Pharmacological Research,[95][96] Risperidone-induced weight gain and reduced locomotor activity in juvenile female rats: the role of histaminergic and NPY pathways AbstractSecond generation antipsychotic drugs (SGAs) such as risperidone are increasingly prescribed (mostly for offlabel use) to children and adolescents for treating various mental disorders. SGAs cause serious weight gain/ obesity and other metabolic side-effects. This study aimed to establish an animal model of risperidoneinduced weight gain in female juvenile rats, and to investigate the effects of risperidone on the expression of hypothalamic histaminergic H1 receptors (H1R) and neuropeptides, and their association with weight gain. Female Sprague Dawley rats were treated orally with risperidone (0.3 mg/kg, 3 times/day) or vehicle (control) starting from postnatal day (PD) 23 (±1 day) for 3 weeks (a period corresponding to the childhoodadolescent period in humans). In the female juvenile rats, risperidone treatment increased food intake and body weight gain, which started to appear after 12 days' treatment. Risperidone also significantly decreased the locomotor activity of the female rats. Consistently, risperidone significantly elevated mRNA expression of hypothalamic H1R, neuropeptide Y (NPY), and agouti-related peptide (AgRP) compared to controls, and H1R and NPY levels were correlated with risperidone enhanced weight gain and food intake in the female juvenile rats. However, risperidone did not affect hypothalamic proopiomelanocortin (POMC) and cocaineand amphetamine-regulated transcript (CART) mRNA expression. Therefore, these results suggested that risperidone elevated appetite and body weight gain in juveniles via regulation of the hypothalamic H1R, NPY and AgRP pathways, as well as by reducing activity.

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“…Research shows increasing rates of psychotropic use and the simultaneous use of multiple psychotropic medications (polypharmacy) among children overall [1][2][3][4][5] and in children with autism spectrum disorders (ASD). [6][7][8][9][10][11][12] General concerns about these medications include the lack of evidence documenting the safety or effectiveness of psychotropic treatment during childhood, when developing brains and bodies may be particularly vulnerable to environmental or biological influences.…”

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confidence: 99%

Psychotropic Medication Use and Polypharmacy in Children With Autism Spectrum Disorders

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Psychotropic use is common and increasing in children with mental disorders but little is known about the long-term patterns of psychotropic use and polypharmacy among commercially insured children with autism spectrum disorders. WHAT THIS STUDY ADDS:Among 33 565 children with autism spectrum disorders, 64% used psychotropic medications and 35% had evidence of polypharmacy. Older children and those who had seizures, attention-deficit disorders, anxiety, bipolar disorder, or depression had increased risk of psychotropic use and polypharmacy.abstract OBJECTIVE: The objectives of this study were to examine rates and predictors of psychotropic use and multiclass polypharmacy among commercially insured children with autism spectrum disorders (ASD).METHODS: This retrospective observational study used administrative medical and pharmacy claims data linked with health plan enrollment and sociodemographic information from 2001 to 2009. Children with ASD were identified by using a validated ASD case algorithm. Psychotropic polypharmacy was defined as concurrent medication fills across $2 classes for at least 30 days. Multinomial logistic regression was used to model 5 categories of psychotropic use and multiclass polypharmacy. RESULTS:Among 33 565 children with ASD, 64% had a filled prescription for at least 1 psychotropic medication, 35% had evidence of psychotropic polypharmacy ($2 classes), and 15% used medications from $3 classes concurrently. Among children with polypharmacy, the median length of polypharmacy was 346 days. Older children, those who had a psychiatrist visit, and those with evidence of cooccurring conditions (seizures, attention-deficit disorders, anxiety, bipolar disorder, or depression) had higher odds of psychotropic use and/or polypharmacy.CONCLUSIONS: Despite minimal evidence of the effectiveness or appropriateness of multidrug treatment of ASD, psychotropic medications are commonly used, singly and in combination, for ASD and its cooccurring conditions. Our results indicate the need to develop standards of care around the prescription of psychotropic medications to children with ASD. Pediatrics 2013;132:833-840

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Trends in Antipsychotic Drug Use by Very Young, Privately Insured Children

Cited by 105 publications

References 41 publications

Antipsychotic Medication Prescribing in Children Enrolled in Medicaid

Antipsychotic Medication Prescribing in Children Enrolled in Medicaid

Risperidone-induced weight gain and reduced locomotor activity in juvenile female rats: The role of histaminergic and NPY pathways

Psychotropic Medication Use and Polypharmacy in Children With Autism Spectrum Disorders

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