A steadily increasing number of patients younger than age 20 received prescriptions for antipsychotic medications between 1993 and 2002, according to a report published in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Antipsychotics are medications used to treat mental disorders, such as schizophrenia and mania, that may involve loss of contact with reality. Several studies have indicated that prescriptions for these medications have been increasing among children and adolescents, raising concerns among professionals and the public. However, no national data have previously been available, according to background information in the article. Most prescriptions given to children and adolescents are for second-generation antipsychotics, which are not approved by the U.S. Food and Drug Administration for pediatric patients.
Mark Olfson, M.D., M.P.H., College of Physicians and Surgeons, Columbia University, New York, and colleagues analyzed data from a national survey of office-based physicians conducted yearly by federal researchers. In addition to recording whether the child or adolescent patient received a prescription for antipsychotics, the physician or a staff member also logged the patient's age, sex and race or ethnicity; the length of the visit; the physician's specialty and whether the patient received psychotherapy.
The number of outpatient health care visits during which patients between the ages of 0 and 20 years received antipsychotic medications increased six-fold between 1993 and 2002, from a yearly average of 201,000 between 1993 and 1995 to 1,224,000 in 2002. For every 100,000 individuals younger than age 21 in the United States, 274.7 such office visits took place each year from 1993 to 1995, compared with 1,341 each year from 2000 to 2002. Overall, 9.2 percent of mental health visits and 18.3 percent of visits to psychiatrists included antipsychotic treatment. Diagnoses among the patients receiving these medications included disruptive behavior disorder (37.8 percent), mood disorders (31.8 percent), pervasive developmental disorders or mental retardation (17.3 percent) and psychotic disorders (14.2 percent). Male and white youth were most likely to receive such treatments.
The availability of new antipsychotics with fewer side effects in adults may have contributed to the increase. In addition, fewer inpatient care options are available for children with mental illnesses, requiring physicians to treat more seriously ill children in an outpatient setting. These severely ill patients are more likely to require powerful medications like antipsychotics. Although these medications may be safe and effective for some mental disorders in pediatric patients, further research is needed to confirm this and provide detailed information about benefits and risks, the authors write.
"In recent years, second-generation antipsychotic medications have become common in the office-based mental health treatment of young people," they conclude. "These medications are used to treat children and adolescents with different mental disorders. Results of clinical trials provide a limited base of support for the short-term safety and efficacy of some second-generation antipsychotic medications for psychosis and disruptive behavior disorders. In light of the widespread and growing use of these medications, there is a pressing need to increase and extend the experimental evaluation of these medications in children and adolescents."
This study was supported by grants from the National Institutes of Health and by an Alicia Koplowitz Foundation Fellowship in Child and Adolescent Psychiatry. Dr. Olfson has received grants from Eli Lilly and Bristol-Myers Squibb and has served as a consultant to Eli Lilly, Pfizer, Bristol-Myers Squibb and McNeil Pharmaceuticals.
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