Antipsychotic Use Up in Adolescents Despite No Mental Health Dx

New research in JAMA Psychiatry reports that use of antipsychotics increased among adolescents and young adults over a four-year period, even though more than half did not have an outpatient or inpatient claim that included a mental disorder diagnosis.

Mark Olfson, MD, MPH, of Columbia University in New York, and colleagues analyzed antipsychotic prescription information from a database that included about 60% of retail pharmacies in the United States. The percentages of younger children, older children, adolescents, and young adults with one or more antipsychotic prescriptions were calculated for the years 2006–2010. Data on 1.3 million children were included in the study.

Overall there were approximately 270,000 antipsychotic prescriptions dispensed to younger children, 2.1 million to older children, 2.8 million to adolescents, and 1.8 million to young adults in 2010. The percentages of young people using antipsychotics in 2006 and 2010, respectively, were 0.14% and 0.11% for younger children aged 1–6, 0.85% and 0.80% for older children aged 7–12, 1.10% and 1.19% for adolescents aged 13–18, and 0.69% and 0.84% for young adults aged 19–24. Males were more likely than females in 2010 to use antipsychotics, particularly during childhood and adolescence. Having a prescription from a psychiatrist was less common among younger children (57.9%) compared to the older age groups (70.4–77.9%). and only a minority of children filled a prescription from a child and adolescent psychiatrist (29.3% of younger children, 39.2% of older children, 39.2% of adolescents, and 14.2% of young adults in 2010).

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A total of 60% of the younger children, 56.7% of the older children, 62% of the adolescents, and 67.1% of the young adults treated with antipsychotic medications had no outpatient or inpatient claim that included a mental disorder diagnosis when 2009 medical claims and a sample from the database were merged. For those with claims for mental disorders in 2009 who were treated with antipsychotics, the most common diagnoses were attention-deficit/hyperactivity disorder in younger children (52.5%), older children (60.1%) and adolescents (34.9%) and depression in young adults (34.5%).

The authors conclude that age and sex antipsychotic use patterns indicate that a significant portion of antipsychotic treatments for children and younger adolescents are targeting age-limited behavioral problems. Improved quality and safety of antipsychotic medication use in young people should be integrated via expanded use of quality measures, physician education, telephone- and Internet-based child and adolescent psychiatry consultation models, and improved access to alternative, evidence-based psychosocial treatments, they conclude.

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