OBJECTIVES: This study examined patterns and determinants of antipsychotic prescribing in children and adolescents receiving outpatient care in the United States. METHODS: Antipsychotic prescribing practices for patients younger than 20 years were examined using the 2003-2004 National Ambulatory Medical Care Survey and the outpatient department portion of the 2003-2004 National Hospital Ambulatory Medical Care Survey. The analysis focused on outpatient visits involving 11 typical and six atypical antipsychotic agents. National visit estimates were used to characterize the nature and extent of antipsychotic prescribing for patients younger than 20 years. Multiple logistic regression analysis was applied to visits involving children and adolescents to examine the need, predisposing, and enabling factors associated with antipsychotic prescribing. RESULTS: Antipsychotic medications were prescribed in two million outpatient visits annually involving children and adolescents, representing 1% of overall visits by children and adolescents in 2003-2004. Most (99%) of these visits involved prescribing of atypical agents. The most frequently prescribed atypical agents were risperidone, quetiapine, and aripiprazole. The majority of the visits involving antipsychotic medications in children were seen in patients over 9 years, males, and whites. Factors positively associated with antipsychotic prescribing in children and adolescents included age over 9 years, diagnoses (bipolar disorder, psychoses, depression, disruptive behavior, and anxiety), and visits to specialists. Private insurance was negatively associated with antipsychotic prescribing. CONCLUSIONS: Although the findings were based on cross-sectional analyses of outpatient visit data, the study revealed that atypical antipsychotic medications are being commonly and extensively prescribed to children and adolescents despite the relatively limited scientific evidence to support their pediatric use. Well-designed studies are urgently needed in children and adolescents to address atypical antipsychotic use for a variety of psychiatric disorders.
OBJECTIVES: This study examined patterns and determinants of antipsychotic prescribing in children and adolescents receiving outpatient care in the United States. METHODS: Antipsychotic prescribing practices for patients younger than 20 years were examined using the 2003-2004 National Ambulatory Medical Care Survey and the outpatient department portion of the 2003-2004 National Hospital Ambulatory Medical Care Survey. The analysis focused on outpatient visits involving 11 typical and six atypical antipsychotic agents. National visit estimates were used to characterize the nature and extent of antipsychotic prescribing for patients younger than 20 years. Multiple logistic regression analysis was applied to visits involving children and adolescents to examine the need, predisposing, and enabling factors associated with antipsychotic prescribing. RESULTS: Antipsychotic medications were prescribed in two million outpatient visits annually involving children and adolescents, representing 1% of overall visits by children and adolescents in 2003-2004. Most (99%) of these visits involved prescribing of atypical agents. The most frequently prescribed atypical agents were risperidone, quetiapine, and aripiprazole. The majority of the visits involving antipsychotic medications in children were seen in patients over 9 years, males, and whites. Factors positively associated with antipsychotic prescribing in children and adolescents included age over 9 years, diagnoses (bipolar disorder, psychoses, depression, disruptive behavior, and anxiety), and visits to specialists. Private insurance was negatively associated with antipsychotic prescribing. CONCLUSIONS: Although the findings were based on cross-sectional analyses of outpatient visit data, the study revealed that atypical antipsychotic medications are being commonly and extensively prescribed to children and adolescents despite the relatively limited scientific evidence to support their pediatric use. Well-designed studies are urgently needed in children and adolescents to address atypical antipsychotic use for a variety of psychiatric disorders.
Authors: Catherine A Fullerton; Arnold M Epstein; Richard G Frank; Sharon-Lise T Normand; Christina X Fu; Thomas G McGuire Journal: Psychiatr Serv Date: 2012-02-01 Impact factor: 3.084
Authors: Bradley D Stein; Emily Leckman-Westin; Edward Okeke; Deborah M Scharf; Mark Sorbero; Qingxian Chen; Ka Ho Brian Chor; Molly Finnerty; Jennifer P Wisdom Journal: J Child Adolesc Psychopharmacol Date: 2014-08-21 Impact factor: 2.576
Authors: Robert L Findling; Sarah McCue Horwitz; Boris Birmaher; Robert A Kowatch; Mary A Fristad; Eric A Youngstrom; Thomas W Frazier; David Axelson; Neal Ryan; Christine A Demeter; Judith Depew; Benjamin Fields; Mary Kay Gill; Elizabeth A Deyling; Brieana M Rowles; L Eugene Arnold Journal: J Child Adolesc Psychopharmacol Date: 2011-08 Impact factor: 2.576