Friday, June 09, 2006

AGP: Antipsychotic use in kids increases

The New York Times highlights this week's article in the Archives of General Psychiatry
suggesting that the use of atypical antipsychotics in children continues to climb. At the top, you can see the relative rates at which folks enter 5 commonly-prescribed antipsychotics in Google's search engine. I would have thought that Zyprexa would have been #1 search, as it is the #1 cost drug for many state Medicaid formularies.

Nearly one-fifth of visits to psychiatrists included prescriptions for antipsychotics. This is quite disturbing, especially because nearly 40% of the kids are taking these for "disruptive behavior disorders". The drugs are approved for schizophrenia and bipolar disorders.

National trends in office-based visits by children and adolescents that included antipsychotic treatment, 1993–2002. Annualized visit rates per 100 000 population aged 0 to 20 years were calculated using National Ambulatory Medical Care Survey and US Census Bureau data:

from the NYT:
Dr. DelBello said that the field "desperately needs more research" to clarify the effects of the antipsychotic drugs, but that many children struggling with bipolar disorder get more symptom relief on these drugs than on others, allowing psychiatrists to cut down on the overall number of medications a child is taking.


On the Same Page said...

I found this whole issue of the Journal a bit distressing. I spent a year in Child & Adolescdent Psychiatry at a Naval Medical Center. It was a small unit where patients and issues were thoroughly staffed. I was satisfied that the over-all philosophy regarding medications and children was sober and evidence-based, and nearly always included psychotherapy and/or family therapy, and educational/support groups for parents. Decisions to prescribe stimulants for ADHD, for example, came only after computerized Connor's Continuous Performance testing, and Connor's reports from parents & teachers had been examined. As always, I fear that stats will reflect prescribing patterns of non-psychiatrists. But a "struggling" child and "wits-end" parents certainly creates a pressured, "do something, anything" office visit.

See, Dinah, not one word about prisoners. But believe me I could...

NeoNurseChic said...
This comment has been removed by the author.
Prue said...


I also find this trend very distressing. As a psychiatrist myself, I see these drugs being used for all sorts of disorders other than what they were intended to treat. I'm not completely against off-label use, when it makes sense.

The antipsychotics, even the newer atypical class, are not without side effects. Sometimes I wonder if other physicians actually bother to get informed consent from their patients or their patients' parents.

Also, another thing that fries my booty are the thousands and thousands of kids who are referred to psychiatry because the school demanded it. Often the only problem these kids have is lousy parents, which no drug will cure the child of.

Just some thoughts...