By Sandra Distelhorst
VANCOUVER — May 8, 2010 — The prescribing of psychoactive medication, particularly atypical antipsychotics, for children and adolescents has steadily increased over the past decade, according to a study presented here at the 2010 Pediatric Academic Societies (PAS) Annual Meeting.
The actual frequency and types of psychoactive medications used is not well known, said Victoria Tutag-Lehr, PharmD, Clinical Pharmacology/Toxicology, Children’s Hospital of Michigan, Detroit, Michigan, on May 1.
The study used claims and encounter data from the MarketScan database to estimate the frequency and type of psychoactive and antipsychotic medication use, multiple medication use (polypharmacy), and comorbid mental health and non-mental health conditions. The retrospective analysis included children aged younger than 18 years on July 1, 2007, who were eligible for health insurance for all of 2007. Medication use was classified by prescriptions dispensed in 2007.
The researchers found data for 2.9 million children who met the criteria of continuous enrolment and reporting of pharmacy and mental health and substance abuse claims. Of these, 227,986 (7.9%) were given at least 1 prescription for a psychoactive medication and 21,549 (0.8%) were given least 1 prescription for an antipsychotic medication.
“The most surprising result was that nearly all [almost 99%] of the children and adolescents who received an antipsychotic received an atypical antipsychotic,” said Dr. Tutag-Lehr.
Children receiving antipsychotic medication were older (mean age 12.4 vs 11.5 years; P < .001) and male (66.7% vs 59.2%; P < .001) and used more psychoactive medications (2.6 vs 1.2; P < .001) compared with those receiving at least 1 prescription for any other psychoactive medication. The most frequent diagnoses associated with antipsychotic use were attention-deficit hyperactivity disorder, bipolar disorder, and major depression. The leading non-mental health conditions in children receiving antipsychotics were chronic lung disease (7%) and neurological disorders (2%).
"The use of these second-generation antipsychotics is worrisome because these agents are associated with weight gain and type I diabetes," said Dr. Tutag-Lehr. "The developing hepatic and endocrine systems in young children may be particularly sensitive to adverse medication consequences," she continued.
The researchers concluded that atypical antipsychotics were frequently prescribed for children aged younger than 18 years.
"There are no long-term studies, so we don't know the long-term outcomes for these medications in this vulnerable population," said Dr. Tutag-Lehr.
[Presentation title: Antipsychotic Use Among Children and Adolescents in a Large Insured Population. Abstract 1490.356]