Abstract
To examine the rates of antipsychotic prescribing in the Irish paediatric and young adult population enrolled in the Irish General Medical Services Scheme pharmacy claims database from the Health Service Executive Primary Care Reimbursement Services database, with a focus on age and sex differences. To examine concomitant prescribing of certain other related medicines in this population. Data were obtained from the Irish General Medical Services (GMS) scheme pharmacy claims database from the Health Service Executive (HSE) - Primary Care Reimbursement Services (PCRS). Participants included children aged <16 years and youth aged 16-24 years availing of medicines under the HSE-PCRS GMS scheme between January 2005 and December 2015. Outcome measures included prescribing rates of antipsychotics from 2005 to 2015, differences in prescribing rates between different ages and sexes, and percentage of concomitant prescriptions for antidepressants, psychostimulants, anxiolytics and hypnosedatives. Overall the trend in prescribing rates of antipsychotic medications was stable at 3.94/1000 in 2005 compared with 3.97/1000 in 2015 for children <16 years, and 48.37/1000 eligible population in 2005 compared to 39.64/1000 in 2015 for those aged 16-24. There was a significant decrease in prescribing rates for males in the 16-24 age group. While rates of antipsychotic prescribing have decreased or remained stable over the timeframe of the study, we did find a significant proportion of this population were prescribed antipsychotics. This study also shows that co-prescribing of antidepressants increased and highlights the need for guidelines for antipsychotic prescribing in children and youth in terms of clinical indication, monitoring, co-prescribing and treatment duration.
Highlights
Antipsychotic medications (APs) are major tranquilisers used primarily in the treatment of psychotic disorders and increasingly for treatment of nonpsychotic disorders, such as mixed or manic episodes in bipolar disorder, irritability in autism spectrum disorder (ASD) and conduct disorder
Atypical APs have reduced extrapyramidal side-effects compared with typical antipsychotics, it is widely recognised that they confer greater risks of weight gain and the metabolic syndrome which are associated with significant morbidity (Clarke, 2004)
In 2005 there were a total of 339,725 youth aged 0–24 on the General Medical Services (GMS) list or 26.45% of the population
Summary
Antipsychotic medications (APs) are major tranquilisers used primarily in the treatment of psychotic disorders and increasingly for treatment of nonpsychotic disorders, such as mixed or manic episodes in bipolar disorder, irritability in autism spectrum disorder (ASD) and conduct disorder. They are classified broadly as first and second generation, referred to as typical and atypical APs respectively. APs result in dopamine blockade in the main dopaminergic pathways in the brain. The different APs have variable receptor binding profiles, with different APs acting on serotonin, histamine and dopamine receptors (Reynolds & Kirk, 2010). Atypical APs have reduced extrapyramidal side-effects compared with typical antipsychotics, it is widely recognised that they confer greater risks of weight gain and the metabolic syndrome which are associated with significant morbidity (Clarke, 2004)
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