Abstract
Objective: Antipsychotics are licensed for psychosis and are also prescribed for behavior control. This study aims to examine characteristics and outcomes of children prescribed antipsychotics.Methods: A cohort study using general practice and hospital records linked with education records for 1,488,936 children living in Wales between 1999 and 2015. The characteristics of the children who were prescribed antipsychotics are presented using descriptive statistics and outcomes such as respiratory illness, diabetes, and injury were analyzed using multilevel logistic regression and the prior event rate ratio (PERR).Results: Children with intellectual difficulty/autism were more likely to be prescribed antipsychotics (2.8% have been prescribed an antipsychotic [75% with autism] compared with 0.15% of children without intellectual difficulty). Those with intellectual disabilities/autism were prescribed antipsychotics at a younger age and for a longer period. Antipsychotic use was associated with a higher rate of respiratory illness for all (PERR of hospital admission: 1.55 [95% CI: 1.51–1.598] or increase in rate of 2 per 100 per year in those treated), and for those with intellectual difficulty/autism, there was a higher rate of injury and hospitalized depression. However, among those without intellectual difficulty/autism, there were lower rates of depression (PERR: 0.55 [95% CI: 0.51–0.59]).Conclusions: This work shows real-world use of antipsychotics and provides information on the rate of possible adverse events in children treated. Antipsychotics are predominantly used for those with intellectual difficulty/autism rather than those with a psychotic diagnosis. There is evidence that rates of respiratory disease, epilepsy, and diabetes are also higher postantipsychotic use for all. In those with intellectual difficulty/autism, hospital-admitted depression and injury are higher postantipsychotic use. The use of antipsychotics for behavioral management is likely to have increased cost implications to the healthcare system.
Highlights
Antipsychotic medication such as haloperidol, aripiprazole, or risperidone are licensed in the United Kingdom for use in children (Kavanagh et al 2015)
Antipsychotic use was associated with a higher rate of respiratory illness for all (PERR of hospital admission: 1.55 [95% CI: 1.51–1.598] or increase in rate of 2 per 100 per year in those treated), and for those with intellectual difficulty/autism, there was a higher rate of injury and hospitalized depression
A total of 1,488,936 children younger than 18 years were identified from general practice (GP) records (Table 1 and Supplementary Data S2) and stratified by (1) no intellectual difficulty/autism, no childhood history of antipsychotic use (n = 1,457,783, [97.9% of population], 51.4% male), (2) no intellectual difficulty/autism, antipsychotic use (n = 2204 [0.15% of population], 60.4% male), (3) intellectual difficulty, no childhood history of antipsychotic use (n = 28,125 [1.9% of population], 67% male), and (4) intellectual difficulty and history of antipsychotic use (n = 824 [0.04% of population], 78.0% male)
Summary
Antipsychotic medication such as haloperidol, aripiprazole (for schizophrenia, bipolar [mania]), or risperidone (for conduct disorders) are licensed in the United Kingdom for use in children (Kavanagh et al 2015). Off-label (not licensed for children and adolescents) olanzapine, quetiapine, and amisulpride are used (Kavanagh et al 2015) and the majority of antipsychotic prescriptions is off label (Carton et al 2015). Long-term use can in rare cases be associated with tardive dyskinesia—a neurological disorder resulting in compulsive movement.
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