Use Of Psychotropic Drugs In Children Research Articles

Effects of parental job loss on psychotropic drug use in children: Long-term effects, timing, and cumulative exposure

Intra-family crossover effects triggered by job losses have received growing attention across scientific disciplines, but existing research has reached discrepant conclusions concerning if, and if so how, parental job losses affect child mental health. Drawing on sociological models of stress and life course epidemiology, we ask if parental job losses have long-term effects on child mental health, and if these effects are conditional on the timing of, or the cumulative exposure to, job losses. We use intergenerationally linked Swedish register data combined with entropy balance and structural nested mean models for the analyses. The data allow us to track 400,000 children over 14 years and thereby test different life-course models of cross-over effects. We identify involuntary job losses using information on workplace closures, thus reducing the risk of confounding. Results show that paternal but not maternal job loss significantly increases the risk of psychotropic drug use among children, that the average effects are modest in size (less than 4% in relative terms), that they may persist for up to five years, and that they are driven by children aged 6–10 years. Moreover, cumulative exposure to multiple job losses are more harmful than zero or one job loss.

1401-P: Psychotropic Drug Use in Children and Adolescents with Type 1 Diabetes

Psychiatric disorders in children and adolescents with type 1 diabetes (T1D) have caught increasing attention. While psychotropic drugs offer great value in managing psychiatric symptoms, their adverse effects engender considerable controversy regarding their use in pediatric patients, let alone in those with T1D. Despite the topic’s high visibility, little evidence exists on the patterns of psychotropic drug use in pediatric T1D patients. We thus conducted this cohort study of 3,720,381 children and adolescents (13,191 [0.36%] had T1D) using several Swedish national registers. We examined the trends and patterns (prescription source and treatment duration) of psychotropic drug use and estimated the risk of initiating psychotropic drugs after T1D onset. We found that psychotropic drug use increased significantly in children and adolescents with T1D from 2006 to 2019 (Figure 1), with ADHD medications, SSRI, hypnotics and anxiolytics among the most used ones. The primary prescription source was psychiatric care, and treatment durations were mostly <12 months (except for ADHD medications). Children and adolescents with newly-onset T1D had a higher risk of initiating any psychotropic drug (hazard ratio 1.29, 95%CI 1.20-1.38) than their peers without T1D. Our findings highlight the need for risk/benefit studies of psychotropic drugs among young users with T1D to inform future research and guideline development. Disclosure S.Liu: None. T.Lagerberg: None. J.F.Ludvigsson: Research Support; Janssen Pharmaceuticals, Inc., MSD Life Science Foundation. M.Taylor: None. B.Donofrio: None. P.Lichtenstein: None. S.Gudbjörnsdottir: None. A.Butwicka: None. Funding Swedish Research Council (2017-00788)

Psychotropic Drug Use in Children and Adolescents Before and During the COVID-19 Pandemic

Psychotropic Drug Use in Children and Adolescents Before and During the COVID-19 Pandemic

Psychotropic use in children and adolescents in Scandinavia and Catalonia: a 10-year population-based study.

The use of psychotropic drugs in the paediatric population has not been the subject of many studies, due to the fact that this population is generally not included in clinical trials and these drugs are not authorized for use on minors. This study aims to provide an accurate description of psychotropic drug use in children and adolescents in the North of Europe and Catalonia. Data from 2008 to 2017 on psychotropic drug consumption in children and adolescents were retrieved from the databases of Catalonia, Denmark, Norway and Sweden. Psychotropic drugs were divided into antipsychotics, anxiolytics (also hypnotics and sedatives), antidepressants and psychostimulants. Data were stratified by group of age (0-4, 5-9, 10-14 and 15-19/15-17 for Denmark and Catalonia) and sex. Overall, the group of anxiolytics shows the highest consumption and the group of antipsychotics the lowest. In 2017, Sweden was the country with the highest consumption of psychotropic drugs (6.67‰) and has the highest increase in consumption (152.8%), and Denmark has the lowest consumption for all groups (3.13‰). Catalonia shows a decrease in psychotropic drugs (-15.9%). Girls consume more than twice as many antidepressants as boys while the opposite is true for psychostimulants. Risperidone and quetiapine are among the most consumed antipsychotics in the Nordic countries, whereas in Catalonia they are risperidone and aripiprazole. Among antidepressants, sertraline is the most consumed. No differences are found among the psychostimulants. Psychotropic consumption in younger populations is increasing, although there are differences between the countries as far as which drugs are used. Nordic countries show a higher prevalence of use than Catalonia. Psychotropic drug consumption increases with age, except for psychostimulants, which have the highest utilization rate among 10-14-year-olds.

Psychotropic Drug Use in Children with Autism Spectrum Disorder Admitted to a Training and Research Hospital Outpatient Clinic: A Retrospective Cross-Sectional Study

AbstractThis study aimed to examine demographic and clinical variables, psychiatric comorbidities, the prevalence of psychotropic drug use, relationships between drug use, demographic and clinical variables, and predictors of drug use in children with autism spectrum disorder (ASD) admitted to a training and research hospital outpatient clinic. Four hundred and eleven children with ASD admitted to the Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, between October 1, 2019 and December 31, 2019, were retrospectively reviewed. Demographic and clinical variables, psychiatric comorbidities, and characteristics of drug use for the cases were recorded. Psychotropic drug use was found in 34.3% (n = 141) of the cases. Our results revealed male sex and psychiatric comorbidity as predictors of psychotropic drug use. Antipsychotics were the most prescribed drugs, and the most common psychiatric comorbidity was conduct disorder. Also, children with ASD who had been toilet-trained, and could express sentences but were illiterate, were using psychotropic drugs more often than others. Future multicentered, large clinic-based studies from training and research hospitals should focus on trends of treatment in psychiatric comorbidities accompanying ASD, and constitute a systematic approach for the psychopharmacological treatment of these cases.

Use of Psychotropic Drugs among Children and Adolescents with Autism Spectrum Disorders in Denmark: A Nationwide Drug Utilization Study.

Children with autism spectrum disorder (ASD) have a considerable use of psychotropics. Leveraging nationwide registry data, we aimed to describe the use of psychotropics among children and adolescents with ASD in Denmark. Use of melatonin and attention-deficit/hyperactivity disorder (ADHD) medication increased from 2010 to 2017, while there were limited changes in use of antidepressants and antipsychotics. Thirty percent of the identified children used psychotropics in 2017 most commonly ADHD medication (17%) and melatonin (13%). Methylphenidate, sertraline and risperidone were most often prescribed. Most children filled more than one prescription and, across drug classes, at least 38% received treatment two years after treatment initiation. Use of psychotropics followed psychiatric comorbidities. Comorbidities did not affect age at treatment initiation. Use of psychotropics varied according to age and sex with limited use in the youngest children. In summary, psychotropic drug use has increased in children with ASD mainly due to an increase in the use of ADHD medication and melatonin. In accordance with previous studies, use seems to follow comorbidities. The long treatment duration underlines the need to investigate long-term effects of psychotropic drug use in children with ASD.

Psychotropic drug utilization in children with concurrent attention-deficit/hyperactivity disorder and anxiety

• We examined psychotropic drug use in children with ADHD and anxiety. • The overall follow-up time was occupied almost evenly by no treatment (∼30%), mono-(∼40%) and combination pharmacotherapy (∼30%). • Treatment prevalence of ADHD outweighed treatment of anxiety. • Both clinical and non-clinical factors had impact on combination pharmacotherapy. • Significant treatment differences exist among the 26 US study states.

Prevalence and characteristics of psychotropic drug use in institutionalized children and adolescents with mild intellectual disability

Psychotropic drugs are a cornerstone in the treatment of psychopathology and/or behavioral problems in children with intellectual disability (ID), despite concerns about efficacy and safety. Studies on the prevalence of psychotropic drug use have mainly been focused on adults with ID or children without ID. Therefore the aim of this cross sectional study was to assess the prevalence and characteristics of psychotropic drug use in children with mild ID who were institutionalized in specialized inpatient treatment facilities in The Netherlands. Demographic data, psychiatric diagnoses, the nature of the behavioral problems, level of intellectual functioning, and medication data were extracted from medical records using a standardized data collection form. Adjusted relative risks (ARR) for the association between patient characteristics and psychotropic drug use were estimated with Cox regression analysis. Of the 472 included children, 29.4% (n=139) used any psychotropic drug, of which 15.3% (n=72) used antipsychotics (mainly risperidone), and 14.8% (n=70) used psychostimulants (mainly methylphenidate). Age, sex, and behavioral problems were associated with psychotropic drug use. Boys had a 1.7 (95%CI 1.1-2.4) higher probability of using psychotropic drugs, compared to girls adjusted for age and behavioral problems. Having any behavioral problem was associated with psychotropic drug use with an ARR of 2.1 (95%CI 1.3-3.3), adjusted for sex and age. The high prevalence of psychotropic drug use in children with ID is worrisome because of the lack of evidence of effectiveness (especially for behavioral problems) at this young age, and the potential of adverse drug reactions.

Psychotropic Medication Use in Children With Autism in the Kentucky Medicaid Population

This study reviewed Kentucky Medicaid claims data for children with autism spectrum disorders to determine psychotropic drug (PTD) use in this population. Children with autism spectrum disorders (ICD-9 code 299.XX) in 3 different age-groups from 2005 to 2008 were identified; PTD use was defined as at least 1 prescription per year. PTD use in all age ranges was higher than in previously reported studies. High PTD use in children between 1 and 5 years is particularly of concern and may reflect perceived inadequacies of comprehensive educational/behavioral services for these children.

The risk of developing type 2 diabetes mellitus associated with psychotropic drug use in children and adolescents: a retrospective cohort analysis.

Type 2 diabetes mellitus in children and adolescents has become an important public health concern, in parallel with the "epidemic" of overweight/obesity in this age group and a sharp increase in children being prescribed antidepressant or antipsychotic medications. In children and adolescents, the prevalence of being prescribed antidepressant or antipsychotic medications was examined as well as the association of these medications with developing type 2 diabetes mellitus. A retrospective cohort design evaluating South Carolina Medicaid medical and pharmacy claims between January 1, 1996, and December 31, 2006, was employed to identify 4,070 children and adolescents diagnosed initially with type 2 diabetes mellitus, 39% of whom were later reclassified as type 1 (using ICD-9 criteria). The added risk of developing type 2 diabetes mellitus posed by the use of antidepressants or antipsychotics was investigated in this cohort, controlling for individual risk factors and comorbid cardiometabolic conditions. Use of antidepressants or antipsychotics alone, or the 2 in combination, conferred an increased risk (1.3 to 2 times greater) of having diagnosed type 2 diabetes mellitus and several comorbid cardiometabolic conditions (obesity, dyslipidemia, and hypertension). However, psychiatric illnesses generally developed and were treated after the initial development of diabetes. Depression was diagnosed and treated in 10% to 20% of this cohort. While antidepressants and antipsychotics, alone or in combination, are associated with a diagnosis of type 2 diabetes mellitus and its cardiometabolic comorbidities by adolescence, they do not appear to be an explanatory factor in the early onset of type 2 diabetes mellitus in this age group and do not appear to cloud the initial, overlapping clinical picture between type 1 and type 2 diabetes mellitus.

Is there potential for the treatment of children with ADHD beyond psychostimulants?

The past decades have seen a tremendous rise in the use of methylphenidate in children and adolescents. While the overall prevalence of psychotropic drug use in children and adolescents in the Netherlands doubled between 1995 and 2001, that of methylphenidate alone almost rose sixfold in those years [1]. Between 2001 and 2006, a further large increase was observed in the prescription rates of methylphenidate, not only in children and adolescents but also in adults [2]. While rates of methylphenidate use are still clearly highest amongst boys aged 6–11 years, the most rapid increase in prevalence rate of methylphenidate use has actually been seen in girls. Between 1996 and 2006 this has risen more than 11.5-fold in girls, according to a pharmacoepidemiological study conducted in the North of the Netherlands [3]. To put this into perspective: the latter study pointed out that the use of methylphenidate in girls in 2006 was almost double that of boys back in 1996. The increased use of methylphenidate contrasts with the lack of long term data on safety and effectiveness. Much of our knowledge about treatment periods of longer than a year comes from following up one study, the Multimodal Treatment of attention deficit/hyperactivity (ADHD) study (MTA) study. Although it should not be forgotten that all MTA data beyond the initial controlled period of 14 months has been strictly observational, so far long term benefits of optimized and well controlled methylphenidate treatment during a limited period of time of 14 months have been hard to demonstrate [4]. Thus, while on one hand, there are clear short-term benefits of methylphenidate for the treatment of ADHD, the uncertainty of long term benefits and risks remains an urgent challenge for the scientific and clinical community. What promise may alternative treatments offer for children with ADHD? Food-based interventions may be one option. In 2009, this Journal had published promising effects of a restricted elimination diet in reducing symptoms of ADHD versus a waiting list control group [5]. Results were recently confirmed in a larger scale Lancet study by the same group of investigators, in which there was a control group that received instructions for a healthy diet [6]. However, the difficulty of establishing a truly blinded control intervention constitutes perhaps the biggest design challenge in trying to more firmly demonstrate the efficacy of food-based treatments for ADHD. Ideally, well-designed and controlled replication studies should be conducted by independent groups who did not develop the intervention themselves. Another alternative treatment option that has now seen a number of randomized controlled trials is electroencephalogram (EEG)-based neurofeedback. This issue (Bakhshayesh et al.) contains a small-scale, but elegantly designed randomized controlled trial of EEG neurofeedback versus a sham condition (biofeedback aimed at forehead muscle relaxation). Importantly, children and parents were not explicitly informed about the two treatment conditions. Results indicated both specific effects of EEG neurofeedback (reduction of inattention symptoms on parent rating scales and reaction time in neuropsychological tests), as well as non-specific factors (regarding hyperactivity and impulsivity), which were similarly improved in the children receiving the sham treatment. Another study in this issue (Benjet et al.), using an epidemiological approach (based on interview data of more than 3,000 adolescents from the Mexican Adolescent Mental Health Survey) once more reminded us that it is not all genetics and neurobiology that determines mental disorders. Rather, it pointed to the important role of family dysfunctioning for the development of psychopathology. As the authors conclude, their study findings at least indirectly provide further evidence for the importance of family focused intervention and prevention efforts. With the ever rising prescription rates of methylphenidate, all too easily impressions of overtreatment rather than undertreatment of ADHD in children may arise. However, many children with impairing ADHD still receive no proper treatment [7]. Thus, effective and easy-to-implement screening questionnaires that can identify those children who are at risk of having ADHD or other behavioral disorders are crucial. The Strengths and Difficulties Questionnaire (SDQ) is one well-known example of a brief screening instrument. Ullebo and colleagues [8] in this issue describe that already the use of the 5-item-only SDQ hyperactivity- inattention subscale has adequate sensitivity for detecting ADHD combined subtype. Are we overtreating children with methylphenidate? There may be both over- and undertreatment. It remains an enormous challenge for the scientific community to more precisely establish the long-term risks and benefits of methylphenidate treatment and also to determine in which cases treatment with psychostimulants or alternative treatments are warranted. Well-designed studies involving alternative treatments remain urgently needed.

Rise in psychotropic drug prescribing in children and adolescents during 1992–2001: a population-based study in the UK

The trend towards increased psychotropic drug prescribing in children and adolescents is well recognised in North America and continental Europe. However, it is unclear to what extent these studies are applicable to clinical practice in the United Kingdom (UK). This study was conducted to estimate the prevalence of psychotropic drug prescribing in children and adolescents aged <19 years in general practice in the UK from January 1992 to December 2001. Data were obtained from the General Practice Research Database (GPRD). Annual age- and sex-specific prevalence of psychotropic drug prescribing was calculated. A total of 143,079 prescriptions were issued to 34,398 study subjects. Stimulant prescriptions rose significantly from 0.03 per 1,000 (95% confidence interval 0.02-0.04) in 1992 to 2.9 per 1,000 (2.52-3.32) in 2001; a 96-fold increase. Methylphenidate accounted for the majority of stimulant prescriptions; 2.4% (349/14,370) of stimulant prescriptions were prescribed to children aged <6 years. Increased prescribing was also noted for antidepressants (1.6-fold), hypnotics/anxiolytics (1.3-fold), antipsychotics (1.3-fold) and anticonvulsants (1.3-fold), whilst the prevalence of clonidine and lithium prescribing remained fairly stable throughout the study period. The use of antidepressant, hypnotic/anxiolytic and anticonvulsant increased with increasing age. A high proportion of boys received stimulants, whereas antidepressants and hypnotics/anxiolytics were more likely prescribed to girls. There is an increased trend of psychotropic drug use in children and adolescents in the UK practice. Since most psychotropic drugs are not licensed for use in children at this time, research is needed to investigate the efficacy and long-term safety in this population.

Table of Contents

AbstractNew Medication Paliperidone (Invega) Approved for Treatment of SchizophreniaCitalopram Shows Limited Effect on Compulsive Sexual BehaviorDelirium Associated with Bupropion and FluoxetineQuetiapine and Quality of Life in Bipolar DepressionIM Aripiprazole for Agitation in SchizophreniaStudy Examines Psychotropic Drug Use in Children with MRComparing HAM‐D‐6 with HAM‐D‐17Hyperglycemia in a Child Treated with AripiprazoleApproval: Paliperidone for SchizophreniaApproval: First Generic Wellbutrin XR

Table of Contents

AbstractBipolar Guideline Cites Diagnostic Validity Dispute, Need for Medication TrialsTreating Aggression in Preschoolers – More Evidence Still Needed from Controlled TrialsShift in Definition of Bipolar in Youths Leads to Increase in DiagnosisAACAP Urges Broad Approach to Screening, Assessment for BipolarTopiramate for Migraine Prevention in AdolescentsMeformin for Weight‐Gain with Atypical AntipsychoticsStudy Examines Psychotropic Drug use in Children with MRPharmacokinetics of Bupropion XL in ChildrenHigh Rates of Prescription Drug Abuse in TeensRizatriptan for Migraines in ChildrenValproate‐Induced Chorea and Encephalopathy in Atypical Nonketotic HyperglycinemiaApproval: Paliperidone for SchizophreniaApproval: First Generic Wellbutrin XL

Pervasive Developmental Disorder, Behavior Problems, and Psychotropic Drug Use in Children and Adolescents With Mental Retardation

This study investigated the interrelationship between psychopharmacotherapy in general and the use of specific psychotropic drugs and pervasive developmental disorder and other behavior problems in children and adolescents with mental retardation. A total of 862 participants 4 to 18 years of age, including all levels of mental retardation, were recruited through facilities for children with mental retardation in Friesland, The Netherlands. Information on medication was collected through parent interviews. Behavior problems were investigated with a standardized parent questionnaire (Developmental Behavior Checklist). A pervasive developmental disorder classification was based on the Pervasive Developmental Disorder in Mental Retardation Scale, completed by psychologists or teachers. Logistic regression analysis was used to investigate the relationship between the use of psychotropic drugs and pervasive developmental disorder and other behavioral problems, in the presence of possible confounders. One of 10 participants used psychotropic medication. The main factors associated with psychotropic drug use were pervasive developmental disorder and disruptive behavior. The level of functioning was also associated. Self-absorbed behavior was statistically significantly associated with clonidine use and disruptive behavior with stimulant use. Pervasive developmental disorder and communication problems were the main factors associated with the use of antipsychotic drugs. Age also played a role, whereas gender, living situation, and level of mental retardation did not. Antipsychotic drugs were associated with pervasive developmental disorder, whereas clonidine and stimulants were associated with self-absorbed and disruptive behavior, respectively. Although clonidine and risperidone are not registered for the problems reported and the other nonstimulants were only sometimes used on-label, their use was associated with specific psychiatric or behavioral problems.

The epidemiology of psychotropic drug use in children and adolescents

Despite the scarcity of evidence on the safety and efficacy of psychotropic drugs in the paediatric population, especially in the long-term, several epidemiological studies have reported an increase in their prescription rates. This increase is especially evident for stimulants and selective serotonin reuptake inhibitors. An analysis of the epidemiological data suggests that the risk of inappropriate use or abuse of these drugs is high. In such a context, not only is additional, independent and transparent research necessary, but also children with mental disorders (and their parents) must be guaranteed appropriate care.

Psychotropic drug use in children

Psychotropic drug use in children

The use of antidepressants by British child psychiatrists

The controversy concerning psychotropic drug use in children has waged over several decades. The recent trend in treatment has moved towards problem-orientated, eclectic and flexible approaches to disturbed children and their families, away from specific “pure” therapy models. Erstwhile over-use of medication in certain conditions, for example psycho-stimulants in hyperactive children in the USA (Werry et al (1980), has handicapped the development of paediatric psychopharmacology.