Psychotropic Drugs In Children Research Articles

Pharmacovigilance of Psychotropic Drugs in Children with Disability

Pharmacovigilance of Psychotropic Drugs in Children with Disability

The metabolic syndrom and the prescription of psychotropic drugs in children and adolescents: three clinical cases

IntroductionAntipsychotics have shown their interest in several pathologies of the child and the adolescent. However, in this vulnerable population, they are not without adverse effects. Depending on the type of molecule used, classical neuroleptics or second generation antipsychotics, but also within these own classes, the profile of tolerance and adverse effects differs. In this sense, children treated with psychotropic drugs have a higher risk of developing metabolic syndrome compared to children who do not take this treatment.ObjectivesThe aim of this work is to discuss the metabolic syndrome in children treated with psychotropic drugs and this through three clinical vignettes.Methodswe conducted our study through an analysis of three clinical casesResultsIt is about three children followed in the service of child psychiatry of the hospital Ar-razi of salé, aged respectively 11, 13 and 14 years, these children were put under psychotropic drugs for various mental disorders and developed during the evolution of metabolic side effects in particular a dyslipidemia, a diabetes of type 2 revealed by a diabetic ketoacidosis and a hyperprolactinemia.ConclusionsSystematic monitoring and preventive programs targeting weight gain and metabolic side effects should be an integral part of the overall management of adolescents on psychotropic medications.Disclosure of InterestNone Declared

Off-label use of psychotropic drugs in a Swiss paediatric service: similar results from two different cohort studies.

The high off-label use of drugs in paediatric patients raises questions on the efficacy and safety when prescribing psychotropic drugs. In our studies, we aimed to characterise the use of psychotropic drugs in the paediatric service of a tertiary hospital and quantify the proportion of off-label prescriptions with respect to age, indication and dosage recommendations approved in Switzerland, France and the USA. We conducted a retrospective cohort study (RCS) that included hospitalised patients from 1 December 2017, to 28 June 2018 with at least one PD prescription (n = 74) and a prospective cohort study (PCS) that included those hospitalised from 29 June 2018, to 30 November 2018 with at least one psychotropic drug prescription (n = 37). For both studies, we collected demographic, medical and medication data. Off-label prescriptions were identified by comparing the marketing authorisations published in the three selected countries. The average age of RCS and PCS patients were 13 ± 3 years and 14 ± 2 years, respectively. Of the 168 and 86 psychotropic prescriptions collected in the RCS and PCS, respectively, 70% and 71% prescriptions were off-label based on Swiss marketing authorisations. These rates declined when compared with French marketing authorisations (61% and 67% prescriptions) and were significantly lower when compared with American marketing authorisations (56% and 51% prescriptions). Psychotropic drugs were often prescribed as needed in both studies (53% and 43% of prescriptions), with only half of the patients actually receiving one of these prescribed psychotropic drugs. Our results showed a high proportion of off-label prescriptions of psychotropic drugs in a hospital setting. The off-label prescription rates according to Swiss marketing authorisations were the highest when compared with French and American marketing authorisations. Harmonisation of either international marketing authorisations or dosage recommendations at a national level could be a step forward to improved and evidence-based use of psychotropic drugs in children and adolescents.

Dynamics of acute poisoning with narcotic and psychotropic drugs in children

Introduction. Acute poisoning of chemical aetiology in children and adolescents is a significant medical and social problem. The average overall assessment of the state of the drug situation in St. Petersburg by all criteria is: in 2018 - 3.6 (pre-crisis condition), in 2019 - 3.5 (pre-crisis), in 2020 - 3.3 (severe). The aim of this work is to analyze the structure of acute poisoning with narcotic and psychodysleptic drugs in children of St. Petersburg. Materials and methods. An analysis was carried out of 4256 cases of acute chemical poisoning in children (form No. 64) admitted to the acute poisoning department of N.F. Filatov St. Petersburg State Children Hospital from 2016 to 2018. Results. The total number of chemical aetiology poisonings was 1441 cases in 2016, 1,527 in 2017 and 1,288 in 2018. Poisoning with narcotic and psychodysleptic drugs was (of the total number of poisonings) in 2016 - 3.1%, in 2017 - 5.8% and 2018 - 4.9%. The top place among poisonings with toxic substances of this group are opiates, methadone, LSD, hashish. The maximum poisoning with psychotropic drugs is psychostimulants such as methamphetamine - 2.6%, amphetamine - 1.4%, ecstasy - 1.2%. There was a significant increase in acute poisoning with unspecified psychotropic drugs from 0.7% (2016) to 4.6% (2018). Conclusions. The obtained results of the study revealed a decrease in the total number of acute chemical poisoning by 18.9%. On the background of a reduction in the total number of poisonings, there is an increase in the frequency of poisoning with neurodestructive substances (methadone, hashish, LSD, benzodiazepine, amphetamine, methamphetamine and ecstasy). The most frequent cause of acute chemical intoxication in children is poisoning with psychotropic drugs.

Depression and its characteristics in childhood and adolescence

Currently the accelerated and troubled routine ends up also affecting children and adolescents, who are still unable to develop, express and assimilate what happens to them, internally and externally, understand their pains and suffering; thus, they end up developing mental disorders, such as depression. Given the importance of seeking more information about depression, this study aimed to produce a bibliographic review article on depression in childhood and adolescence and its characteristics. The databases Pubmed (US National Library of Medicine), Scielo (Scientific Electronic Library Online), and Google ScholarⓇ were used in the present study, using the descriptors: depression, psychotropic drugs, mental disorders and psychotherapy. The articles analyzed were written in Portuguese, English and Spanish, for the past 22 years. For the diagnosis of children or adolescents, the clinical investigation has its particularities, the anamnesis must be more in-depth and it must go beyond the parents' complaint and the history of the child or adolescent. During treatments, psychopharmaceuticals can be used, as well as alternative therapies, such as supportive psychotherapy, interpersonal therapy, brief dynamic psychotherapy, behavioral therapy, among others. However, according to studies carried out recently, the use of psychotropic drugs in children and adolescents brings worrying revelations. It is concluded, through the study, that care must be taken both in the diagnosis and in the treatment of depression in children and adolescents.

Use of Tic-Suppressing Medication and Other Psychotropic Drugs in Children and Adolescents with Newly Diagnosed Tic Disorders in Denmark.

Objective: Only few psychotropic drugs are approved to treat tic disorders. The aim was to describe use of tic-suppressing medication and other psychotropic drugs in children with tics. Methods: Using nationwide registries, we identified children receiving a tic diagnosis in Denmark during 2006-2017 and extracted data on tic-suppressing medication and other psychotropic drugs. Results: Antipsychotics were used by 12%. Use of tic-suppressing medication increased with age and varied according to sex. Over time less children with tics were medicated (from 44% to 38% in the total use of psychotropic drugs) mainly due to decreased use of antipsychotics (from 18% to 6.4%). In recent years, use of aripiprazole exceeded that of risperidone (38% vs. 35%), although risperidone was most often first choice (34%) followed by aripiprazole (22%). Most children stayed on their initial treatment. Attention-deficit/hyperactivity disorder medication (27%) was the most common additional psychotropic drug class used. Regional variations were found in the treatment of tics. Hospital specialists were mainly responsible for treatment. Conclusions: Most children with tics do not use tic-suppressing or other psychotropic drugs. The use of aripiprazole superseded risperidone, however risperidone remains the most common first-choice treatment. Treatment was mainly handled by specialists, which is reassuring given the lack of national guidelines, however, regional variations merit further attention as do the variation in treatment between young girls and boys.

This elusive unknown quantity: reflections on the prescription of psychotropic drugs in early childhood

The scope of this article is to study aspects related to prescription habits and the use of psychoactive drugs in early childhood. It takes as a starting point the bibliographical survey carried out on the BVS and Scielo databases on epidemiological and clinical research in Brazil regarding the use of psychotropic drugs in children under six years of age. Based on international literature, it highlights the increase in the number of children diagnosed with mental and behavioral disorders, as well as the respective prescription of psychotropic drugs. It discusses the predominantly off-label character of psychoactive drugs for children under six years of age, the heterogeneous use of prescriptions and polypharmacology, pointing to an ethical paradox regarding clinical research in this age group. It concludes that the use of psychotropic drugs in early childhood is as yet not well known in Brazil, and epidemiological studies are urgently needed in this area.

Prescription prevalence of psychotropic drugs in children and adolescents: an analysis of international data.

We conducted a review and meta-analysis to establish the international pooled prevalence of psychotropic drugs in children and adolescents, and comment on recent trends. Medline, Embase, and PsycINFO were searched for studies with annual prevalence estimates of attention deficit hyperactivity disorder (ADHD) medications, antidepressants, antipsychotics, sedative/hypnotics and anxiolytics in outpatient children and adolescents. Data were extracted regarding the representativeness, sampling frame, and the quality of reporting. A total of 59 studies reporting prevalence data for 23 countries were collected. Most studies were conducted in Europe (42) and were at high or moderate risk of bias (35). The global random-effect pooled prevalence was 15.3‰ (95% confidence interval [CI], 7.6-25.7‰) for ADHD medications, 6.4‰ (95%CI 4.3-8.7) for antidepressants, and 5.5‰ (95%CI 3.6-7.8) for antipsychotics. Heterogeneity was extremely high (I2> 99%). Large increases were found in the prevalence of ADHD medications in most countries, particularly up until 2010. The antidepressants' trend was U-shaped in most countries with the lowest prevalence in 2007-2009 and rise more recently. Large to weak increases in the prevalence of antipsychotics were seen until 2011, and contrasting data were found more recently. Data on anxiolytics and sedative/hypnotics were limited. The study provides global estimates of paediatric psychotropic drug prevalence and its trends. Systematic monitoring is lacking in most countries, and very heterogeneous reporting is common across studies.

Pharmacovigilance in child and adolescent psychiatry

Rational pharmacotherapy is a challenging task in child and adolescent psychiatry. Increasing prescription numbers contrast with the uncertainties of safety and efficacy issues. The lack of clinical (authorization) trials often implies a non- age-specific use of drugs. However, young patients show particular metabolic conditions and a higher vulnerability for adverse drug reactions. Thus it seems mandatory to create age-specific pharmacological data about efficacy and safety of psychotropic drug use in minors. Legislation authorities became aware of this situation and introduced European and national scientific pharmacovigilance regulations and programmes accordingly in order to continuously evaluate the benefit-risk-ratio, detect, collect, minimize, and prevent adverse effects of drugs by appropriate measures, e.g., therapeutic drug monitoring. In this paper the principles and needs of pharmacovigilance in child and adolescent psychiatry are discussed. Furthermore a large multicenter clinical trial («TDM-VIGIL»), funded by the German Federal Institute for Drugs and Medical Devices, is presented, which appeals to collect epidemiological prescription and safety data of psychotropic drugs in children and adolescents using an internet-based data infrastructure (patient registry).

PS-343 The Relationship Between Prolonged Qtc Intervals And Antipsychotic Drugs In Children And Adolescents: A Retrospective Chart Review

Background Several psychotropic drugs are associated with the prolonged corrected QT interval (QTc) as measured on the electrocardiogram (ECG) that can lead to Torsades de Pointes (TdP) and sudden cardiac death. However, only few studies have evaluated the relationship between prolonged QTc intervals and administration of psychotropic drugs in children and adolescents. Therefore, the objectives of this study were to study the frequency of prolonged QTc intervals and to assess whether there exists a relationship between prolonged QTc intervals and the dose of antipsychotic drugs administered to adolescent psychiatric inpatients. Methods The study subjects comprised 59 children and adolescents (15 male, 44 female) who were inpatients diagnosed as having F2 according to ICD-10 Classification of Mental and Behavioural Disorders at admission between April 2012 and March 2013. The average age of the subjects was 15.2 ± 2.0 years (range: 10.5–18.5 years). We retrospectively reviewed their medical records to characterise patient demographics, medication received, and QTc intervals on the ECG. Results The average QTc interval recorded was 434.5 ± 20.3 msec (range: 391–487). The QTc duration was ≥440 msec (range: 442–487) for 21 patients (35.6%). Chlorpromazine equivalents were similar between patients with normal and prolonged QTc values (353.9 ± 301.3 vs. 420.6 ± 348.8; p = 0.47). There were no patients with sudden death or syncope related to TdP. Conclusions In this study, the frequency of prolonged QTc interval on admission was higher than that previously reported (1.97%), and it did not correlate with the current chlorpromazine equivalents. In the future, we intend to examine the frequency of prolonged QTc intervals among various psychiatric disorders.

USO DE PSICOFÁRMACOS EM CRIANÇAS E ADOLESCENTES

We tried this experiment to verify the efficacy, in dications and contraindications for the use of psychotropic drugs in children and adolescen ts. For this purpose, is a literature in journals, books and articles published on the Internet, throu gh which one can conclude that: 1) the health care professional must understand the pharmacological class of each drug, its indications, contraindications, drug interactions and adverse ef fects, 2) the selection and initiation of drug

Combination Pharmacotherapy for Psychiatric Disorders in Children and Adolescents: Prevalence, Efficacy, Risks and Research Needs

Polypharmacy, defined as the concomitant use of two or more psychotropic drugs, has become increasingly common in the paediatric and adolescent population over the past two decades. Combining psychotropic drugs leads to possible increases in benefits, but also in risks, particularly given the potential for psychotropic drug interactions. Despite the increasing use of concomitant therapy in children and adolescents, there is very little evidence from controlled clinical trials to provide guidance for prescribers. Even while acknowledging the small evidence base, clinical practice guidelines from eminent medical organizations are either relatively silent on or tend to support the use of concomitant treatments more enthusiastically than the evidence would warrant, so that practice and guidance are running ahead of the science. Our narrative review shows that the published evidence for efficacy and safety of concomitant psychotropic drugs in children and adolescents is scanty. A comprehensive search located 37 studies published over the last decade, of which 18 were randomized controlled trials (RCTs). These focused mainly on stimulants, central sympatholytics (such as clonidine), antipsychotics and 'mood stabilizers'. While several small, often methodologically weak, RCTs demonstrated statistically significant advantages for dual pharmacotherapy over monotherapy, only adding central sympatholytics to stimulants for treating attention-deficit hyperactivity disorder (ADHD) symptoms was supported by substantial studies with an effect size large enough to suggest clinical importance. Non-randomized studies tended to have results that supported concomitant treatment, but all have design-related problems that decrease the reliability of the results. Two studies that specifically examined tolerability of combination pharmacotherapy compared with monotherapy showed significant increases in adverse effects, both subjective and objective, and other studies confirmed a statistically significant increase in adverse effects, including sedation and self-harm. Given the extent of combination therapy occurring, particularly in conditions such as ADHD, and the ambiguous evidence for benefit with clear evidence of harm, we propose that further research should be carried out as a matter of urgency. Until such a time, the attitude to combination pharmacotherapy should be conservative, and combining psychotropic medications should be considered as an 'n of 1' trial to be closely monitored.

Psychopharmacological treatments in children and adolescents. Adequate use or abuse?

Psychopharmacological treatments in children and adolescents. Adequate use or abuse?

Polypharmacy with antidepressants in children and adolescents

The aim of this study was to review current epidemiological data on the use of antidepressants in co-prescription with other psychotropic drugs in children and adolescents, as well as available efficacy and safety information. A Medline search from inception until February 2012 was performed to identify epidemiological and clinical studies, reviews and reports containing potentially relevant information on polypharmacy with antidepressants in young people. There has been an increase in polypharmacy in children and adolescents involving antidepressants in recent years. Antidepressants have become one of the drug classes most frequently prescribed in combination and are commonly co-prescribed with stimulants and antipsychotics. Most information regarding efficacy and safety of polypharmacy patterns was provided by case series and open-label studies. Efficacy studies gave some support for the use of a combination of antidepressants and antipsychotics in the management of refractory obsessive-compulsive disorder and some residual symptoms in major depressive disorder. Even less empirical support was found for a combination of stimulants and antidepressants in co-morbid attention deficit hyperactivity disorder and mood or anxiety disorders. Adverse events were similar to those found with individual medication groups, with severe adverse events mostly reported by individual case reports. The use of polypharmacy with antidepressants has become a regular practice in clinical settings. Although there is still little efficacy and safety information, preliminary evidence points to the potential clinical usefulness of some polypharmacy patterns. Further research on patients with co-morbidities or more severe conditions is needed, in order to improve knowledge of this issue.

Pediatricians Get Help Managing Psychotropic Drugs in Children

Pediatricians Get Help Managing Psychotropic Drugs in Children

FEATURES OF PSYCHOEMOTIONAL STATUS IN CHILDREN WITH VARIOUS FORMS OF IRRITABLE BOWEL SYNDROME

The purpose of the study was to investigate the characteristics of mental and emotional status of children with different forms of irritable bowel syndrome (IBS). The study of mental and emotional status in 67 children aged 12 to 17 years with various IBS was carried out. The high frequency of dysthymia and a high level of anxiety, combined with a variety of character accentuations have been revealed. It is advisable to conduct psychological counseling and inclusion in the complex therapy of psychotropic drugs for children with CRK.

Panorama de la prescription et de la consommation des psychotropes chez l’enfant et l’adolescent en France

ObjectivesThis work had several aims: to estimate the frequency of prescription of psychotropic medications in children and adolescents in France; to compare the prevalence of prescription with the consumption data for adolescents aged 17; to study associations of psychotropics because of the increase co-prescriptions as practice; Finally, to assess the impact of public health measures such as warnings about the prescription of antidepressants by studying changes in their prevalence between 2002 and 2006. MethodsData from different health insurance companies were used to calculate the estimate of the prevalence of various psychotropic French. Consumption was calculated using data from the Survey of Health and Consumption in the Call for Defense Readiness (ESCAPAD). A database of prescriptions of general practitioners and psychiatrists (Cegedim Strategic Data) was used to model the combination therapies and to monitor prescriptions of antidepressants between 2002 and 2006. ResultsThe estimated annual frequency of prescription of psychotropic drugs in children and adolescents 18 years of age is 2.2% in France. However, psychotropic consumption is higher. In 2005, 14.9% of subjects aged 17 took treatment for sleep or nerves. Only half of these came from a drug taken by a medical indication. Moreover, nearly one third of prescriptions were multiple. Antidepressants are most concerned. Finally, prescriptions of antidepressants significantly decreased since the warnings issued in 2004. ConclusionThis work has allowed us to characterize the frequency of use of psychotropic drugs in France and some of their terms of use. It recalls at various points the unofficial way these treatments are often prescribed and used, and the need for monitoring these practices in terms of Public Health. These terms of use are themselves a reflection of cultural representations of mental illness of the child.

Therapeutic Drug Monitoring in Child and Adolescent Psychiatry*

Psychopharmacotherapy in children and adolescents is characterized by an increased susceptibility for adverse events and an increased risk of ineffective treatment due to specific age-dependent and developmental characteristics in comparison to adults. Dosing in paediatric psychiatric patients requires careful handling, since the dose recommendations for adults can not simply be extrapolated to minors because of pharmacokinetic and pharmacodynamic differences. In addition, psychopharmacotherapy in children and adolescents is hampered by lack of high quality evidence on efficacy and safety in many indications and subsequently a high degree of off-label use. Therapeutic Drug Monitoring (TDM) is an established and useful tool in psychiatry to individualize and optimize the outcomes (efficacy/safety balance) of psychopharmacological drug treatment in the individual patient by dose adjustments based upon measured serum concentrations. In children and adolescents the administration of psychotropic drugs is a general indication for performing TDM. However, TDM studies specific in these age groups are necessary to identify age and indication specific therapeutic ranges of serum concentrations. Systematic collection of data on drug exposure, serum concentrations and clinical characteristics as well as outcomes can generate such practice-based evidence. A German-Swiss-Austrian competence network for TDM in child and adolescent psychiatry using a multi-centre internet-based data infrastructure was founded to document and collect demographic, safety and efficacy data as well as blood concentrations of psychotropic drugs in children and adolescents (further information: www.tdm-kjp.com).

Endocrine and Metabolic Adverse Effects of Psychotropic Drugs in Children and Adolescents

ABSTRACT Much as an increase in the use of psychotropic drugs is observed in children and adolescents over the last decade, the endocrine and metabolic side effects of these drugs can limit their use. Atypical antipsychotics can cause many side effects, which are not suitable for the developmental periods of children and adolescents, such as those related with thyroid, blood sugar, level of sex hormones, growth rate and bone metabolism. Children are under a more serious risk regarding the weight increasing effects of atypical antipsychotics and weight gain that is not proportionate with age is especially important due to the association between glucose or lipid abnormalities and cardiovascular mortality. Aripiprazole and ziprasidone are the least risky antipsychotic drugs when it comes to metabolic side affects. The antipsychotic drug that is associated with weight increase and diabetes in children and adolescents most is olanzapine. Even though there are no comparative long-term data concerning children, it is suggested by the currently available information that metabolic side effects including dyslipidemia and impaired glucose tolerance are at an alarming level when it comes to long-term treatment with antipsychotics. The most risky agents in terms of hyperglycemia and glucosuria development are olanzapine and clozapine. Use of risperidone and haloperidol should be undertaken with caution since it may bring about the risk of hyperprolactinemia. Among the antidepressants associated with weight loss and suppression of appetite are selective serotonin reuptake inhibitors, bupropion and venlafaxine. Thyroid functions can be affected by lithium, carbamazepine and valproate treatments. It is reported that the side effect most frequently associated with valproate is weight increase. The relationship between valproate treatment and the development of hyperandrogenism and polycystic ovary syndrome in young women should also be kept in mind.

Drug monitoring in child and adolescent psychiatry for improved efficacy and safety of psychopharmacotherapy

Most psychotropic drugs used in the treatment of children and adolescents are applied "off label" with a direct risk of under- or overdosing and a delayed risk of long-term side effects. The selection of doses in paediatric psychiatric patients requires a consideration of pharmacokinetic parameters and the development of central nervous system, and warrants specific studies in children and adolescents. Because these are lacking for most of the psychotropic drugs applied in the Child and Adolescent and Psychiatry, therapeutic drug monitoring (TDM) is a valid tool to optimise pharmacotherapy and to enable to adjust the dosage of drugs according to the characteristics of the individual patient. Multi-centre TDM studies enable the identification of age- and development-dependent therapeutic ranges of blood concentrations and facilitate a highly qualified standardized documentation in the child and adolescent health care system. In addition, they will provide data for future research on psychopharmacological treatment in children and adolescents, as a baseline for example for clinically relevant interactions with various co-medications. Therefore, a German-Austrian-Swiss "Competence Network on Therapeutic Drug Monitoring in Child and Adolescent Psychiatry" was founded [1] introducing a comprehensive internet data base for the collection of demographic, safety and efficacy data as well as blood concentrations of psychotropic drugs in children and adolescents.