Antipsychotic use among US young people has risen sixfold
Janice Hopkins Tanne
New York
Between 1993 and 2003 the number of prescriptions of antipsychotic drugs
to children and teenagers in the United States increased sixfold,
reports a study of prescriptions written during visits to doctors' and
psychiatrists' practices. Psychotherapy was little used, it found.
The increase in prescriptions of these drugs to young people is thought
to be due to the availability of new antipsychotic drugs that have fewer
short term adverse affects in adults than older drugs and "declining
access to and duration of inpatient psychiatric treatment," say the
authors of the report in the Archives of General Psychiatry (2006;63:
679-85[Abstract/Free Full Text]).
They say that doctors have had to treat more severely ill children and
adolescents as outpatients, leading to increased use of antipsychotic drugs.
The authors, from the Mailman School of Public Health at Columbia
University in New York and the National Institute of Mental Health in
Bethesda, Maryland, say, "There has been a sharp national increase in
antipsychotic treatment among children in office based medical
practice," but "little is known about the characteristics of those who
receive them."
Among the more commonly used "second generation" antipsychotic drugs are
risperidone (Risperdal), used to treat schizophrenia, and olanzapine
(Zyprexa), used to treat schizophrenia and acute bipolar disorder.
These drugs have not been approved by the US Food and Drug
Administration for use in children. The authors call for evaluation of
the effects of these drugs in children and adolescents.
In 1993 only about 201 000 visits by young people to doctors' practices
involved a prescription for antipsychotic drugs. By 2002 the number of
such visits had grown to 1 224 000.
From 2000 to 2002 a diagnosis of a mental disorder was made in about
90% of visits by children and adolescents in which an antipsychotic drug
was prescribed, but only 36% of these visits included psychotherapy.
Second generation drugs were prescribed in 92% of visits that included
antipsychotic treatment.
The patients who received these prescriptions were predominantly white
boys or young men with public health insurance (rather than private
health insurance) who were being treated by a psychiatrist. The most
common diagnoses were psychotic disorder, pervasive development
disorder, mental retardation, and tic disorder. "Each significantly
increased the likelihood of receiving antipsychotic treatment," the
authors write.
The reasons the young people were seen and given a prescription for an
antipsychotic were disruptive behaviour disorders (38% of visits), mood
disorders (32%), pervasive developmental disorders or mental retardation
(17%), and psychotic disorders (14%).
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