Proportion of Tennessee children using antipsychotic medications up significantly


CHICAGO — The proportion of children and adolescents in Tennessee taking antipsychotic medications nearly doubled between 1996 and 2001, with the largest increase in the use of antipsychotics to treat attention-deficit/hyperactivity disorder, conduct disorder, and affective disorders, according to an article in the August issue of The Archives of Pediatrics & Adolescent Medicine, a theme issue on pediatric mental health and one of the JAMA/Archives journals.

According to the article, the use of antipsychotic medications in children and adolescents for illnesses other than Tourette syndrome or psychosis is controversial, although some studies indicate that antipsychotics may help treat symptoms associated with behavior disorders including attention deficit/hyperactivity disorder (ADHD), and conduct disorders. The introduction of newer antipsychotics that differ significantly from older antipsychotics in terms of their pharmacological properties (referred to as "atypical" antipsychotics) with lower incidences of adverse effects has led to the possibility that these drugs may be prescribed more frequently in children with these kinds of behavioral disorders. However, atypical antipsychotics still pose some health risks, including weight gain, diabetes, and adverse cardiovascular effects.

William O. Cooper, M.D., M.P.H., of Vanderbilt University School of Medicine, Nashville, Tenn., and colleagues determined trends in new use of antipsychotic medications among patients aged two to 18 years in Tennessee's managed care program for Medicaid enrolles and the uninsured (TennCare) between 1996 and 2001. The study took place after the introduction of two of the most widely-used atypical antipsychotic medications: risperidone and olanzapine.

The researchers found that the proportion of TennCare children who were new users of antipsychotics nearly doubled from 23 in 10,000 in 1996 to 45 in 10,000 in 2001. In 1996, 6.8 percent of new users received an atypical antipsychotic, and by 2001, 95.9 percent of new users received atypical antipsychotics. New use of antipsychotics for ADHD and affective disorders (mental illnesses characterized by abnormalities in mood) increased 2.5-fold. Trends of increasing use of antipsychotics were most pronounced among children aged six to 12 years (93 percent increase) and 13 to 18 years (116 percent increase). Use among preschool children increased 61 percent between 1996 and 2001.

"New use of antipsychotics in study children and adolescents nearly doubled in the six years after the introduction of the atypical antipsychotics." The authors write. "The most probable explanation for this trend was substantially increased use for ADHD or conduct disorder and affective disorders. At present, no high-quality scientific evidence supports the use of atypical antipsychotics for these indications in pediatric populations. However, substantial evidence documents the adverse effects of these drugs. Thus, there is an urgent need to conduct well-controlled clinical studies to determine whether the benefits of this expanded use outweigh the risks."

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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