More children are being prescribed antipsychotic medications — drugs designed to treat such mental illnesses as schizophrenia and bipolar disorder — and pediatricians and psychiatrists at the University of Vermont conducted a study to find out why.
Specifically, the researchers wanted to find out “whether the right youth are being prescribed the right medications at the proper time in their treatment,” they state in the journal Pediatrics. Their findings, for the first time, delve into the clinical decision-making process of doctors who prescribe these drugs to children.
“There are risks associated with using these medicines,” said David Rettew, M.D., associate professor of psychiatry and pediatrics. “At the same time, I think they’ve saved lives.”
Research has shown increasing use of antipsychotic medications in pediatric patients. In fact, treatment with such drugs climbed 62 percent for children on Medicaid between 2002 and 2007, reaching 2.4 percent of those youth, according to The Agency for Healthcare Research.
Rettew and fellow members of a Vermont state task force that keeps watch on use of psychiatric medications for young people wanted to answer the question: “Is this a reasonable thing, or are these medications potentially being overused?”
From Medicaid claims data, the researchers sent a survey to the prescriber of every antipsychotic medication — most commonly risperidone, quetiapine, and aripiprazole — issued between July and October 2012. Relevant surveys were received by 147 physicians who wrote prescriptions for 647 patients.
The American Academy of Child and Adolescent Psychiatry (AACAP) advises that kids who haven’t been diagnosed with major mental illness such as schizophrenia but who have other types of behavioral problems, such as aggression, eating disorders, or oppositional defiant disorder, receive treatment with these drugs only after other medications or nonpharmacological therapies are tried.
“Part of our concern is that these medicines may be getting pulled out too early in the treatment planning for things like oppositional behavior, ahead of things like behavioral therapy that could be tried first,” says Rettew, director of the Pediatric Psychiatry Clinic at the University of Vermont Medical Center and the Vermont Center for Children, Youth and Families.
In half of the cases, the results show, doctors veered from the guidelines. The most common problem was not prescribing lab tests to monitor cholesterol and blood-glucose levels before and after the patient began taking the medicine. The AACAP recommends the lab work because of the risk for using these drugs in patients with high cholesterol and diabetes.
Nearly 92 percent of doctors prescribed the drugs under the proper circumstances. While they did try antipsychotics as secondary treatment for aggression and mood instability, they did not prescribe them for low-level problems — for example, to help a child sleep or control temper tantrums, Rettew says.
“I’m not anti-antipsychotics; I just want to make sure they’re used very carefully,” says Rettew. “These findings could help us design a game plan for measures to improve best-practice prescribing.”
Source: University of Vermont