The prescription of antipsychotic medications for children
and adolescents in the US increased nearly 6-fold between
1993 and 2002, according to survey results.
The US Food and Drug Administration
has approved only three antipsychotic drugs - haloperidol,
thioridazine hydrochloride and pimozide -- for use in
patients younger than 18 years, but most of the prescriptions
written were for newer medications.
"What was most striking is that nearly one in five --
18 percent -- of visits to psychiatrists by young people
resulted in their being prescribed an antipsychotic medication,"
lead investigator Dr. Mark Olfson stated.
Interest in this issue followed "earlier studies that
reported significant increases in the use of antipsychotics
by young people within the Medicaid population," the researcher
added. "We wanted to find out if this was a general trend
that more broadly affects the mental health care of youths
in the US."
Olfson, from Columbia University in New York City, and
his associates therefore evaluated data from the National
Ambulatory Medical Care Survey. Their findings appear
in the Archives of General Psychiatry.
The data indicate that "there is a gap between what has
been learned in carefully controlled studies and what
is actually occurring in practice," the researcher noted.
Approximately 90 percent of antipsychotics prescribed
were for the second-generation drugs -- clozapine, risperidone,
olanzapine, and quetiapine. None of these drugs are approved
for treating adolescents or children.
The researchers note that these drugs were prescribed
primarily for disruptive behavior disorders (37.8 percent),
mood disorders (31.8 percent), or pervasive developmental
disorders or mental retardation (17.3 percent). Only 14.2
percent were prescribed for psychotic disorders.
"It is my guess," Olfson said, that the "water cooler
effect," in which "physicians learn from one another informally"
during discussions or attendance at professional meetings,
"has probably contributed to the dissemination of these
kinds of prescribing practices."
A major concern, Olfson said "is that we don't know enough
about the metabolic effects of newer antipsychotics, particularly
the long-term effects in young people."
SOURCE: Archives of General Psychiatry, June 2006.
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