A three-country comparison of psychotropic medication prevalence in youth

Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland, USA.
Child and Adolescent Psychiatry and Mental Health 10/2008; 2(1):26. DOI: 10.1186/1753-2000-2-26
Source: PubMed


The study aims to compare cross-national prevalence of psychotropic medication use in youth.
A population-based analysis of psychotropic medication use based on administrative claims data for the year 2000 was undertaken for insured enrollees from 3 countries in relation to age group (0-4, 5-9, 10-14, and 15-19), gender, drug subclass pattern and concomitant use. The data include insured youth aged 0-19 in the year 2000 from the Netherlands (n = 110,944), Germany (n = 356,520) and the United States (n = 127,157).
The annual prevalence of any psychotropic medication in youth was significantly greater in the US (6.7%) than in the Netherlands (2.9%) and in Germany (2.0%). Antidepressant and stimulant prevalence were 3 or more times greater in the US than in the Netherlands and Germany, while antipsychotic prevalence was 1.5-2.2 times greater. The atypical antipsychotic subclass represented only 5% of antipsychotic use in Germany, but 48% in the Netherlands and 66% in the US. The less commonly used drugs e.g. alpha agonists, lithium and antiparkinsonian agents generally followed the ranking of US>Dutch>German youth with very rare (less than 0.05%) use in Dutch and German youth. Though rarely used, anxiolytics were twice as common in Dutch as in US and German youth. Prescription hypnotics were half as common as anxiolytics in Dutch and US youth and were very uncommon in German youth. Concomitant drug use applied to 19.2% of US youth which was more than double the Dutch use and three times that of German youth.
Prominent differences in psychotropic medication treatment patterns exist between youth in the US and Western Europe and within Western Europe. Differences in policies regarding direct to consumer drug advertising, government regulatory restrictions, reimbursement policies, diagnostic classification systems, and cultural beliefs regarding the role of medication for emotional and behavioral treatment are likely to account for these differences.

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Available from: James Gardner, Jun 03, 2015
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    • "Mental health problems among adolescents have been documented in several international studies (Kessler et al. 2007, Patel et al. 2007, Steffenak et al. 2012a). In addition, studies indicate increased psychotropic drug use among adolescents (Zito et al. 2008, Tournier et al. 2010, Hartz et al. 2012, Steffenak et al. 2012b). Some of those adolescents struggling with mental health problems and psychotropic drug use may need support and different therapies for a shorter or longer period of time (Kessler et al. 2007). "
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    ABSTRACT: Aims and objectivesThe purpose of the paper was to describe the perceptions of public health nurses’ roles in relation to psychotropic drug use by adolescents.Background Mental health problems among adolescents are documented with studies indicating an increased use of psychotropic drugs. In Norway, care for such adolescents may fall naturally into the remit of public health nurses.DesignA phenomenographic approach was used to analyse the data.MethodA qualitative interview study was made of 20 Norwegian public health nurses, strategically chosen using phenomenographic methodology.ResultsThe public health nurses described three categories: discovering public health nurses who become aware of psychotropic drug use in the health dialogue with adolescents and choose to either act or not act in relation to psychotropic drug use. Those public health nurses who take action are cooperating public health nurses, who cooperate with adolescents, their families, schools and others. If cooperation has been established, supporting public health nurses teach and support the adolescent in relation to psychotropic drug use.Conclusion The public health nurses who do not act can hinder or delay further treatment. Public health nurses need to acquire knowledge about psychotropic drugs, to fulfil their role in nursing mental health problems among adolescents and the increasing use of psychotropic drugs.Relevance to clinical practiceThe results demonstrated that public health nurses, working in health centres and schools, have the responsibility and the opportunity to identify young people struggling with mental health problems and psychotropic drug use as well as teach and support significant others, e.g. parents and siblings. Intervention studies are needed with regard to health promotion programmes aimed at fortifying young people's mental health.
    Journal of Clinical Nursing 12/2014; 24(7-8). DOI:10.1111/jocn.12716 · 1.26 Impact Factor
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    • "Second generation antipsychotic prescribing to young people under 25 years of age is increasing internationally [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12]. The rise in prescription trends has generated controversy given available pediatric evidence for second generation antipsychotic effectiveness and safety data and the unknown longterm consequences with intermittent or continuous exposure [13] [14] [15] [16]. "
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    ABSTRACT: Objectives . To explore the lived experience of youth, caregivers, and prescribers with antipsychotic medications. Design . We conducted a qualitative interpretive phenomenology study. Youth aged 11 to 25 with recent experience taking antipsychotics, the caregivers of youth taking antipsychotics, and the prescribers of antipsychotics were recruited. Subjects . Eighteen youth, 10 caregivers (parents), and 11 prescribers participated. Results . Eleven of 18 youth, six of ten parents, and all prescribers discussed antipsychotic-related weight gain. Participants were attuned to the numeric weight changes usually measured in pounds. Significant discussions occurred around weight changes in the context of body image, adherence and persistence, managing weight increases, and metabolic effects. These concepts were often inextricably linked but maintained the significance as separate issues. Participants discussed tradeoffs regarding the perceived benefits and risks of weight gain, often with uncertainty and inadequate information regarding the short- and long-term consequences. Conclusion . Antipsychotic-related weight gain in youth influences body image and weight management strategies and impacts treatment courses with respect to adherence and persistence. In our study, the experience of monitoring for weight and metabolic changes was primarily reactive in nature. Participants expressed ambiguity regarding the short- and long-term consequences of weight and metabolic changes.
    11/2013; 2013(1):390130. DOI:10.1155/2013/390130
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    • "uring the past two decades, the prevalence of psychotropic prescribing for children and adolescents with behavioral problems has significantly increased (Gadow 1997; Olfson et al. 2002; Safer et al. 2003; Zito et al. 2003; Cooper et al. 2004, 2006; Schubert et al. 2010; Pringsheim et al. 2011), more so in the United States and Canada than in other countries (Schirm et al. 2001; Zito et al. 2006, 2008a), with polypharmacy, the use of multiple psychotropic medications for one patient, becoming more the rule than the exception (Connor et al. 1997; Olfson et al. 2002; Safer et al. 2003; Zito et al. 2003; DosReis, et al. 2005; Cooper et al. 2006; Comer, et al. 2010). Co-prescription of second generation antipsychotic (SGA) medications in youth has become more commonplace , despite a lack of data supporting the safety and efficacy of polypharmacy (Greenhill et al. 2003; Safer et al. 2003; Correll et al. 2006, 2007; Henin et al. 2009; Roke et al. 2009; Constantine et al. 2010). "
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    ABSTRACT: Objective: The purpose of this study was to assess whether polypharmacy regimens can be safely and effectively reduced for youth placed in a residential treatment center, and to assess the cost savings achieved from medication reductions. Methods: Data were collected for 131 youth ages 11-18, who were admitted to and discharged from a residential treatment center between 2007 and 2011. Six month postdischarge data were available for 51 youth. Data include demographics, admission and discharge medications, place of discharge, and postdischarge stability level. Results: Upon admission, 30 youth were not on medication, at discharge 48 were not; a 60% increase. Mean number of admission medications was 2.16 (SD=0.97) versus 1.55 (SD=0.70) upon discharge. Upon admission, one youth was on five and nine were on four medications. At end-point, only one youth was on four medications. The number of youth needing two or more medications declined by 55%, and the number of those needing three or more declined by 69%. The largest reduction was seen in the number of antipsychotics and antidepressants. Mood stabilizer and antipsychotic combinations declined by 65%. Youth with medication reduction were more likely to be discharged to a less restrictive setting than were youth without medication reduction (72.6% vs. 53.8%), p=0.03. At 6 months postdischarge, of the 51 out of 131 youth with available follow-up data, 71% were doing well. Cost analysis based on discontinued medication by class showed monthly savings of $21,365, or $256,368 yearly. The largest contributor was the reduction in the use of antipsychotics, accounting for $205,332 of the total savings. Conclusions: Our study indicates that comprehensive treatment can lead to significant reductions in polypharmacy, and positive short- and longer-term treatment outcomes. Judicial prescribing also resulted in significant cost reduction in an already costly healthcare system.
    Journal of child and adolescent psychopharmacology 11/2013; 23(9):620-627. DOI:10.1089/cap.2013.0014 · 2.93 Impact Factor
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