Antipsychotic Polypharmacy in the Treatment of Children and Adolescents in the Fee-for-Service Component of a Large State Medicaid Program

Florida Mental Health Institute, University of South Florida, Tampa, Florida 33612, USA.
Clinical Therapeutics (Impact Factor: 2.73). 05/2010; 32(5):949-59. DOI: 10.1016/j.clinthera.2010.04.021
Source: PubMed

ABSTRACT The aims of this study were to quantify and describe antipsychotic polypharmacy use among patients aged 6 to 12 years (children) and 13 to 17 years (adolescents) and to identify the characteristics of polypharmacy recipients.
Data from patients enrolled in Florida's Medicaid fee-for-service program and receiving treatment with an antipsychotic were included. Antipsychotic polypharmacy was defined as the receipt of > or = 2 antipsychotic medications concurrently for >60 days, with no gaps >15 days in polypharmacy treatment. The prevalence of antipsychotic polypharmacy, durations of treatment episodes, times to antipsychotic polypharmacy after initiation of antipsychotic monotherapy, and rates of antipsychotic combination use were calculated for the period between July 2002 and June 2007.
During the 5-year period, 12,764 children and 10,419 adolescents received antipsychotic treatment. The proportions of patients who were male (73% and 63%) and whose race was indicated as "other" (31% and 14%) were significantly greater in children than in adolescents, respectively (both, P < 0.001). Seven percent of the children and 8% of the adolescents were prescribed antipsychotic polypharmacy (P = 0.001). Mean (SD) durations of polypharmacy episodes were 170.0 (139.0) days in children and 185.5 (175.9) days in adolescents (P = 0.010). Times to initiation of polypharmacy were 505.8 (440.5) days in children and 384.9 (424.3) days in adolescents (P < 0.001). Adolescents (odds ratio [OR] = 1.16; 95% CI, 1.04-1.29) were more likely than children to be polypharmacy recipients, as were those with psychotic disorders (OR = 1.47; 95% CI, 1.20-1.81) compared with those with bipolar I disorder. Patients whose race was indicated as "other" were more likely than patients of white race to receive polypharmacy (OR = 1.18; 95% CI, 1.04-1.34; P < 0.001); other ethnic/racial groups did not differ significantly. The most common specific antipsychotic combinations prescribed in children and adolescents were aripiprazole/quetiapine (23% and 17%, respectively), risperidone/quetiapine (18% and 15%), aripiprazole/risperidone (17% and 11%), risperidone/olanzapine (5% and 6%), and quetiapine/olanzapine (4% and 7%).
The prevalence and duration of Antipsychotic polypharmacy among antipsychotic recipients in this Medicaid fee-for-service population were noteworthy. Research on the risks and benefits of the practice in the pediatric population is needed.

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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). A longitudinal study of 1958 inpatients with bipolar disorder (Brooks et al. 2011) found that 10% of patients ‡15 years of age who were taking at least 1 SGA were prescribed more than one SGA. "
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