Epidemiologic features of antipsychotic prescribing to children and adolescents in primary care in the United Kingdom

Centre for Pediatric Pharmacy Research, The School of Pharmacy, University of London, 29-39 Brunswick Square, London WC1N 1AX, United Kingdom.
PEDIATRICS (Impact Factor: 5.47). 05/2008; 121(5):1002-9. DOI: 10.1542/peds.2007-2008
Source: PubMed


The goal was to investigate the epidemiologic features of antipsychotic prescribing to children and adolescents in general practice in the United Kingdom.
A total of 384 participating general practices from the United Kingdom General Practice Research Database were used to identify patients 0 to 18 years of age who were prescribed > or = 1 antipsychotic medication between January 1, 1992, and December 31, 2005. Annual age-specific prevalences and incidences of antipsychotic prescribing were calculated.
The overall prevalence of use of all antipsychotics increased from 1992 (0.39 users per 1000 patient-years) to 2005 (0.77 users per 1000 patient-years). The prescribing prevalence for patients 7 to 12 years of age almost tripled between 1992 (0.23 users per 1000 patient-years) and 2005 (0.61 users per 1000 patient-years). Atypical antipsychotic prescribing increased 60-fold from 1994 (0.01 users per 1000 patient-years) to 2005 (0.61 users per 1000 patient-years). However, typical antipsychotic prescribing decreased significantly from 2000 (0.44 users per 1000 patient-years) to 2005 (0.18 users per 1000 patient-years). The incidences for typical and atypical antipsychotics showed trends similar to those of the respective prevalences. However, the overall incidence (number of new starters) for all antipsychotics was relatively stable between 1992 and 2005, which suggests that patients remain on treatment longer.
The overall prevalence of antipsychotics almost doubled between 1992 and 2005; however, the rate of increase was much lower than the reported figures in the United States. The prescribing of atypical antipsychotic drugs has increased despite the lack of conclusive evidence showing their superiority over older conventional antipsychotics. Additional investigation is required to evaluate their efficacy and safety in children and adolescents.

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    • "The use of antipsychotic drugs (APDs) in children and adolescents is rapidly increasing worldwide, despite serious limitation in the safety and efficacy of APD use in these population groups (Alexander et al., 2011; Hoekstra, 2014; Olfson et al., 2010, 2012; Rani et al., 2008; Seida et al., 2012; Varley and McClellan, 2009). Whilst first-generation APDs (e.g. "
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    ABSTRACT: Childhood/adolescent antipsychotic drug (APD) use is exponentially increasing worldwide, despite limited knowledge of the long-term effects of early APD treatment. Whilst investigations have found that early treatment has resulted in some alterations to dopamine and serotonin neurotransmission systems (essential to APD efficacy), there have only been limited studies into potential long-term behavioural changes. This study, using an animal model for childhood/adolescent APD treatment, investigated the long-term effects of aripiprazole, olanzapine and risperidone on adult behaviours of male and female rats. Open-field/holeboard, elevated plus maze (EPM), social interaction and forced swim (FS) tests were then conducted in adult rats. Our results indicated that in the male cohort, early risperidone and olanzapine treatment elicited long-term hyper-locomotor effects (open-field/holeboard and FS tests), whilst a decrease in depressive-like behaviour (in FS test) was observed in response to olanzapine treatment. Furthermore, anxiolytic-like behaviours were found following testing in the open-field/holeboard and EPM in response to all three drug treatments. Effects in the female cohort, however, were to a far lesser extent, with behavioural attributes indicative of an increased depressive-like behaviour and hypo-locomotor activity exhibited in the FS test following early risperidone and olanzapine treatment. These results suggest that various APDs have different long-term effects on the behaviours of adult rats.
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    • "Not all off-label prescriptions are supported by sufficient evidence, which is very concerning. Both in the USA and in Europe, prescription rates of SGAs to patients younger than 18 years of age are significantly higher than the prevalence of psychotic disorders (Rani et al., 2008; Kalverdijk et al., 2008; Zito et al., 2013). In fact, these medications are being prescribed for aggression, irritability, negativistic and hostile behaviour in various conditions, such as autism spectrum disorder, oppositional defiant disorder and conduct disorder (Olfson et al., 2012), when evidence of efficacy in " pure " conduct disorder (i.e., without co-morbid intellectual disability) is limited (Findling et al., 2000). "
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    European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 06/2015; DOI:10.1016/j.euroneuro.2015.06.009 · 4.37 Impact Factor
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    • "stranger anxiety, fear of the dark, existential questioning) as they develop cognitively and emotionally and engage with the world. Significant increases in the rates of psychotropic prescriptions in CYP have been found in America (Olfson et al., 2002), Europe (Steinhausen and Bisgaard, 2014) and the UK (Middleton et al., 2001; Rani et al., 2008) over the past three decades. Such findings contribute to concern over the medicalisation of normal human experience, particularly following the release of the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5; American Psychiatric Association, 2013). "
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