Article

# Use of psychotropic medications in Italian children and adolescents

Laboratory of Mother and Child Health, Mario Negri Institute for Pharmacological Research, Milano, Lombardy, Italy
(Impact Factor: 1.89). 04/2007; 166(4):339-47. DOI: 10.1007/s00431-006-0244-7
Source: PubMed

ABSTRACT

Introduction
The evidence of psychotropic drug safety and efficacy in the pediatric population is scant and widely debated. Yet, the prescription prevalence and incidence are increasing. A drug utilization study, based on a multiregional prescription database was therefore carried out in a sample of 1,484,770 Italian children and adolescents younger than 18 years during the year 2004. Furthermore, the trend of psychotropic prescription prevalence was evaluated from 1998 to 2004. During 2004, 4,316 children and adolescents received psychotropic drugs (2.91‰ youths). Antidepressants were prescribed to 3,503 youths (2.36‰), antipsychotics to 1,005 (0.68‰), and lithium to 73 (0.05‰). A total of 265 youths received drugs from more than one psychotropic class. The prevalence rate of psychotropic drug prescriptions increased with increasing age, with a statistically significant trend ($$\chi ^{2}_{t} = 2443$$; p<0.0001), and it increased in the period 1998–2004 with a statistically significant trend ($$\chi ^{2}_{t} = 298$$; p<0.0001), reaching its highest value in 2002 (3.08‰). The trend for antidepressants was similar ($$\chi ^{2}_{t} = 501$$; p<0.0001), while the prevalence of antipsychotics did not increase.
Conclusion
Even though the prevalence of psychotropic drug prescriptions in Italian children is lower than that reported in other countries (e.g. United States, Canada, Netherlands, UK), the increase in antidepressant prescriptions raises some concerns. Data concerning safety and efficacy of these antidepressants in pediatrics are still limited and further studies are needed to guarantee evidence based therapeutic approaches in children, adolescents and their families.

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• "For each severity level a valuation is available that is based on the judgment of the general public about the value of this health state. Values on the five dimensions will be transformed into one single score by applying a formula, ranging from 0 to 1 (with lower scores representing more problems), and by using the British tariff [30]. We will use the British tariff because this is used by default in Europe, and thus the results are more generalizable and the comparison between studies is more adequate. "
##### Article: Cost-effectiveness of Multisystemic Therapy for adolescents with antisocial behaviour: Study protocol of a randomized controlled trial
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ABSTRACT: Background: Multisystemic Therapy (MST) is an intensive, short, family- and community-based treatment for serious antisocial behaviour and delinquency in youth. It is an emerging intervention for serious juvenile delinquents. However, conclusive evidence on the balance between costs and effects is limited and in fact non-existent for the Netherlands. The aim of this protocol is to describe the design of a study to evaluate the cost-effectiveness of MST as compared to Care-As-Usual (CAU). Methods: The cost-effectiveness of MST will be assessed through a Randomised Controlled Trial. Primary outcomes aggressive and delinquent behaviour will be assessed with the parent-reported CBCL and adolescent-reported YSR. Health care utilisation, production loss, and quality of life are recorded using the self-report 'Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness' (TiC-P), and with the MOS Short-Form General Health Survey (SF-20) and EuroQol -5D (EQ-5D), respectively. The study aims to enrol 100 clients in both conditions (MST and CAU). Data will be obtained before treatment (T1), immediately after treatment (T2; 5 months after T1) and at follow up (T3; 6 months after the end of the treatment) from a variety of sources, i.e. clients, parents/primary carers, professionals and police records. Discussion: Studying the cost-effectiveness of this treatment for youth antisocial behaviour is important in order to provide information to policy makers on whether the provision of this intervention represents good value for money. Introducing a cost-effective evidence based programme may result in valuable health gains for moderate costs. Trial registration: NTR1390.
Full-text · Article · Apr 2013 · BMC Public Health
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• "In Verona LHU's large population, the prevalence of psychotropic drug prescriptions was lower than in Italy as a whole [18,21] and in other countries [14-17]. "
##### Article: Antidepressant and antipsychotic use in an Italian pediatric population
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ABSTRACT: The safety and effectiveness of psychotropic drug use in the paediatric population is widely debated, in particular because of the lack of data concerning long term effects.In Italy the prevalence of psychotropic drug prescriptions increased in the early 2000s and decreased afterwards. In such a context, a study with the aim to estimate the incidence and prevalence of psychotropic drug prescription in the paediatric population and to describe diagnostic and therapeutic approaches was performed. The study population was composed of 76,000 youths less than 18 years and living in the area covered by the local health unit of Verona, Italy. The data source was the Verona local health unit's administrative prescription database. Prevalence and incidence of antidepressant and/or antipsychotic drug prescriptions in the 2004-2008 period were estimated. Children and adolescents receiving antidepressant and/or antipsychotic drug prescriptions between 1 January 2005 and 31 December 2006 were identified and questionnaires were sent to the prescribers with the aim to collect data concerning diagnostic and therapeutic approaches, and care strategies. The prevalence of psychotropic drug prescriptions did not change in the 2004-2008 period, while incidence slightly increased (from 7.0 in 2005 to 8.3 per 10,000 in 2008). Between 1 January 2005 and 31 December 2006, 111 youths received at least one psychotropic drug prescription, 91 of whom received antidepressants. Only 28 patients attended child and adolescent psychiatry services. Information concerning diagnostic and therapeutic approaches, and care strategies was collected for 52 patients (47%). Anxiety-depressive syndrome and attention disorders were the diseases for which psychotropic drugs were most commonly prescribed. In all, 75% youths also received psychological support and 20% were prescribed drugs for 2 or more years. Despite the low drug prescription prevalence, the finding that most children were not cared for by child and adolescent psychiatric services is of concern and calls for a systematic, continuous monitoring of psychopharmacological treatments.
Full-text · Article · May 2011 · BMC Pediatrics
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• "A number of studies from the United States have reported large increases in the prescribing of many different types of psychotropics to children and adolescents in recent years (Bhatara, et al., 2004; Cooper, et al., 2006; Thomas, et al., 2006). Studies from the United Kingdom and other European countries have reported similar increases (Schirm, et al., 2001; Wong, et al., 2004; Clavenna, et al., 2007). "
##### Article: Off-label psychotropic prescribing for young persons in medium security
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ABSTRACT: Psychotropic drug prescribing for children and adolescents is frequently off-label and has increased over time and can be controversial. Psychotropic prescribing in two large UK medium secure units for young people has been studied. A total of 89 patients were included, 64% being aged less than 18 years. A total of 137 of 202 (67.8%) of prescriptions were off-label. The most common reasons for a prescription being off-label were the indication (N = 103) and the patient's age (N = 41). The main classes of drugs involved were antipsychotics (N = 59), antiepileptics as mood stabilisers (N = 22), anticholinergics and hyoscine (N = 15) and antidepressants (N = 11). Aggression (N = 48) and post-traumatic stress disorder (N = 30) were the most common off-label indications. Some antidepressant prescriptions were contrary to advice of the Committee on Safety of Medicines (CSM). Meta-analyses or randomised controlled trials supported 27% of off-label prescriptions, with lesser quality studies supporting a further 29.2% and expert opinion 38.7%, whereas for 5.1% no evidence could be found. Prescribers tended to over-estimate the level of evidence from clinical trials or extrapolated from findings in adults. They often quoted their own experience rather than expert sources to justify their prescribing practice. It is important that prescribers are fully aware of the quality of experimental data and the risk-benefit ratio when prescribing off-label for young persons. If the evidence base is limited, it is particularly important to provide information about the risks and benefits of the treatment to the patient/relatives. A second opinion may be helpful. Both target symptoms and side effects should be monitored and regularly reviewed.
Full-text · Article · Jun 2009 · Journal of Psychopharmacology