National Trends in the Outpatient Treatment
of Children and Adolescents With Antipsychotic Drugs
Mark Olfson, MD, MPH; Carlos Blanco, MD, PhD; Linxu Liu, PhD; Carmen Moreno, MD; Gonzalo Laje, MD
Context: Although there are indications that antipsy-
chotic drugs are increasingly used to treat children and
adolescents, little is known about the characteristics of
those who receive them.
Objective: To examine national trends and patterns in
antipsychotic treatment of youth seen by physicians in
office-based medical practice.
Design: Analysis of national trends of visits (1993-
2002) that included prescription of antipsychotics, and
comparison of the clinical and demographic character-
istics of visits (2000-2002) that included or did not in-
clude antipsychotic treatment.
Setting: Outpatient visits to physicians in office-based
Participants: Patient visits by persons 20 years and
veys from 1993 to 2002.
Main Outcome Measures: Visits that included pre-
scription of antipsychotics.
Results: In the United States, the estimated number of
office-based visits by youth that included antipsychotic
to 1224000 in 2002. From 2000 to 2002, the number
of visits that included antipsychotic treatment was sig-
its per 100000 population) than for youth of other ra-
cial or ethnic groups (426 visits per 100000 popula-
tion). Overall, 9.2% of mental health visits and 18.3% of
visits to psychiatrists included antipsychotic treatment.
From 2000 to 2002, 92.3% of visits with prescription of
an antipsychotic included a second-generation medica-
tion. Mental health visits with prescription of an anti-
psychotic included patients with diagnoses of disrup-
pervasive developmental disorders or mental retarda-
tion (17.3%), and psychotic disorders (14.2%).
Conclusions: There has been a sharp national increase
in antipsychotic treatment among children and adoles-
cents in office-based medical practice. Second-
generation antipsychotics are being widely prescribed,
port that is limited to short-term safety and efficacy.
Arch Gen Psychiatry. 2006;63:679-685
scription database, for example, treat-
the number of child and adolescent Med-
icaid enrollees prescribed second-
generation antipsychotic medications in-
tipsychotic medications increased 160%
during that period.2Similar increases in
youth antipsychotic treatment have been
reported among the Tennessee Medicaid
TUDIES1-3OF PRIVATELY AND
publicly insured popula-
tions indicate recent growth
in the treatment of young
people with antipsychotic
drugs. In a large privately insured pre-
acteristics of youth who receive antipsy-
chotic treatment. Analysis of commer-
cial4and Medicaid2prescription claims
nificantly greater among boys than girls.
ity disorder, conduct disorder, and mood
disorders accounts for most of the in-
crease in antipsychotic use.3In a study of
youth in residential treatment, antipsy-
chotic treatment was significantly re-
lated to delinquent behavior, substance
behavioral problems.5In a large conve-
nience sample of psychiatric outpatients,
77% of youth who received an antipsy-
chotic medication did not have a diagno-
sis of a psychotic disorder.6
Author Affiliations: New York
State Psychiatric Institute and
Department of Psychiatry,
College of Physicians and
Surgeons (Drs Olfson, Blanco,
Liu, and Moreno), and
Department of Biostatistics,
Mailman School of Public
Health (Dr Liu), Columbia
University, New York; and
Genetic Basis of Mood and
Anxiety Disorders, Mood and
Anxiety Program, National
Institute of Mental Health,
Bethesda, Md (Dr Laje).
(REPRINTED) ARCH GEN PSYCHIATRY/VOL 63, JUNE 2006WWW.ARCHGENPSYCHIATRY.COM
©2006 American Medical Association. All rights reserved.
lescents, 1997-2000. Arch Pediatr Adolesc Med. 2003;157:997-1004.
2. Patel NC, Sanchez RJ, Johnsrud MT, Crismon ML. Trends in antipsychotic use
Adolesc Psychopharmacol. 2002;12:221-229.
3. Cooper WO, Hickson GB, Fuchs C, Arbogast PG, Ray WA. New users of antipsy-
chotic medications among children enrolled in TennCare. Arch Pediatr Adolesc
4. Curtis LH, Masselink LE, Ostbye T, Hutchison S, Dans PE, Wright A, Krishnan
RR, Schulman KA. Prevalence of atypical antipsychotic drug use among com-
mercially insured youths in the United States. Arch Pediatr Adolesc Med. 2005;
5. Rawal PH, Lyons JS, MacIntyre JC, Hunter JC. Regional variation and clinical
J Behav Health Serv Res. 2004;31:178-188.
6. Staller JA, Wade MJ, Baker M. Current prescribing patterns in outpatient child
and adolescent psychiatric practice in central New York. J Child Adolesc
7. National Center for Health Statistics. NAMCS description. http://www.cdc.gov
/nchs/about/major/ahcd/namcsdes.htm. Accessed July 7, 2005.
.pdf. Accessed June 3, 2005.
10. Pottick KJ, McAlpine DD, Andelman RB. Changing patterns of psychiatric inpa-
tient care for children and adolescents in general hospitals, 1988-1995. Am J
PCT12, PCT12A, and PCT12H. http://factfinder.census.gov. Accessed April 17,
12. Shah BV, Barnwell BG, Dieler GS. SUDAAN User’s Manual, Release 7.5. Re-
search Triangle Park, NC: Research Triangle Institute; 1997.
13. Olfson M, Marcus SC, Weissman MM, Jensen PS. National trends in the use of
14. Zito JM, Safer DJ, DosReis S, Gardner JF, Magder L, Soeken K, Boles M, Lynch
F, Riddle MA. Psychotropic practice patterns for youth: a 10-year perspective.
Arch Pediatr Adolesc Med. 2003;157:17-25.
second-generation antipsychotics: a systematic review of 1-year studies. Am J
16. Leslie DL, Rosenheck RA, Horwitz SM. Patterns of mental health utilization and
costs among children in a privately insured population. Health Serv Res. 2001;
in a privately insured population, 1993 to 1995. Med Care. 1999;37:457-468.
18. Stigler KA, Potenza MN, Posey DJ, McDougle CJ. Weight gain associated with
atypical antipsychotic use in children and adolescents: prevalence, clinical rel-
evance, and management. Paediatr Drugs. 2004;6:33-44.
19. Toren P, Ratner S, Laor N, Weeizman A. Benefit-risk assessment of atypical an-
tipsychotics in the treatment of schizophrenia and comorbid disorders in chil-
dren and adolescents. Drug Saf. 2004;27:1135-1156.
20. Pappagallo M, Silva R. The effect of atypical antipsychotic agents on prolactin
levels in children and adolescents. J Child Adolesc Psychopharmacol. 2004;
adolescents: clinical applications. J Clin Psychiatry. 2004;65(suppl 6):30-44.
22. Sikich L, Hamer RM, Bashford RA, Sheitman BB, Lieberman JA. A pilot study of
domized, 8-week trial. Neuropsychopharmacology. 2004;29:133-145.
population: an observational study. J Paediatr Child Health. 2003;39:523-527.
24. Wolraich ML, Hannah JN, Pinnock TY, Baumgaertel A, Brown J. Comparison of
diagnostic criteria for attention-deficit hyperactivity disorder in a county-wide
sample. J Am Acad Child Adolesc Psychiatry. 1996;35:319-324.
25. Lanzi G, Zambrino CA, Termine C, Palestra M, Ferrari-Ginevra O, Orcesi S, Man-
fredi P, Beghi E. Prevalence of tic disorders among primary school students in
the city of Pavia, Italy. Arch Dis Child. 2004;89:45-47.
26. Khalifa N, von Knorring AL. Prevalence of tic disorders and Tourette syndrome
in a Swedish school population. Dev Med Child Neurol. 2003;45:315-319.
Arch Gen Psychiatry. 2003;60:524-530.
28. Steffenburg S, Gollberg C. Autism and autistic-like conditions in Swedish rural
and urban areas: a population study. Br J Psychiatry. 1986;149:81-87.
29. Zito JM, Safer DJ, Zuckerman IH, Gardner JF, Soeken K. Effect of Medicaid eli-
youths. Psychiatr Serv. 2005;56:157-163.
30. Delbello MP, Schwiers ML, Rosenberg HL, Strakowski SM. A double-blind, ran-
lescent mania. J Am Acad Child Adolesc Psychiatry. 2002;41:1216-1223.
31. Frazier JA, Biederman J, Tohen M, Feldman PD, Jacobs TG, Toma V, Rater MA,
lin ZM. A prospective open-label treatment trial of olanzapine monotherapy in
32. Frazier JA, Myer MC, Biederman J, Wozniak J, Wilens TE, Spencer TJ, Kim GS,
Shapiro S. Risperidone treatment for juvenile bipolar disorder: a retrospective
chart review. J Am Acad Child Adolesc Psychiatry. 1999;38:960-965.
33. Calabrese JR, Keck PE, MacFadden W, Minkwitz M, Ketter TA, Weisler TH, Cut-
blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II
depression. Am J Psychiatry. 2005;162:1351-1360.
34. Tohen M, Vieta E, Calabrese J, Ketter TA, Sachs G, Bowden C, Mitchell PB, Cen-
torrino F, Risser R, Baker RW, Evans AR, Beymer K, Dube S, Tollefson GD, Brier
I depression. Arch Gen Psychiatry. 2003;60:1079-1088.
observational study. Br J Clin Pharmacol. 2003;56:569-575.
36. Blanco C, Goodwin RD, Liebowitz MR, Schmidt AB, Lewis-Fernandez R, Olfson
M. Use of psychotropic medications for patients with office visits who receive a
diagnosis of panic disorder. Med Care. 2004;42:1242-1245.
37. McCracken JT, McGough J, Shah B, Cronin P, Hong D, Aman MG. Risperidone
in children with autism and serious behavioral problems. N Engl J Med. 2002;
38. McDougle CJ, Scahill L, Aman MG, McCracken JT, Tierney E, Davies M, Arnold
LE, Posey DJ, Martin A, Ghuman JK, Shah B, Chuang SZ, Swiezy NB, Gonzalez
symptom domains of autism: results from the study by autism network of the
Research Units on Pediatric Psychopharmacology. Am J Psychiatry. 2005;
the treatment of disruptive behavioral symptoms in children with autistic and
other pervasive developmental disorders. Pediatrics. 2004;114:e634. http://
www.pediatrics.org. Accessed March 17, 2006.
40. Aman MG, DeSmedt G, Derivan A, Lyons B, Findling RL; Risperidone Disruptive
the treatment of disruptive behaviors in children with subaverage intelligence.
Am J Psychiatry. 2002;159:1337-1346.
41. Snyder R, Turgay A, Aman M, Binder C, Fisman S, Carroll A; Risperidone Con-
42. Dion Y, Annable L, Sandor P, Chouinard G. Risperidone in the treatment of Tou-
43. Scahill L, Leckman JF, Schultz RT, Katsovich L, Peterson BS. A placebo-
controlled trial of risperidone in Tourette syndrome. Neurology. 2003;60:1130-
44. Kumra S, Frazier JA, Jacobsen LK, McKenna K, Gordon CT, Lenane MC, Ham-
burger SD, Smith AK, Albus KE, Alaghband-Rad J, Rapoport JL. Childhood-
A, Findling RL, Malone RP, Derivan A, Schooler N, Sikich L, Greenhill L, Schur
SB, Felton CJ, Kranzler H, Rube DM, Sverd J, Finnerty M, Ketner S, Siennick SE,
Jensen PS. Treatment Recommendations for the Use of Atypical Antipsychotics
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