The epidemiology of psychotropic drug use in children and adolescents
Laboratory for Mother and Child Health, Mario Negri Pharmacological Research Institute, Milan, Italy. International Review of Psychiatry
(Impact Factor: 1.8).
07/2005; 17(3):181-8. DOI: 10.1080/09540260500093768
Despite the scarcity of evidence on the safety and efficacy of psychotropic drugs in the paediatric population, especially in the long-term, several epidemiological studies have reported an increase in their prescription rates. This increase is especially evident for stimulants and selective serotonin reuptake inhibitors. An analysis of the epidemiological data suggests that the risk of inappropriate use or abuse of these drugs is high. In such a context, not only is additional, independent and transparent research necessary, but also children with mental disorders (and their parents) must be guaranteed appropriate care.
Available from: Wasantha Jayawardene
- "Recent advances in medical management of chronic pain, depression, anxiety, and attention-deficit hyperactivity disorder have increased the prescription rates of opioids (narcotics or pain relievers), central nervous system (CNS) depressants (tranquilizers and sedatives), and stimulants (psychostimulants ), which have a potential for abuse and dependence (Bonati and Clavenna, 2005; Hertz and Knight, 2006; Catalano, 2009), particularly among adolescents (Substance Abuse and Mental Health Services Administration, 2003). The criteria associated with abuse and dependence compared with safe therapeutic use were dose, route of administration, coadministration with other drugs, context of use, and purpose (Compton and Volkow, 2006). "
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ABSTRACT: This study aimed to identify the sequential patterns of drug use initiation, which included prescription drugs misuse (PDM), among 12th-grade students in Indiana. The study also tested the suitability of the data mining method Market Basket Analysis (MBA) to detect common drug use initiation sequences in large-scale surveys.
Data from 2007 to 2009 Annual Surveys of Alcohol, Tobacco, and Other Drug Use by Indiana Children and Adolescents were used for this study. A close-ended, self-administered questionnaire was used to ask adolescents about the use of 21 substance categories and the age of first use. "Support%" and "confidence%" statistics of Market Basket Analysis detected multiple and substitute addictions, respectively.
The lifetime prevalence of using any addictive substance was 73.3%, and it has been decreasing during past few years. Although the lifetime prevalence of PDM was 19.2%, it has been increasing. Males and whites were more likely to use drugs and engage in multiple addictions. Market Basket Analysis identified common drug use initiation sequences that involved 11 drugs. High levels of support existed for associations among alcohol, cigarettes, and marijuana, whereas associations that included prescription drugs had medium levels of support.
Market Basket Analysis is useful for the detection of common substance use initiation sequences in large-scale surveys. Before initiation of prescription drugs, physicians should consider the adolescents' risk of addiction. Prevention programs should address multiple addictions, substitute addictions, common sequences in drug use initiation, sex and racial differences in PDM, and normative beliefs of parents and adolescents in relation to PDM.
Available from: Antonio Clavenna
- "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]. "
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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.
Available from: PubMed Central
- "In childhood and adolescence, MDD and DD are characterized by irritable mood, associated with several depressive symptoms and feelings; however, expression of symptom varies with developmental stage, and some children and adolescents may have difficulty identifying and describing internal mood states.4–21 The prevalence of MDD ranges from 1.8% to 2.5% for children and from 2.9% to 4.7% for adolescents and the prevalence of DD ranges from 0.6% to 4.6% for children and from 1.6% to 8% for adolescents.2,22–24 BD is not a single disorder but a category of mood disorders and is defined as the presence of 1 or more episodes of abnormally elevated mood, which is clinically referred to as mania. "
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ABSTRACT: Diagnosis and treatment of mood disorders in youth are still problematic because in this age the clinical presentation is atypical, and the diagnostic tools and the therapies are the same as that used for the adults. Mood disorders are categorically divided into unipolar disorders (major depressive disorder and dysthymic disorder) and bipolar disorder in Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision), but mood symptoms are also comprised in the diagnostic criteria of the adjustment disorder (AD), which occur in many different psychiatric disorders, and may also be found in some physical conditions. The differential diagnosis is not much addressed in the midst of clinical investigation and so remains the major problem in the clinical practice.
The associations between some variables and the depressive disorder and AD were analyzed to make considerations about differential diagnosis.
We reported a retrospective study of 60 patients affected by depressive disorder and AD. The analysis has evaluated the association between some variables and the single diagnostic categories. We have considered 10 variables, of which 6 are specific to the disorders, and 4 have been considered related problems.
The statistical analysis showed significant results for the associations of 3 variables (prevalent symptoms, treatment, and family history) with the single diagnostic categories.
The discriminate analysis resulted in statistically significant differences between patients with depressive disorders and those with AD on 3 variables, of which 2 are specific to the disorders, and 1 is included in the related problems. The other variables were weakly associated with the single diagnostic categories without any statistically significant differences. The 3 variables that were associated with the single diagnostic categories support the distinct construct validity of the 2 diagnostic categories, but, to date, it is difficult to establish if these variables can be considered diagnostic predictors. On the other hand, the other variables did not support the distinct construct validity of the 2 diagnostic categories, which suggest an overlapping and dimensional concept. The spectrum approach could unify categorical classification that is essential with a dimensional view. Combination of dimensional and categorical principles for classifying mood disorders may help to reduce the problems of underdiagnosis and undertreatment.
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