Pediatric Antipsychotic Prescription Rates Soar

Pediatric Antipsychotic Prescription Rates Soar

Olfson M, Blanco C, Liu L, et al.
National trends in the outpatient treatment of children and adolescents with antipsychotic drugs.
Arch Gen Psychiatry. 2006;63:679–685;

To characterize the use of antipsychotic drugs in children and adolescents, authors from the Columbia University College of Physicians and Surgeons in New York and The National Institute of Mental Health in Bethesda, Md analyzed National Ambulatory Medical Care Survey (NAMCS) results from 1993 to 2002. The NAMCS is conducted annually and includes a nationally representative sample of visits to non-federally employed physicians in office practice. For trend analysis, population-based estimates were determined using NAMCS data and US Census Bureau population estimates for the same years.

The estimated number of US office visits that included prescription of antipsychotic medication for children under 21 years old skyrocketed from approximately 201,000 in 1993–1995 to 1,224,000 in 2002. In that time period, annual estimated office visits that included antipsychotic medication for patients under age 21 years increased from 274.7 to 1438.4 per 100,000 population.

Further scrutiny of 2000–2002 data reveals that psychiatrists provided care at 83.5% of visits that included antipsychotic treatment. Overall, only 9.2% of all mental health visits and 18.3% of visits to psychiatrists included antipsychotic treatment. Second generation antipsychotics were prescribed in 92.3% of the visits that included antipsychotic treatment. Diagnoses for youth in the antipsychotic-prescribed group included disruptive behavior disorders (37.8%), mood disorders (31.8%), pervasive developmental disorder or mental retardation (17.3%), and psychotic disorders (14.2%). Antipsychotic treatment rates were significantly higher for male youths than female, for white non-Hispanics than other racial/ethnic groups, and for those having public health insurance (Medicare, Medicaid, and other government insurance) than those privately insured. When compared with youth mental health visits that did not result in antipsychotic treatment, visits with prescribed antipsychotic medication were more likely to involve patients with more than 1 mental disorder and to include treatment with a mood stabilizer.

AAP Grand Rounds 16:25-26 (2006)
© 2006 American Academy of Pediatrics