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West LM, Mooney SJ, Chavez L, Beck A, Clarke GN, Pabiniak CJ, Renz AD, Penfold RB. Evaluation of the Safer Use of Antipsychotics in Youth Study on Population Level Antipsychotic Initiation: An Interrupted Time Series Analysis. J Child Adolesc Psychopharmacol 2024; 34:310-318. [PMID: 38743639 DOI: 10.1089/cap.2024.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background: Antipsychotics carry a higher-risk profile than other psychotropic medications and may be prescribed for youth with conditions in which other first-line treatments are more appropriate. This study aimed to evaluate the population-level effect of the Safer Use of Antipsychotics in Youth (SUAY) trial, which aimed to reduce person-days of antipsychotic use among participants. Methods: We conducted an interrupted time series analysis using segmented regression to measure changes in prescribing trends of antipsychotic initiation rates pre-SUAY and post-SUAY trial at four U.S. health systems between 2013 and 2020. Results: In our overall model, adjusted for age and insurance type, antipsychotic initiation rates decreased by 0.73 (95% confidence interval [CI]: 0.30, 1.16, p = 0.002) prescriptions per 10,000 person-months before the SUAY trial. In the first quarter following the start of the trial, there was an immediate decrease in the rate of antipsychotic initiations of 6.57 (95% CI: 0.99, 12.15) prescriptions per 10,000 person-months. When comparing the posttrial period to the pretrial period, there was an increase of 1.09 (95% CI: 0.32, 1.85) prescriptions per 10,000 person-months, but the increasing rate in the posttrial period alone was not statistically significant (0.36 prescriptions per 10,000 person-months, 95% CI: -0.27, 0.99). Conclusion: The declining trend of antipsychotic initiation seen between 2013 and 2018 (pre-SUAY trial) may have naturally reached a level at which prescribing was clinically warranted and appropriate, resulting in a floor effect. The COVID-19 pandemic, which began in the final three quarters of the posttrial period, may also be related to increased antipsychotic medication initiation.
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Affiliation(s)
- Laura M West
- Department of Epidemiology, University of Washington Seattle, Seattle, Washington, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Stephen J Mooney
- Department of Epidemiology, University of Washington Seattle, Seattle, Washington, USA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA
| | - Laura Chavez
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, Denver, Colorado, USA
| | - Gregory N Clarke
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Chester J Pabiniak
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Anne D Renz
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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Driscoll DJO, McCarthy S. Antipsychotic prescribing: national findings of children and adolescents attending mental health services in Ireland. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02428-4. [PMID: 38607458 DOI: 10.1007/s00787-024-02428-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/23/2024] [Indexed: 04/13/2024]
Abstract
Antipsychotic prescribing trends vary internationally, albeit off-label use remains high (i.e., target symptoms). We aim to describe antipsychotic use, target conditions, target symptoms and dosing regimens in children and adolescents in Ireland. We used a sampled cohort from a national audit of children and adolescents attending mental health services with predefined inclusion and exclusion criteria from Jul-2021 to Dec-2021 who were prescribed at least one psychotropic medication and up to and including 17-years of age (n = 3528). Each service provided anonymised data. We described the frequency of antipsychotic medication, medication type, target condition, target symptom and medication doses. We used multivariable logistic regression, adjusted with available co-variates to assess the association of being prescribed an antipsychotic medication. Twelve percentage (n = 437) were prescribed an antipsychotic and 16-17-years (n = 211, 48.3%) was the most common age category. The commonest reason for prescribing an antipsychotic was target symptoms (i.e., off-label use) (n = 329; 75.%) and of these symptoms, agitation (n = 77/329; 25%) and irritability (56/239; 25%) were the most common. Quetiapine (n = 127; 29%) was the most common antipsychotic, followed by risperidone (n = 125; 28.6%), aripiprazole (n = 107; 24.5%), and olanzapine (n = 66; 15.1%). In adjusted analysis, having a psychotic disorder ((adjusted-odds-ratio) aOR: 39.63, CI 95%, 13.40-117.22), bipolar disorder (aOR: 16.96, CI 95%, 3.60-80.00), autism spectrum disorder (aOR: 3.24, CI 95%, 2.45-4.28) or aggression symptoms (aOR: 16.75, CI 95%, 7.22-38.89) was associated with prescribing an antipsychotic medication. This is the first study in children and adolescents that describes the target conditions and target symptoms for antipsychotic use in Ireland. Our results show a high proportion of antipsychotic prescribing based on target symptoms rather than target condition or diagnosis.
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Affiliation(s)
- David J O Driscoll
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.
- Specialist Neurodevelopmental ADHD Pathway (SNAP), Cork and Kerry Mental Health Services, Cork, Ireland.
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Klau J, Gonzalez‐Chica D, Raven M, Jureidini J. Antipsychotic prescribing patterns in children and adolescents attending Australian general practice in 2011 and 2017. JCPP ADVANCES 2024; 4:e12208. [PMID: 38486961 PMCID: PMC10933664 DOI: 10.1002/jcv2.12208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/12/2023] [Indexed: 03/17/2024] Open
Abstract
Background Antipsychotics are increasingly prescribed to children and adolescents worldwide, but little is known about reasons for prescribing. We aimed to examine patterns of paediatric antipsychotic prescribing in Australian primary care services in 2011 and 2017, including diagnoses, sociodemographic characteristics, off-label prescribing, and psychotropic co-prescribing. Methods Retrospective analysis of electronic health records (EHRs) using a large Australian general practice database (MedicineInsight). Diagnoses of mental disorders were extracted from EHRs and associated with antipsychotic prescriptions within the same calendar year for three age-groups: 0-9, 10-14, and 15-18-year-olds. Results In 2017, children/adolescents with mental health diagnoses were more likely to be prescribed antipsychotics (2.9% of 27,412 patients) than in 2011 (2.0% of 8418 patients; absolute difference +0.9, 95% CI + 0.5, +1.4). The likelihood was greater for patients with bipolar disorders (21.6% vs. 41.5%), eating disorders (1.1% vs. 7.2%), and autism without behavioural problems (3.7% vs. 6.1%). Depression/anxiety (adjusted 26.8% of patients 2011; 30.8% 2017) was the most common diagnosis associated with antipsychotics in both years. Most antipsychotics were prescribed off-label (69.8% 2011; 79.7% 2017; absolute difference +9.8, 95% CI + 1.54, +18.4). Off-label prescribing increased most among those aged 15-18-years, females, and patients living in outer regional/remote/very remote communities and the most disadvantaged areas. The three most frequently prescribed antipsychotics in both years were risperidone, quetiapine, and olanzapine. Psychotropic co-prescribing among patients receiving antipsychotic prescriptions was approximately 69% in both years. Conclusions Prescribing antipsychotics for mental health diagnoses to children/adolescents attending Australian general practices was more frequent in 2017 than 2011, and most commonly associated with depression/anxiety diagnoses. In both years, most prescribing was off-label. The majority of patients were co-prescribed other classes of psychotropics along with antipsychotics.
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Affiliation(s)
- Julie Klau
- Robinson Research InstituteCritical and Ethical Mental Health Research GroupUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - David Gonzalez‐Chica
- Discipline of General PracticeUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Melissa Raven
- Robinson Research InstituteCritical and Ethical Mental Health Research GroupUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Jon Jureidini
- Robinson Research InstituteCritical and Ethical Mental Health Research GroupUniversity of AdelaideAdelaideSouth AustraliaAustralia
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Hawker P, Bellamy J, McHugh C, Wong TY, Williams K, Wood A, Anderson V, Tonge BJ, Ward P, Sciberras E, Bellgrove MA, Silk T, Lin PI, Eapen V. Effectiveness of lifestyle interventions for improving the physical health of children and adolescents taking antipsychotic medications: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e073893. [PMID: 37890972 PMCID: PMC10619077 DOI: 10.1136/bmjopen-2023-073893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Children and adolescents are increasingly prescribed antipsychotic medications off-label in the treatment of behavioural disorders. While antipsychotic medications are effective in managing behavioural issues, they carry a significant risk of adverse events that compromise ongoing physical health. Of particular concern is the negative impact antipsychotic medications have on cardiometabolic health. Interventions that aim to modify lifestyle habits have the potential to alleviate the adverse effects of antipsychotic medication by enhancing weight management, increasing physical activity, promoting better nutritional practices, improving dietary habits and promoting healthier sleep patterns and sleep hygiene. However, a comprehensive review has not been performed to ascertain the effectiveness of lifestyle interventions for children and adolescents who are at increased risk of antipsychotic-induced compromises to their physical health. METHODS AND ANALYSIS This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Four databases will be searched without any year constraints to identify randomised controlled trials that are published in the English language and report a lifestyle intervention compared with usual care with any physical health outcome measure. Trial registers and results repositories will be scoured to identify additional studies. Two reviewers will independently conduct screening, data extraction and quality assessment and compare the results. Quantitative data will be synthesised, where appropriate, through a random-effects meta-analysis model. Otherwise, data will be reported in a qualitative (narrative) synthesis. Heterogeneity will be quantified using the I2 statistic. The Cochrane Risk of Bias 2 tool will be used for risk of bias assessment. The Grading of Recommendations, Assessment, Development and Evaluation system will be used to evaluate the cumulative body of evidence. ETHICS AND DISSEMINATION Ethics approval is not required. The publication plan will target high-impact, peer-reviewed journals that fall under the scope of Psychiatry and Mental Health. PROSPERO REGISTRATION NUMBER CRD42022380277.
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Affiliation(s)
- Patrick Hawker
- Discipline of Psychiatry & Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Jessica Bellamy
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Catherine McHugh
- Discipline of Psychiatry & Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Tsz Ying Wong
- Discipline of Psychiatry & Mental Health, UNSW, Sydney, New South Wales, Australia
| | | | - Amanda Wood
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Vicki Anderson
- The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | | | - Philip Ward
- Discipline of Psychiatry & Mental Health, UNSW, Sydney, New South Wales, Australia
| | | | | | - Tim Silk
- Deakin University, Burwood, Victoria, Australia
| | - Ping-I Lin
- UNSW, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry & Mental Health, UNSW, Sydney, New South Wales, Australia
- ICAMHS, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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Conlan K, McGrath J, Teeling M, MacAvin MJ, Bennett K, Gallagher L. Antipsychotic prescribing in GMS paediatric and young adult population in Ireland 2005-2015: repeated cross-sectional study. Ir J Psychol Med 2023; 40:343-352. [PMID: 33745473 DOI: 10.1017/ipm.2021.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To examine the rates of antipsychotic prescribing in the Irish paediatric and young adult population enrolled in the Irish General Medical Services Scheme pharmacy claims database from the Health Service Executive Primary Care Reimbursement Services database, with a focus on age and sex differences. To examine concomitant prescribing of certain other related medicines in this population. METHODS Data were obtained from the Irish General Medical Services (GMS) scheme pharmacy claims database from the Health Service Executive (HSE) - Primary Care Reimbursement Services (PCRS). Participants included children aged <16 years and youth aged 16-24 years availing of medicines under the HSE-PCRS GMS scheme between January 2005 and December 2015. Outcome measures included prescribing rates of antipsychotics from 2005 to 2015, differences in prescribing rates between different ages and sexes, and percentage of concomitant prescriptions for antidepressants, psychostimulants, anxiolytics and hypnosedatives. RESULTS Overall the trend in prescribing rates of antipsychotic medications was stable at 3.94/1000 in 2005 compared with 3.97/1000 in 2015 for children <16 years, and 48.37/1000 eligible population in 2005 compared to 39.64/1000 in 2015 for those aged 16-24. There was a significant decrease in prescribing rates for males in the 16-24 age group. CONCLUSIONS While rates of antipsychotic prescribing have decreased or remained stable over the timeframe of the study, we did find a significant proportion of this population were prescribed antipsychotics. This study also shows that co-prescribing of antidepressants increased and highlights the need for guidelines for antipsychotic prescribing in children and youth in terms of clinical indication, monitoring, co-prescribing and treatment duration.
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Affiliation(s)
- K Conlan
- Linn Dara CAMHS Approved Centre, Cherry Orchard Hospital, Dublin 10, Ireland
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - J McGrath
- ADMiRE Service, Lily Suite, Linn Dara CAMHS, Cherry Orchard Hospital, Ballyfermot, Ireland
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - M Teeling
- Department of Pharmacology and Therapeutics, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - M J MacAvin
- Department of Pharmacology and Therapeutics, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - K Bennett
- HRB Research Leader Unit, RCSI, Division of Population Health Sciences, Beaux Lane House, Mercer Street Lower, Dublin 2, Ireland
| | - L Gallagher
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Beechpark Autism Services, Bryan S. Ryan Building, Main Road, Tallaght, Ireland
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Evers S, Hsu C, Gray MF, Chisolm DJ, Dolcé M, Autio K, Thompson EE, Ervin E, Quintana LM, Beck A, Hansell L, Penfold R. Decision-making among adolescents prescribed antipsychotic medications: Interviews to gain perspectives of youth without psychosis or mania. Clin Child Psychol Psychiatry 2023; 28:683-696. [PMID: 35695248 DOI: 10.1177/13591045221105197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to understand the experiences of youth who had been prescribed antipsychotics but did not have psychosis, mania, autism spectrum disorder, or developmental disability. METHODS Twenty-three qualitative telephone interviews were conducted with youth aged 11-18 who had been prescribed an antipsychotic medication but did not have a diagnosis of psychotic disorder, bipolar disorder, autism spectrum disorder, or developmental disability. Participants were recruited from four U.S. healthcare systems participating in the pragmatic trial Safer Use of Antipsychotics in Youth (SUAY). Interviews were recorded, transcribed and analyzed using template analysis techniques. RESULTS Prior to initiating an antipsychotic medication, most participants experienced behavioral health crises; many felt that they had no options other than to start the medication. Other core themes included: (1) antipsychotics had both positive psychosocial outcomes, such as improvement of family life, and adverse effects, such as drowsiness or weight gain, (2) antipsychotics were only one part of a broader treatment plan, (3) efforts were made to maximize benefits and minimize side effects through careful titration, (4) feedback from friends and family was important in the decision to continue. CONCLUSIONS The findings provide valuable insights into how to engage youth in conversations around the use of antipsychotics.
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Affiliation(s)
- Sarah Evers
- 343041Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Clarissa Hsu
- 343041Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Marlaine F Gray
- 343041Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Deena J Chisolm
- 51711The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Millie Dolcé
- 51711The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Kirsti Autio
- Henry Ford Health System, 2971Center for Health Policy and Health Services Research, Detroit, MI, USA
| | - Ella E Thompson
- 343041Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Emma Ervin
- 51711The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - LeeAnn M Quintana
- 535886Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
| | - Arne Beck
- 535886Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
| | - Laurel Hansell
- 343041Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Rob Penfold
- 343041Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Klau J, Bernardo CDO, Gonzalez-Chica DA, Raven M, Jureidini J. Trends in prescription of psychotropic medications to children and adolescents in Australian primary care from 2011 to 2018. Aust N Z J Psychiatry 2022; 56:1477-1490. [PMID: 34963342 DOI: 10.1177/00048674211067720] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine trends in prescribing psychotropic medications to children and adolescents in Australian primary care from 2011 to 2018. METHOD A retrospective cohort study examined prescriptions written by general practitioners using MedicineInsight, a large Australian primary care database, covering approximately 9% of all general practitioner practices. Numbers of patients receiving prescriptions for five main classes of psychotropics (antipsychotics, antidepressants, attention deficit hyperactivity disorder medications, anxiolytics, and hypnotics/sedatives [including benzodiazepines and Z-drugs, but excluding melatonin]) were examined annually by age-group (0-4, 5-9, 10-14, 15-18 years). Melatonin was analysed separately. RESULTS The number of patients prescribed any psychotropic increased from 25.6 to 36.2 per 1000 individuals from 2011 to 2018 (average annual increase +4.5%, 95% confidence interval [4.1%, 4.9%]; overall +41.4%). Among the five main classes, the largest annual increase was for attention deficit hyperactivity disorder medications (+9.6%, 95% confidence interval [8.8%, 10.5%]; overall +95.8%), followed by antipsychotics (+6.2%, 95% confidence interval [5.0%, 7.3%]; overall +62.8%) and antidepressants (+4.5%, 95% confidence interval [4.0%, 5.0%]; overall +42.8%). Hypnotic/sedative prescribing decreased on average 6.5% per year (95% confidence interval [-8.0%, -5.0%]; overall -40.2%). Anxiolytic prescribing remained steady. Melatonin prescriptions showed the highest increase of all (+24.7%, 95% confidence interval [23.7%, 25.8%]; overall +606.7%). The largest annual increase in antipsychotic, antidepressant or attention deficit hyperactivity disorder medication prescribing occurred in 10- to 14-year-olds (+7.5%, +6.5% and +10.4%, respectively). The largest point prevalence occurred in 2018 among 15- to 18-year-olds, with 98.5 per 1000 prescribed antidepressants. Antidepressants were more frequently prescribed to females; antipsychotics, attention deficit hyperactivity disorder medications and melatonin more often to males. The most prescribed antipsychotics were risperidone (<15 years) and quetiapine (15- to 18-year-olds). Fluoxetine was the most prescribed antidepressant in those aged 5+ years and amitriptyline in 0- to 4-year-olds. CONCLUSION General practitioner prescribing of melatonin, antipsychotics, antidepressants and attention deficit hyperactivity disorder medications to under-19-year-olds increased markedly from 2011 to 2018. Although benzodiazepine and Z-drug prescriptions declined, this was offset by a substantial increase in melatonin prescribing.
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Affiliation(s)
- Julie Klau
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Carla De Oliveira Bernardo
- Discipline of General Practice, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - David Alejandro Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Melissa Raven
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jon Jureidini
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Lee H, Zhang C, Rose R, dosReis S. Pediatric Off-Label Antipsychotic Use for Attention-Deficit/Hyperactivity Disorder. Clin Ther 2022; 44:e83-e90. [PMID: 35965110 DOI: 10.1016/j.clinthera.2022.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Off-label antipsychotic use for behavioral symptoms in pediatric attention-deficit/hyperactivity disorder (ADHD) poses safety concerns, and evidence to support such use is limited. This study aims to investigate the risk of off-label antipsychotic use associated with comorbid disruptive behavior disorder (DBD) among a cohort of youth with ADHD. METHODS A cohort study was conducted using IQVIA PharMetrics Plus for Academics data from 2007 to 2020. Youth 5 to 15 years of age at the index ADHD visit were included in the cohort. The index ADHD visit meets at least 1 of the following criteria: (1) 1 inpatient ADHD visit, (2) 2 outpatient ADHD visits within 90 days, or (3) an ADHD medication prescription fill within 30 days of an outpatient ADHD visit. We excluded youth who had a diagnosis of DBD or a US Food and Drug Administration (FDA)-approved indication for antipsychotics at baseline. Youth were followed up until antipsychotic initiation or were censored at a loss of coverage, receipt of an FDA-indicated diagnosis, or end of the study. A Cox proportional hazards regression model with DBD as a time-varying covariate estimated the hazard of antipsychotic use after the index ADHD visit. FINDINGS Of 41,098 youth with ADHD who met the study criteria, 4557 were diagnosed with DBD during follow-up. The incidence of antipsychotic initiation was 19.6 (95% CI, 18.7- 20.5) per 1000 person-years. After adjustment for baseline covariates, the hazard ratio of antipsychotic initiation associated with DBD was 4.64 (95% CI, 4.15-5.18). IMPLICATIONS Antipsychotic use among youth with ADHD is more likely in the presence of DBD, suggesting that an off-label use is for behavior problems.
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Affiliation(s)
- Haeyoung Lee
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Chengchen Zhang
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Roderick Rose
- University of Maryland School of Social Work, Baltimore, Maryland
| | - Susan dosReis
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland.
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Olin SCS, Freed GL, Scholle SH, Applegate MS. Aligning to Improve Pediatric Health Care Quality. Acad Pediatr 2022; 22:S115-S118. [PMID: 34496314 DOI: 10.1016/j.acap.2021.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 08/05/2021] [Accepted: 08/28/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Su-Chin Serene Olin
- Research & Analysis (SCS Olin and SH Scholle), National Committee for Quality Assurance, Washington, DC.
| | - Gary L Freed
- Susan Meister Child Health Evaluation and Research Center, Department of Pediatrics (GL Freed), University of Michigan, Ann Arbor, Mich
| | - Sarah H Scholle
- Research & Analysis (SCS Olin and SH Scholle), National Committee for Quality Assurance, Washington, DC
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10
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Vuori M, Sourander A, Aronen ET, Kronström K, Saastamoinen LK. Relative Age and the Use of Second-Generation Antipsychotics from 7 to 17 Years of Age: A Population-Based Register Study. J Child Adolesc Psychopharmacol 2022; 32:45-51. [PMID: 34619034 DOI: 10.1089/cap.2021.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: The youngest children in a classroom have a higher risk of attention-deficit/hyperactivity disorders (ADHDs) and depression than their relatively older peers. However, there has been a lack of research on how relative age is related to second-generation antipsychotic (SGA) medication use. Methods: This study used the Finnish National Prescription Register data and comprised all 669,726 Finnish children and adolescents aged 7-17 in 2018. We extracted data for those who were dispensed SGAs (risperidone, quetiapine, aripiprazole, and olanzapine) and ADHD medication (methylphenidate, atomoxetine, dexamphetamine, and lisdexamfetamine). Odds ratios (OR) and 95% confidence intervals (CI) were calculated for medication dispensed to schoolchildren born from January to April (the relatively oldest), May to August, and September to December (the relatively youngest). Dispensed prescriptions were a proxy for medication use. Results: SGAs were dispensed to 9146 (1.4%) individuals in 2018. Their use was lower among girls aged 12-17 years born from September to December than January to April (OR 0.89; 95% CI 0.83-0.97), with no association between SGA use and birth month among boys. However, younger relative age was associated with combined SGA and ADHD medication, which was used by 2556 (0.4%) of the cohort: 2074 (0.6%) boys and 482 (0.1%) girls. The OR was 1.27 for boys aged 12-17 born from September to December (95% CI 1.10-1.46), compared with January to April. The OR for girls born from May to August was 1.35 (95% CI 1.04-1.76) and from September to December it was 1.33 (95% CI 1.02-1.74), compared with January to April. Conclusions: A novel discovery of this study was that using both SGA and ADHD medication at the age of 12-17 years was more common among the youngest subjects in a school year than their relatively older peers.
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Affiliation(s)
- Miika Vuori
- Department of Teacher Education, Turku Institute of Advanced Studies, University of Turku, Turku, Finland.,Department of Child Psychiatry, University of Turku, Turku University Hospital, Turku, Finland
| | - Andre Sourander
- Department of Child Psychiatry, University of Turku, Turku University Hospital, Turku, Finland.,Invest Flagship, University of Turku, Turku, Finland
| | - Eeva T Aronen
- Child Psychiatry, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.,Laboratory of Developmental Psychopathology, Pediatric Research Center, New Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Kim Kronström
- Department of Child Psychiatry, University of Turku, Turku University Hospital, Turku, Finland.,Department of Adolescent Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
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Penfold RB, Thompson EE, Hilt RJ, Schwartz N, Robb AS, Correll CU, Newton D, Rogalski K, Earls MF, Kowatch RA, Beck A, Yarborough BJH, Crystal S, Vitiello B, Kelleher KJ, Simon GE. Development of a Symptom-Focused Model to Guide the Prescribing of Antipsychotics in Children and Adolescents: Results of the First Phase of the Safer Use of Antipsychotics in Youth (SUAY) Clinical Trial. J Am Acad Child Adolesc Psychiatry 2022; 61:93-102. [PMID: 34256967 PMCID: PMC8566327 DOI: 10.1016/j.jaac.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 03/24/2021] [Accepted: 04/01/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To develop a new approach to prescribing guidelines as part of a pragmatic trial, Safer Use of Antipsychotics in Youth (SUAY; ClinicalTrials.gov Identifier: NCT03448575), which supports prescribers in delivering high-quality mental health care to youths. METHOD A nominal group technique was used to identify first- to nth-line treatments for target symptoms and potential diagnoses. The panel included US pediatricians, child and adolescent psychiatrists, and psychopharmacology experts. Meeting materials included information about Medicaid review programs, systematic reviews, prescribing guidelines, and a description of the pragmatic trial. Afterward, a series of 4 webinar discussions were held to achieve consensus on recommendations. RESULTS The panel unanimously agreed that the guideline should focus on target symptoms rather than diagnoses. Guidance included recommendations for first- to nth-line treatment of target mental health symptoms, environmental factors to be addressed, possible underlying diagnoses that should first be considered and ruled out, and general considerations for pharmacological and therapeutic treatments. CONCLUSION Prescribing guidelines are often ignored because they do not incorporate the real-world availability of first-line psychosocial treatments, comorbid conditions, and clinical complexity. Our approach addresses some of these concerns. If the approach proves successful in our ongoing pragmatic trial, Safer Use of Antipsychotics in Youth (SUAY), it may serve as a model to state Medicaid programs and health systems to support clinicians in delivering high-quality mental health care to youths. CLINICAL TRIAL REGISTRATION INFORMATION Safer Use of Antipsychotics in Youth; http://clinicaltrials.gov/; NCT03448575.
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Affiliation(s)
- Robert B Penfold
- Drs. Penfold, Simon, and Ms. Thompson are with Kaiser Permanente Washington Health Research Institute, Seattle.
| | - Ella E Thompson
- Drs. Penfold, Simon, and Ms. Thompson are with Kaiser Permanente Washington Health Research Institute, Seattle
| | - Robert J Hilt
- Dr. Hilt is with Seattle Children's Hospital, Washington
| | - Nadine Schwartz
- Drs. Schwartz, Kowatch, and Kelleher are with Nationwide Children's Hospital, Columbus, Ohio
| | - Adelaide S Robb
- Dr. Robb is with Children's National Hospital, Washington, DC
| | - Christoph U Correll
- Dr. Correll is with The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York; Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; The Feinstein Institute for Medical Research, Manhasset, New York; and Charité Universitätsmedizin Berlin, Germany
| | - Douglas Newton
- Dr. Newton is with Sondermind, Denver, Colorado. At the time of the study, Dr. Newton was with Optum Behavioral Health, Denver, Colorado
| | - Kelly Rogalski
- Dr. Rogalski is with Henry Ford Health System, Detroit, Michigan
| | - Marian F Earls
- Dr. Earls is with Community Care of North Carolina, Raleigh
| | - Robert A Kowatch
- Drs. Schwartz, Kowatch, and Kelleher are with Nationwide Children's Hospital, Columbus, Ohio
| | - Arne Beck
- Dr. Beck is with Kaiser Permanente Colorado Institute for Health Research, Denver
| | - Bobbi Jo H Yarborough
- Dr. Yarborough is with Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Stephen Crystal
- Dr. Crystal is with Rutgers University, Brunswick, New Jersey
| | | | - Kelly J Kelleher
- Drs. Schwartz, Kowatch, and Kelleher are with Nationwide Children's Hospital, Columbus, Ohio
| | - Gregory E Simon
- Drs. Penfold, Simon, and Ms. Thompson are with Kaiser Permanente Washington Health Research Institute, Seattle
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12
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Acute Hyperkinetic Movement Disorders as a Multifactorial Pharmacodynamic Drug Interaction Between Methylphenidate and Risperidone in Children and Adolescents. J Clin Psychopharmacol 2022; 42:238-246. [PMID: 35489029 PMCID: PMC9060383 DOI: 10.1097/jcp.0000000000001547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE/BACKGROUND Acute hyperkinetic movement disorders have been reported with the concomitant use of attention-deficit/hyperactivity disorder (ADHD) stimulants and antipsychotics in children and adolescents. We analyzed postmarketing reports of suspected acute hyperkinetic movement disorder associated with concomitant use of ADHD stimulants and antipsychotics. METHODS/PROCEDURES We searched for postmarketing reports of acute hyperkinetic movement disorders associated with concomitant use of ADHD stimulants-antipsychotics in the US Food and Drug Administration Adverse Event Reporting System through December 6, 2019. PubMed and EMBASE were also searched for acute hyperkinetic movement reports with the concomitant use of ADHD stimulants-antipsychotics through January 13, 2020. FINDINGS/RESULTS We identified 36 cases resulting in acute hyperkinetic movement disorder associated with the concomitant use of ADHD stimulants-antipsychotics, 19 of which were also identified in the medical literature. From an ADHD stimulant perspective, methylphenidate products accounted for the largest number of cases (n = 23 [64%]), followed by amphetamine products (n = 9 [25%]) and atomoxetine (n = 4 [11%]). From an antipsychotic perspective, all 36 cases were reported with second-generation antipsychotics, particularly risperidone (n = 20 [56%]). Most of the cases were reported in boys (n = 31 [86%]) aged 6 to 12 years (n = 27 [75%]). Approximately 53% of the cases reported a time to onset within 24 hours of the drug change. Acute dystonic reactions (n = 27 [75%]) were the most frequently reported movement disorder. IMPLICATIONS/CONCLUSIONS As outlined in changes to the US prescribing information for all methylphenidate and risperidone products, health care professionals should be aware that changes to this combination may be associated with a pharmacodynamic drug-drug interaction resulting in acute hyperkinetic movement disorder.
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13
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Kretchy IA, Blewuada EK, Debrah AB. A qualitative study exploring community pharmacists’ perspectives of child and adolescent mental healthcare. SCIENTIFIC AFRICAN 2021. [DOI: 10.1016/j.sciaf.2021.e00969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Bushnell GA, Crystal S, Olfson M. Trends in Antipsychotic Medication Use in Young Privately Insured Children. J Am Acad Child Adolesc Psychiatry 2021; 60:877-886. [PMID: 33091567 PMCID: PMC8055725 DOI: 10.1016/j.jaac.2020.09.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/16/2020] [Accepted: 10/13/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate trends of annual antipsychotic medication use by privately insured young children (aged 2-7 years) in the United States, and to describe the clinical and treatment characteristics of these children. METHOD The study population included young children from a nationwide commercial claims database (2007-2017). We estimated annual antipsychotic use by age and sex, defined as the number of children dispensed an antipsychotic per year divided by the number enrolled. We described clinical diagnoses and mental health service use in those with prescription antipsychotic use in 2009 and 2017. RESULTS Annual antipsychotic use in young children was 0.27% in 2007, peaked at 0.29% in 2009, and statistically significantly declined to 0.17% by 2017 (linear trend: -0.017% per year, 95% CI: -0.018 to -0.016). Antipsychotic use was higher in boys than in girls. A greater proportion of antipsychotic users received a mental disorder diagnosis in 2017 (89%) than in 2009 (86%, p < .01). The most common clinical diagnoses in antipsychotic users, under a hierarchical classification, were pervasive developmental disorder (2009 = 27%, 2017 = 38%, p < .01), conduct or disruptive behavior disorder (2009 = 15%, 2017 = 21%, p < .01), and attention-deficit/hyperactivity disorder (2009 = 24%, 2017 = 18%, p < .01). Among 2017 antipsychotic users, 32% had 4+ psychotherapy claims, 43% had a psychiatrist visit, and the majority used another psychotropic medication, most commonly a stimulant (boys = 57%, girls = 50%). CONCLUSION In privately insured young children, antipsychotic use declined from 2009 to 2017, with shifts toward indications with some supporting evidence. Nevertheless, a majority of use remains off label and for conditions lacking effectiveness and safety data. Improving antipsychotic prescribing in young children remains a challenge.
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Affiliation(s)
- Greta A Bushnell
- Rutgers School of Public Health, Piscataway, and the Rutgers Center for Pharmacoepidemiology and Treatment Science, New Brunswick, New Jersey.
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research at Rutgers University in New Brunswick, New Jersey
| | - Mark Olfson
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University Mailman School of Public Health, and the New York State Psychiatric Institute in New York
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15
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Melamed OC, LaChance LR, O'Neill BG, Rodak T, Taylor VH. Interventions to Improve Metabolic Risk Screening Among Children and Adolescents on Antipsychotic Medication: A Systematic Review. J Child Adolesc Psychopharmacol 2021; 31:63-72. [PMID: 33512274 DOI: 10.1089/cap.2020.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: Antipsychotic use among youth is common and is associated with metabolic side effects such as weight gain. Guidelines recommend periodic screening of metabolic measures in youth prescribed antipsychotics; however, a guideline-to-practice gap exists. We systematically reviewed the literature to synthesize the knowledge from interventions that aim to improve antipsychotic metabolic screening. We described the interventions' effect on screening rates, the strategies used for improvement, and study quality. Methods: We conducted a systematic review of studies that attempted to improve antipsychotic metabolic risk screening practices among pediatric populations published between 2004 and August 2019. We included studies with an improvement intervention that compared screening rates before and after the intervention. We extracted data about study characteristics, screening rates in pre- and postintervention groups, strategies used to influence screening practices, and assessed studies' risk of bias. This review was prospectively registered with PROSPERO #CRD42018088241. Results: We identified six studies that demonstrated modest improvements in median metabolic screening rates for waist circumference (0%-16%), glucose (9%-39%), and lipids (11%-37%). Median postintervention screening rates were higher for weight and blood pressure (84% and 72.5%) compared with glucose and lipids (39% and 37%). Interventions used a variety of improvement strategies to address patient-, provider-, and organization-level barriers for screening, including increasing patient and provider knowledge regarding antipsychotic side effects, fostering social clinical environments that promote screening, and organizational commitment for screening antipsychotic-treated youth. All interventions were deemed at high risk of bias due to uncontrolled design and lack of adjustment for confounders. Conclusions: Included studies reported partial success in improving antipsychotic screening rates but were of poor methodological quality. Common improvement strategies may affect provider behavior to conduct metabolic screening, but these need to be tailored to local resources and organization structure. Future studies need to use rigorous methodology and theory-informed improvement strategies aligned with organizational actions to prioritize safe and judicious practice of antipsychotics among pediatric populations.
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Affiliation(s)
- Osnat C Melamed
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura R LaChance
- St. Mary's Hospital, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Braden G O'Neill
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,North York General Hospital, Toronto, Ontario, Canada
| | - Terri Rodak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
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Maruf AA, Stein K, Arnold PD, Aitchison KJ, Müller DJ, Bousman C. CYP2D6 and Antipsychotic Treatment Outcomes in Children and Youth: A Systematic Review. J Child Adolesc Psychopharmacol 2021; 31:33-45. [PMID: 33074724 DOI: 10.1089/cap.2020.0093] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: To systematically review the impact of CYP2D6 genetic variation on antipsychotic pharmacokinetics, efficacy, and adverse drug reactions among children and youth. Method: The published literature was systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations and critically evaluated using standardized tools and consensus criteria. Results: A total of 20 eligible studies comprising 1078 children and youth were evaluated. The included studies were of fair to moderate quality and included mostly males, individuals of European ancestry, and those treated with risperidone. CYP2D6 poor metabolizers (PMs) were consistently shown to have increased concentrations of risperidone relative to normal metabolizers (NMs). PMs were also consistently shown to have a greater propensity to experience antipsychotic (primarily risperidone) associated adverse drug reactions relative to NMs. However, robust evidence for an association between CYP2D6 and efficacy was less apparent. Conclusion and Clinical Significance: The current knowledge base suggests that CYP2D6 genetic variation has an appreciable impact on antipsychotic pharmacokinetics and the propensity for adverse drug reactions, particularly among children receiving risperidone treatment. However, several limitations with the current literature (e.g., sample sizes, study design, sample heterogeneity) should be addressed in future studies. Assuming that future studies support the link between CYP2D6 genetic variation and antipsychotic outcomes, we would anticipate an increase in the implementation of CYP2D6-guided antipsychotic drug selection and dose optimization in child and adolescent psychiatric services.
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Affiliation(s)
- Abdullah Al Maruf
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Psychiatry, University of Calgary, Calgary, Canada.,Department of Physiology and Pharmacology, University of Calgary, Calgary, Canada
| | - Kiera Stein
- Department of Medical Genetics, University of Calgary, Calgary, Canada
| | - Paul D Arnold
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Psychiatry, University of Calgary, Calgary, Canada.,Department of Medical Genetics, University of Calgary, Calgary, Canada
| | - Katherine J Aitchison
- Departments of Psychiatry and Medical Genetics, University of Alberta, Edmonton, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Daniel J Müller
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Chad Bousman
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Psychiatry, University of Calgary, Calgary, Canada.,Department of Medical Genetics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
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17
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Penfold RB, Thompson EE, Hilt RJ, Kelleher KJ, Schwartz N, Beck A, Clarke GN, Ralston JD, Hartzler AL, Coley RY, Akosile M, Vitiello B, Simon GE. Safer use of antipsychotics in youth (SUAY) pragmatic trial protocol. Contemp Clin Trials 2020; 99:106184. [PMID: 33091587 PMCID: PMC7726008 DOI: 10.1016/j.cct.2020.106184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/18/2020] [Accepted: 10/15/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Programs such as the Pediatric Access Line in Washington state have shown decreases in antipsychotic medication use by youth with non-psychotic disorders. Program outcomes have been studied with observational designs. This manuscript describes the protocol for Targeted and Safer Use of Antipsychotics in Youth (SUAY), a randomized controlled trial of psychiatrist review of prescriptions and facilitated access to psychosocial care. The aim of the intervention is to reduce the number of person-days of antipsychotic use among participants. METHODS Recruitment occurs at 4 health systems. Targeted enrollment is 800 youth aged 3-17 years. Clinicians are block randomized to intervention versus usual care prior to the study. Youth are nested within the arm of the prescribing clinician. Clinicians in the intervention group receive an EHR-based best practice alert with options to expedite access to psychosocial care and all medication orders are reviewed by a child and adolescent psychiatrist with feedback provided to the prescriber. The primary outcome is person-days of antipsychotic medication use in the 6 months following the initial order. All randomized individuals contribute data regardless of their level of participation (including declining all services). DISCUSSION The trial has been approved by the institutional review boards at each of the 4 sites. The intervention has 4 novel design features including automated recruitment using a best practice alert, psychiatrist medication order review and consultation, telephone navigation to psychosocial care, and telemental health visits. Recruitment began in March of 2018 and will be completed in June 2020. Follow-up will be completed December 31, 2020. TRIAL REGISTRATION Clinicaltrials.gov, NCT03448575.
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Affiliation(s)
- Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Ella E Thompson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Kelly J Kelleher
- Nationwide Children's Hospital, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Nadine Schwartz
- Nationwide Children's Hospital, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, USA
| | - Gregory N Clarke
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Mary Akosile
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Benedetto Vitiello
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, University of Turin, Turin, Italy
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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18
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Purtle J, Nelson KL, Bruns EJ, Hoagwood KE. Dissemination Strategies to Accelerate the Policy Impact of Children's Mental Health Services Research. Psychiatr Serv 2020; 71:1170-1178. [PMID: 32517640 PMCID: PMC9721469 DOI: 10.1176/appi.ps.201900527] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The United States is in the midst of a children's mental health crisis, with rates of depression, anxiety, and suicide increasing precipitously. Evidence produced by children's mental health services research can help address this crisis by informing public policy decisions about service delivery, system design, and investments in the social determinants of mental health. Unfortunately, the policy impact of children's mental health services research is limited because evidence often fails to reach policy makers, be responsive to their needs, resonate with their worldview, or reflect the contexts in which they make decisions. Dissemination strategies-defined as the development and targeted distribution of messages and materials about research evidence pertaining to a specific issue or intervention-can help address these challenges. Yet, limited integrated guidance exists to inform the design of such strategies. This article addresses this need by synthesizing the results of empirical studies to provide guidance about how to enhance the dissemination of children's mental health services research to policy makers. The article provides four recommendations about the content of policy maker-focused dissemination materials, discusses how strategic framing and message tailoring can increase the chances that evidence is persuasive to policy makers, and highlights strategies to ensure that evidence reaches policy makers.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia (Purtle, Nelson); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Bruns); Department of Child and Adolescent Psychiatry, New York University Langone School of Medicine, New York (Hoagwood)
| | - Katherine L Nelson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia (Purtle, Nelson); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Bruns); Department of Child and Adolescent Psychiatry, New York University Langone School of Medicine, New York (Hoagwood)
| | - Eric J Bruns
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia (Purtle, Nelson); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Bruns); Department of Child and Adolescent Psychiatry, New York University Langone School of Medicine, New York (Hoagwood)
| | - Kimberly E Hoagwood
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia (Purtle, Nelson); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Bruns); Department of Child and Adolescent Psychiatry, New York University Langone School of Medicine, New York (Hoagwood)
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19
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Kelleher KJ, Rubin D, Hoagwood K. Policy and Practice Innovations to Improve Prescribing of Psychoactive Medications for Children. Psychiatr Serv 2020; 71:706-712. [PMID: 32188362 DOI: 10.1176/appi.ps.201900417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Psychoactive medications are the most expensive and fastest-growing class of pharmaceutical agents for children. The cost, side effects, and unprecedented growth rate at which these drugs are prescribed have raised alarms from health care clinicians, patient advocates, and agencies about the appropriateness of how these drugs are distributed to parents and their children. This article examines current prescribing of three classes of psychoactive drugs-stimulants, antidepressants, and antipsychotics-and efforts to improve pediatric prescribing of these agents. Federal policy efforts to curb questionable prescribing of psychoactive medications to children have focused particularly on oversight of antipsychotic use among foster care children. The article reviews system-level interventions, including delivery system enhancements, which increase availability of alternatives to medication treatments, employ electronic medical record reminders, and increase cross-sector care coordination; clinician prescribing enhancements, which disseminate best-practice guidelines, create quality and learning collaboratives, and offer "second opinion" psychiatric consultations; and prescriber monitoring programs, which include retrospective review and prospective monitoring of physicians' prescribing to identify patterns suggestive of inappropriate prescribing. Potential interventions to deter inappropriate pediatric prescribing are briefly described, such as transparency in drug prices and incentives among insurers, public agencies, and pharmacy benefit managers; value-based purchasing, specifically value-based payment for medications; and preventive interventions, such as parent training.
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Affiliation(s)
- Kelly J Kelleher
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (Kelleher); PolicyLab at Children's Hospital of Philadelphia, Philadelphia (Rubin); Department of Pediatrics, New York University Langone Health, New York (Hoagwood)
| | - David Rubin
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (Kelleher); PolicyLab at Children's Hospital of Philadelphia, Philadelphia (Rubin); Department of Pediatrics, New York University Langone Health, New York (Hoagwood)
| | - Kimberly Hoagwood
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (Kelleher); PolicyLab at Children's Hospital of Philadelphia, Philadelphia (Rubin); Department of Pediatrics, New York University Langone Health, New York (Hoagwood)
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20
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Tural Hesapcioglu S, Ceylan MF, Kandemir G, Kasak M, Sen CP, Correll CU. Frequency and Correlates of Acute Dystonic Reactions After Antipsychotic Initiation in 441 Children and Adolescents. J Child Adolesc Psychopharmacol 2020; 30:366-375. [PMID: 32255662 DOI: 10.1089/cap.2019.0123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: To determine the incidence of acute dystonic reactions (ADRs) and risk factors for ADRs in children and adolescents treated with antipsychotics. Methods: This was a retrospective chart review-based cohort study of consecutive patients who attended a university hospital's child and adolescent psychiatry department between 2015 and 2017 and who were treated with antipsychotics and had at least two follow-up visits. Results: Thirty of 441 patients (6.8%) 4-19 years of age who were treated with antipsychotics for conduct disorders (21.5%), attention-deficit/hyperactivity disorder (13.2%) and, irritability and aggression that accompanied intellectual disability (12.9%) and followed for 99.5 ± 223.3 (median: 34) days developed ADRs. ADRs developed in 11/391 patients (2.8%) treated with one antipsychotic and 19/50 patients (38.0%) treated with two antipsychotics (p < 0.001). In patients treated with one antipsychotic that developed ADRs, the time to ADRs was 4.0 ± 4.0 days after antipsychotic initiation and 2.7 ± 2.4 days after an increase in the antipsychotic dose. The time to ADRs in those treated with two antipsychotics was 3.0 ± 2.3 days after the addition of the second antipsychotic and 1.6 ± 0.8 days after a dose increase in the second antipsychotic. The incidence of ADRs during antipsychotic monotherapy was 10.5% with first-generation antipsychotics (FGAs) and 2.2% with second-generation antipsychotics (SGAs; p = 0.037). The antipsychotic was changed due to ADRs in 12/30 (40.0%) of ADR cases. Independent factors associated with ADRs were antipsychotic polypharmacy (p < 0.0001), inpatient treatment (p = 0.013), FGA use (p = 0.015), and diagnoses of schizophrenia (p = 0.039) or bipolar disorder (p < 0.0001). Conclusion: SGAs and low-potency FGA monotherapy in children and adolescents were associated with a relatively low ADR risk, whereas high- and mid-potency FGAs were associated with a high risk. Independent predictors of ADRs were antipsychotic polypharmacy, inpatient treatment, FGAs, and schizophrenia or bipolar disorder diagnoses, which may be related to more aggressive antipsychotic dosing.
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Affiliation(s)
- Selma Tural Hesapcioglu
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Mehmet Fatih Ceylan
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Gözde Kandemir
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Meryem Kasak
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Cansu Pınar Sen
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Christoph U Correll
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA.,Department of Child and Adolescent Psychiatry, Charité Universitäts medizin Berlin, Berlin, Germany
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21
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'Use of antipsychotics in children and adolescents: a picture from the ARITMO population-based European cohort study'. Epidemiol Psychiatr Sci 2020; 29:e117. [PMID: 32308179 PMCID: PMC7214736 DOI: 10.1017/s2045796020000293] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AIMS Prevalence of the use of antipsychotics (APs) in the paediatric population is globally increasing. The aim of this study was to describe multinational trends and patterns in AP use in children and adolescents in Europe. METHODS This was a dynamic retrospective cohort study comprising all children and adolescents (⩽18 years of age). Data were extracted from five population-based electronic healthcare databases in Europe (Denmark, Germany, Italy, the Netherlands and United Kingdom) from 2000 to 2010. Yearly prevalence and incidence of AP use was expressed per 1000 person-years (PYs). RESULTS Prevalence increased from 1.44 to 3.41/1000 PYs (2008) in Denmark and from 2.07 to 4.35/1000 PYs in the NL (2009), moderately increased from 2.8 to 3.24/1000 in UK (2009) and from 1.53 to 1.74/1000 PYs in Germany (2008) and remained low from 0.61 to 0.34/1000 PYs in Italy (2010). Similarly, incidence rates increased from 0.69 to 1.52/1000 PYs in Denmark and from 0.86 to 1.49/1000 PYs in the NL, stabilised from 2.29 to 2.37/1000 PYs in the UK and from 0.79 to 0.80/1000 PYs in Germany and remained low from 0.32 to 0.2/1000 PYs in Italy. AP use was highest in 15-18 year olds and in boys compared to girls. Yet, the use observed in the 5-9 year olds was found to be comparatively high in the NL. Prescriptions of second generation APs, especially risperidone, were privileged but the first generation APs were still prescribed in the youngest. CONCLUSIONS A steady increase in AP use in children and adolescents was observed essentially in the NL and Denmark. The use in Germany and Italy was lowest among countries. The use of APs under 9 years of age underlines their off-label use and should be carefully monitored as the risk/benefit ratio of these medications remains unclear in young children. AP use was altogether lower in Europe as compared to that reported in North America.
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Prescribing antipsychotics in child and adolescent psychiatry: guideline adherence. Eur Child Adolesc Psychiatry 2020; 29:1717-1727. [PMID: 32052173 PMCID: PMC7641940 DOI: 10.1007/s00787-020-01488-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 02/01/2020] [Indexed: 12/23/2022]
Abstract
Antipsychotics are often prescribed to children and adolescents, mostly off-label. We aimed to assess adherence to recommendations of guidelines for antipsychotic prescription. We reviewed 436 medical records from 155 clinicians from 26 clinics within three Dutch child and adolescent psychiatry organizations (n = 398 outpatient, n = 38 inpatient care). We assessed target symptoms, diagnostic process, prior and concomitant treatment, and consideration of contra-indications. Multiple logistic regression assessed the role of age, sex, and psychiatric diagnosis on adherence to three main recommendations: to (1) prescribe antipsychotics only after other treatments proved insufficient, (2) always combine antipsychotics with psychosocial interventions, and (3) not prescribe multiple antipsychotics simultaneously. Most patients received off-label antipsychotics. Main target symptoms were inattention/hyperactivity (25%), aggression (24%), and other disruptive behaviors (41%). Most patients underwent diagnostic evaluation before the first prescription; however, screening of contra-indications was low (0.2-19%). About 84% had previously received psychosocial treatment and 48% other psychoactive medication, but 9% had not received any treatment. Notably, only 37% continuously received concomitant psychosocial treatment. Simultaneous use of multiple antipsychotics occurred in 3.2%. Younger children were at higher risk of non-adherence to guideline recommendations regarding prior and concomitant treatment, children with autism spectrum disorder or attention-deficit/hyperactivity disorder more likely not to receive concomitant psychosocial treatment. Sex did not significantly affect adherence. Our findings implicate insufficient adherence to important recommendations regarding antipsychotic use in children and adolescents. Especially younger children are at higher risk of receiving suboptimal care. There is an urgency to consistently offer psychosocial interventions during antipsychotic treatment.
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Olin S, Storfer-Isser A, Morden E, Yin Y, Altamirano L, Byron SC, Scholle SH. Quality Measures for Managing Prescription of Antipsychotic Medication Among Youths: Factors Associated With Health Plan Performance. Psychiatr Serv 2019; 70:1020-1026. [PMID: 31337323 DOI: 10.1176/appi.ps.201900089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the performance of health plans on two HEDIS measures: metabolic monitoring of children and adolescents prescribed an antipsychotic and use of first-line psychosocial care for children and adolescents prescribed an antipsychotic for a nonindicated use. Plan characteristics and other contextual factors that may be associated with health plan performance were examined to identify potential strategies for improving care. METHODS The study population included 279 commercial and 169 Medicaid health plans that voluntarily submitted data for care provided in 2016. Bivariate associations between performance on the two measures and each plan characteristic (eligible population size, region, profit status, model type, and operating in a state with legislation on prior authorization for antipsychotics) were examined. Main-effects multivariable linear regression models were used to examine the combined association of plan characteristics with each measure. RESULTS Performance rates on both measures were comparable for commercial and Medicaid plans. Among commercial plans, not-for-profit plans outperformed for-profit plans on both measures. Commercial and Medicaid plans in the North performed significantly better on the metabolic monitoring measure. Commercial plans in the South and Medicaid plans in the West performed significantly worse on the first-line psychosocial care measure. Plans operating in states requiring prior authorization performed significantly better on the metabolic monitoring measure. CONCLUSIONS This study identified key plan characteristics and other contextual factors associated with health plan performance on quality measures related to pediatric antipsychotic prescribing. Findings suggest that quality measures, in conjunction with policies such as prior authorization, can encourage better care delivery to vulnerable populations.
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Affiliation(s)
- Serene Olin
- National Committee for Quality Assurance, Washington, D.C
| | | | - Emily Morden
- National Committee for Quality Assurance, Washington, D.C
| | - Yijun Yin
- National Committee for Quality Assurance, Washington, D.C
| | - Lee Altamirano
- National Committee for Quality Assurance, Washington, D.C
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Hartzler AL, Ralston JD, A Hannan T, Kelleher KJ, Penfold RB. Designing Safer Use of Antipsychotics Among Youths: A Human-Centered Approach to an Algorithm-Based Solution. Psychiatr Serv 2019; 70:944-947. [PMID: 31310188 PMCID: PMC6773473 DOI: 10.1176/appi.ps.201800390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Guidelines recommend against prescribing antipsychotics without an indication, yet prescription rates remain undesirably high for youths. Information technology can facilitate guideline-based prescribing, but little is known about providers' needs. The Safer Use of Antipsychotics in Youth project is implementing an algorithm-based workflow for peer consultation, care navigation, and expedited psychotherapy access. To optimize workflow for a multisite trial, we engaged providers for input. METHODS Guided by human-centered design, we interviewed 15 providers from Kaiser Permanente Washington and Nationwide Children's Hospital about their prescribing barriers and workflow preferences. We identified qualitative themes on barriers affecting implementation and design opportunities to optimize workflow. RESULTS Providers expressed two major barriers: potential disruptions to clinical practice and threats to professional autonomy. Three design opportunities emerged: à la carte orders, passive review of orders, and consultation self-acknowledgment. CONCLUSIONS Human-centered design offers an innovative approach to improve guideline-based prescribing with optimizations that are grounded in providers' needs.
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Affiliation(s)
- Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle (Hartzler); Kaiser Permanente Washington Health Research Institute, Seattle (Ralston, Hannan, Penfold); Nationwide Children's Hospital, Abigail Wexner Research Institute, Center for Innovation in Pediatric Practice, Columbus, Ohio (Kelleher)
| | - James D Ralston
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle (Hartzler); Kaiser Permanente Washington Health Research Institute, Seattle (Ralston, Hannan, Penfold); Nationwide Children's Hospital, Abigail Wexner Research Institute, Center for Innovation in Pediatric Practice, Columbus, Ohio (Kelleher)
| | - Terry A Hannan
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle (Hartzler); Kaiser Permanente Washington Health Research Institute, Seattle (Ralston, Hannan, Penfold); Nationwide Children's Hospital, Abigail Wexner Research Institute, Center for Innovation in Pediatric Practice, Columbus, Ohio (Kelleher)
| | - Kelly J Kelleher
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle (Hartzler); Kaiser Permanente Washington Health Research Institute, Seattle (Ralston, Hannan, Penfold); Nationwide Children's Hospital, Abigail Wexner Research Institute, Center for Innovation in Pediatric Practice, Columbus, Ohio (Kelleher)
| | - Robert B Penfold
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle (Hartzler); Kaiser Permanente Washington Health Research Institute, Seattle (Ralston, Hannan, Penfold); Nationwide Children's Hospital, Abigail Wexner Research Institute, Center for Innovation in Pediatric Practice, Columbus, Ohio (Kelleher)
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Schoenfelder Gonzalez E, Myers K, Thompson EE, King DA, Glass AM, Penfold RB. Developing home-based telemental health services for youth: Practices from the SUAY Study. J Telemed Telecare 2019; 27:110-115. [PMID: 31342851 DOI: 10.1177/1357633x19863208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There are no published procedural or safety guidelines for home-based telemental health (TMH) therapy with youth, despite the unique challenges and risks of providing services to this population outside of a traditional clinic setting. We developed clinical, logistical, and safety procedures for home-based TMH with youth in the context of a large clinical trial. METHODS A Targeted Approach to Safer Use of Antipsychotics in Youth (SUAY) study identifies youth ages 3-17 who are prescribed second-generation antipsychotic medication for non-psychotic disorders within large healthcare systems. Prescribing physicians receive psychopharmacology consultation. Patients receive a "navigator" to coordinate treatments and access to TMH if they do not have a local therapist. We optimized access by allowing TMH sessions to take place in the family's home, while providing guidelines for privacy, safety, and in-session crises. RESULTS Clinical issues included providing flexibility in the treatment modality and engaging families. Logistical issues included remote consenting for treatment and troubleshooting technological problems. Safety issues included crisis and safety planning with the youth and family before and during treatment. DISCUSSION The provision of home-based TMH therapy for youth requires adaptations to existing TMH procedural and safety guidelines to optimize clinical care, technology coordination, and safety.Trial registration number and trial register: Clinicaltrials.gov: NCT03448575.
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Affiliation(s)
- Erin Schoenfelder Gonzalez
- University of Washington School of Medicine; Seattle, WA USA.,Center for Children's Health, Behavior, and Development, Seattle Children's Hospital, Seattle WA USA
| | - Kathleen Myers
- University of Washington School of Medicine; Seattle, WA USA.,Center for Children's Health, Behavior, and Development, Seattle Children's Hospital, Seattle WA USA
| | - Ella E Thompson
- Kaiser Permanente Washington Health Research Institute; Seattle, WA USA
| | - Deborah A King
- Kaiser Permanente Washington Health Research Institute; Seattle, WA USA
| | - Ashley M Glass
- Kaiser Permanente Washington Health Research Institute; Seattle, WA USA
| | - Robert B Penfold
- Kaiser Permanente Washington Health Research Institute; Seattle, WA USA
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Modesitt T, Kubascik E, Ott C. Extent of use of long-acting injectable antipsychotics in children and adolescents within Indiana Medicaid. Ment Health Clin 2018; 8:202-207. [PMID: 30206502 PMCID: PMC6125120 DOI: 10.9740/mhc.2018.09.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Oral formulations of the antipsychotics aripiprazole, asenapine, lurasidone, olanzapine, paliperidone, quetiapine, and risperidone are indicated for use in pediatrics for several diagnoses. Long-acting injectable (LAI) antipsychotics are of interest in this special population because they may be used due to convenience and desire to improve adherence, despite limited support in the literature. The primary intent of this study is to provide descriptive information on the use of paliperidone palmitate, risperidone microspheres, aripiprazole extended-release injection, and olanzapine pamoate in pediatric patients within Indiana Medicaid. Methods: This study was a retrospective database analysis, which retrieved information from Indiana Medicaid over a 2-year timeframe spanning from July 1, 2012, through June 30, 2014. The study included the prescription medications filled for all children and adolescents within Indiana Medicaid who received the LAI antipsychotics paliperidone palmitate, risperidone microspheres, aripiprazole extended-release injection, and olanzapine pamoate. Results: From July 1, 2012, through June 30, 2014, 150 Indiana Medicaid patients younger than 18 years old were prescribed a LAI atypical antipsychotic. A total of 1013 LAI atypical antipsychotic doses were billed to Indiana Medicaid during the study period for pediatric patients. Paliperidone palmitate was billed most frequently. Discussion: Long-acting injectable atypical antipsychotics are being prescribed for children and adolescents within Indiana Medicaid, despite minimal clinical evidence supporting use. There is a need for further research in this area to increase generalizability of results and aid in implementation of policies to prevent inappropriate use of LAI antipsychotics in children and adolescents.
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Affiliation(s)
- Taylor Modesitt
- (Corresponding author) Clinical Pharmacy Specialist Mental Health, VA Northern Indiana Health Care System, Department of Veterans Affairs Medical Center, Fort Wayne, Indiana,
| | - Erica Kubascik
- Pharmaceutical Sciences Student, Purdue University College of Pharmacy, West Lafayette, Indiana
| | - Carol Ott
- Clinical Professor of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, Indiana; Clinical Pharmacy Specialist, Outpatient Psychiatry, Eskenazi/Midtown Community Mental Health, Ezkenazi Health, Indianapolis, Indiana
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Felin T, Naveed S, Chaudhary AM. Aripiprazole-Induced Neutropenia: Case Report and Literature Review. J Psychosoc Nurs Ment Health Serv 2018; 56:21-24. [PMID: 29715374 DOI: 10.3928/02793695-20180419-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Aripiprazole is a third-generation atypical antipsychotic medication, which is widely used for various psychiatric disorders across the lifespan. Aripiprazole can cause side effects including headache, insomnia, agitation, nervousness, lightheadedness, dizziness, somnolence, akathisia, and weight gain. Neutropenia is a less frequent side effect of aripiprazole. The current article reviews a case of a 10-year-old African American boy who developed neutropenia with aripiprazole. It is important for clinicians to be aware of this rare side effect. [Journal of Psychosocial Nursing and Mental Health Services, 56(5), 21-24.].
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Kirsch DJ, Doerfler LA, Domakonda M. Chart Review Study of Prescription of Antipsychotic Medication in College Students Referred for Psychopharmacologic Evaluation. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2018. [DOI: 10.1080/87568225.2018.1453759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Daniel J. Kirsch
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Leonard A. Doerfler
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Assumption College, Worcester, Massachusetts, USA
| | - Mirjana Domakonda
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Sukasem C, Vanwong N, Srisawasdi P, Ngamsamut N, Nuntamool N, Hongkaew Y, Puangpetch A, Chamkrachangpada B, Limsila P. Pharmacogenetics of Risperidone-Induced Insulin Resistance in Children and Adolescents with Autism Spectrum Disorder. Basic Clin Pharmacol Toxicol 2018; 123:42-50. [DOI: 10.1111/bcpt.12970] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/15/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Chonlaphat Sukasem
- Division of Pharmacogenomics and Personalized Medicine; Department of Pathology; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
- Laboratory for Pharmacogenomics; Somdech Phra Debaratana Medical Center (SDMC); Ramathibodi Hospital; Bangkok Thailand
| | - Natchaya Vanwong
- Division of Pharmacogenomics and Personalized Medicine; Department of Pathology; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
- Laboratory for Pharmacogenomics; Somdech Phra Debaratana Medical Center (SDMC); Ramathibodi Hospital; Bangkok Thailand
| | - Pornpen Srisawasdi
- Division of Clinical Chemistry; Department of Pathology; Faculty of Medicine; Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Nattawat Ngamsamut
- Department of Mental Health Services; Yuwaprasart Waithayopathum Child and Adolescent Psychiatric Hospital; Ministry of Public Health; Samut Prakan Thailand
| | - Nopphadol Nuntamool
- Division of Pharmacogenomics and Personalized Medicine; Department of Pathology; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
- Laboratory for Pharmacogenomics; Somdech Phra Debaratana Medical Center (SDMC); Ramathibodi Hospital; Bangkok Thailand
- Molecular Medicine; Faculty of Science; Mahidol University; Bangkok Thailand
| | - Yaowaluck Hongkaew
- Division of Pharmacogenomics and Personalized Medicine; Department of Pathology; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
- Laboratory for Pharmacogenomics; Somdech Phra Debaratana Medical Center (SDMC); Ramathibodi Hospital; Bangkok Thailand
| | - Apichaya Puangpetch
- Division of Pharmacogenomics and Personalized Medicine; Department of Pathology; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
- Laboratory for Pharmacogenomics; Somdech Phra Debaratana Medical Center (SDMC); Ramathibodi Hospital; Bangkok Thailand
| | - Bhunnada Chamkrachangpada
- Department of Mental Health Services; Yuwaprasart Waithayopathum Child and Adolescent Psychiatric Hospital; Ministry of Public Health; Samut Prakan Thailand
| | - Penkhae Limsila
- Department of Mental Health Services; Yuwaprasart Waithayopathum Child and Adolescent Psychiatric Hospital; Ministry of Public Health; Samut Prakan Thailand
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Becerra TA, Massolo ML, Yau VM, Owen-Smith AA, Lynch FL, Crawford PM, Pearson KA, Pomichowski ME, Quinn VP, Yoshida CK, Croen LA. A Survey of Parents with Children on the Autism Spectrum: Experience with Services and Treatments. Perm J 2018; 21:16-009. [PMID: 28488981 DOI: 10.7812/tpp/16-009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Autism spectrum disorders (ASD) are lifelong neurodevelopmental disorders, and little is known about how parents address the health and psychosocial consequences of ASD. Few studies have examined use of various treatments and services in a large, diverse sample of children with ASD and their families. OBJECTIVE This paper presents methods to create an autism research resource across multiple large health delivery systems and describes services and treatments used by children with ASD and their families. METHODS Four study sites conducted a Web survey of parents of children and adolescents with ASD who were members of Kaiser Permanente. We tabulated data distributions of survey responses and calculated χ2 statistics for differences between responders and nonresponders. RESULTS The children of the 1155 respondents were racially and ethnically diverse (55% white, 6% black, 5% Asian, 9% multiracial, 24% Hispanic) and representative of the total population invited to participate with respect to child sex (83% male), child age (57% < 10 years), and ASD diagnosis (64% autistic disorder). The most frequently used services and treatments were Individualized Education Programs (85%), family physician visits (78%), and occupational and speech therapy (55% and 60%, respectively). Home-based programs frequently included implementation of social skills training (44%) and behavior management (42%). Prescription medication use was high (48%). Caregivers reported disruption of personal and family routines because of problem behaviors. CONCLUSION These survey data help to elucidate parents' experiences with health services for their children with ASD and serve as a potential resource for future research.
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Affiliation(s)
- Tracy A Becerra
- Postdoctoral Research Fellow at the Department of Research & Evaluation for Kaiser Permanente Southern California in Pasadena.
| | - Maria L Massolo
- Senior Research Project Manager for the Division of Research in Oakland, CA.
| | - Vincent M Yau
- Former Staff Scientist for the Autism Research Program at the Division of Research in Oakland, CA.
| | - Ashli A Owen-Smith
- Behavioral Scientist and Assistant Professor in Health Management and Policy at Georgia State University in Atlanta.
| | - Frances L Lynch
- Health Economist and Senior Investigator at the Center for Health Research in Portland, OR.
| | | | - Kathryn A Pearson
- Former Research Project Manager at the Center for Health Research in Portland, OR.
| | - Magdalena E Pomichowski
- Former Research Associate at the Department of Research & Evaluation for Kaiser Permanente Southern California in Pasadena.
| | - Virginia P Quinn
- Former Research Scientist II in the Department of Research & Evaluation for Kaiser Permanente Southern California in Pasadena.
| | | | - Lisa A Croen
- Senior Research Scientist at the Division of Research in Oakland, CA.
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Houseknecht KL, Bouchard CC, Black CA. Elucidating the Mechanism(s) Underlying Antipsychotic and Antidepressant-Mediated Fractures. ACTA ACUST UNITED AC 2017; 1:9-13. [PMID: 31008454 PMCID: PMC6469345 DOI: 10.29245/2578-2959/2018/1.1106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mood spectrum disorders and medications used to treat these disorders, such as atypical antipsychotic drugs (AA), are associated with metabolic and endocrine side effects including obesity, dyslipidemia, hyperglycemia and increased risk of fractures. Antidepressant medications, including selective serotonin reuptake inhibitors (SSRI), have also been reported to increase fracture risk in some patients. The pharmacology underlying the increased risk of fractures is currently unknown. Possible mechanisms include alternations in dopaminergic and/or serotonergic signaling pathways. As these medications distribute to the bone marrow as well as to the brain, it is possible that drug-induced fractures are due to both centrally mediated effects as well as direct effects on bone turnover. Given the growing patient population that is prescribed these medications for both on- and off-label indications, understanding the level of risk and the mechanisms underlying drug-induced fractures is important for informing both prescribing and patient monitoring practices.
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Affiliation(s)
- Karen L Houseknecht
- College of Osteopathic Medicine, University of New England, 11 Hills Beach Road, Biddeford, ME 04005, USA.,College of Pharmacy, University of New England, 11 Hills Beach Road, Biddeford, ME 04005 USA
| | - C C Bouchard
- College of Osteopathic Medicine, University of New England, 11 Hills Beach Road, Biddeford, ME 04005, USA
| | - C A Black
- College of Pharmacy, University of New England, 11 Hills Beach Road, Biddeford, ME 04005 USA
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Hulvershorn L, Parkhurst S, Jones S, Dauss K, Adams C. Improved Metabolic and Psychiatric Outcomes with Discontinuation of Atypical Antipsychotics in Youth Hospitalized in a State Psychiatric Facility. J Child Adolesc Psychopharmacol 2017; 27:897-907. [PMID: 28880609 DOI: 10.1089/cap.2017.0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess the impact of antipsychotic tapering and discontinuation on measures of metabolic functioning and psychiatric symptom severity in severely impaired youth hospitalized in a psychiatric state hospital. METHODS The study examined psychiatric and metabolic measures in 67 hospitalized children and adolescents (mean age 11.9; 56 with discontinued use of antipsychotics, 10 with continued use of antipsychotics, and 1 started on an antipsychotic) from admission to discharge. RESULTS Upon admission, 56 youth were tapered off of antipsychotic medications, started on other forms of pharmacotherapy (92.9% were started on medications used to treat attention-deficit/hyperactivity disorder), and received evidence-based behavioral programming and were ultimately discharged from the hospital. The mean duration of treatment was 228 days for the discontinuation group and 204 days for the continuation group. Significant decreases in body mass index [BMI; t(53) = 7.12, p = 0.0001] and BMI percentile [t(53) = 6.73, p = 0.0001] were found from admission to discharge in the antipsychotic discontinuation group. Changes in BMI, BMI percentile, or systolic blood pressure were not found in the group (n = 10) who were maintained on antipsychotics. Both groups experienced a significant increase in their Global Assessment of Functioning score [t(52) = 19.98, p = 0.0001 for discontinued; t(8) = 5.092, p = 0.001 for maintained]. Psychiatric symptom severity scores significantly improved in many subscales relevant to disruptive behaviors and mood disorders for those who were removed from the medications. For those maintained on the antipsychotics, there were fewer changes in psychiatric symptom scores. CONCLUSION Discontinuation of atypical antipsychotic medications in conjunction with tailoring treatment to presenting diagnoses resulted in metabolic and psychiatric symptom improvement among severely impaired state hospital inpatient youth. These results serve as a feasibility demonstration that discontinuation of antipsychotics does not provoke psychiatric destabilization, particularly among disruptive behavior disordered youth.
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Affiliation(s)
- Leslie Hulvershorn
- 1 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| | - Samantha Parkhurst
- 1 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| | - Shannon Jones
- 2 Evansville Psychiatric Children's Center , Indiana Family and Social Services Agency, Evansville, Indiana
| | - Kristin Dauss
- 1 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| | - Caitlin Adams
- 1 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
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Biscontri RG, Jha S, Collins DM, Bugden S, Katz LY, Alessi-Severini S. Movement Disorders in Children and Adolescents Receiving Antipsychotic Pharmacotherapy: A Population-Based Study. J Child Adolesc Psychopharmacol 2017; 27:892-896. [PMID: 29091743 DOI: 10.1089/cap.2017.0036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To describe a cohort of young users of risperidone and quetiapine in the province of Manitoba (Canada) and assess the risk for movement disorders in the two treatments. METHODS This was a population-based study conducted on all residents of the province of 19 years of age and younger who received prescriptions for risperidone or quetiapine between April 1, 1996, and March 31, 2011. Incident rates of antipsychotic use were reported. The risk for movement disorders in patients treated with quetiapine compared with those treated with risperidone was assessed by time-to-event analysis using Cox proportional hazards models. RESULTS Between April 1, 1996, and March 31, 2011, 23,888 youth (age ≤19 years) were prescribed an antipsychotic agent. Among them, 8756 were identified as new incident users. After applying exclusion criteria, 2594 individuals comprised the cohort of users of risperidone and quetiapine. The use of quetiapine was associated with a lower risk of extrapyramidal symptoms (EPSs) adverse events. The unadjusted and adjusted hazard ratios (95% confidence interval [CI]) for quetiapine versus risperidone were 0.83 (0.56-1.25) and 0.53 (0.34-0.83), respectively. CONCLUSION EPS diagnoses have been detected in children treated with quetiapine; however, the risk of movement disorders appears to be higher with treatment with risperidone. Clinicians should always take into consideration the risk-benefit before treating children with antipsychotic medications and should be vigilant of the onset of drug-induced adverse events.
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Affiliation(s)
- Robert G Biscontri
- 1 Asper School of Business, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Sarita Jha
- 2 College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg, Manitoba, Canada
| | - David M Collins
- 2 College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Shawn Bugden
- 2 College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg, Manitoba, Canada .,3 Manitoba Centre for Health Policy, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Laurence Y Katz
- 3 Manitoba Centre for Health Policy, University of Manitoba , Winnipeg, Manitoba, Canada .,4 Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Silvia Alessi-Severini
- 2 College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg, Manitoba, Canada .,3 Manitoba Centre for Health Policy, University of Manitoba , Winnipeg, Manitoba, Canada
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Xing S, Lee TA. Increased Risk of Diabetes Among 6-24-Year-Olds Using Second Generation Antipsychotics. J Child Adolesc Psychopharmacol 2017; 27:782-791. [PMID: 28799787 DOI: 10.1089/cap.2016.0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The goal of this study was to estimate the association between use of second generation antipsychotics (SGAs) and type 2 diabetes (T2DM) among commercially insured children and young adults 6-24 years compared to users of non-SGA psychotropic medications. METHODS Using the Truven MarketScan Commercial Claims and Encounters Database, new users of SGA and non-SGA psychotropic medications (anxiolytics, antidepressants, hypnotics, and mood stabilizers) between July 1, 2009 and December 31, 2013 who were 6-24 years of age and had continuous coverage ≥180 days before their index date (i.e., date of first fill of SGA or non-SGA psychotic) were identified. SGA users were propensity score (PS) matched to non-SGA psychotropic users at a 1:1 ratio. Individuals were followed until diabetes diagnosis, discontinuation or switch from index medication, end of continuous coverage, or end of the study period. The Cox proportional hazards model was used to estimate the hazard ratio (HR) for incident T2DM for SGA users compared to non-SGA users. RESULTS A total of 45,289 SGA users and 932,336 non-SGA psychotropic users met inclusion criteria. In the PS matched sample, there were 102,028 patient-years of follow-up and median time to event was 202 days for SGA users (n = 43,407) and 290 days for non-SGA psychotropic users (n = 43,407). A total of 141 SGA users (33 cases per 10,000 patient-years) and 110 of the non-SGA psychotropic users (18 cases per 10,000 patient-years) developed T2DM. The SGA users had a 1.7 times higher risk of T2DM (HR 1.71, 95% confidence intervals [CI] 1.33-2.20) compared to non-SGA psychotropic users. CONCLUSION Risk of T2DM should be considered when evaluating the risk/benefit of SGA use among children and young adults. Future studies aimed at evaluating risk factors, diabetes prevention strategies, and effective management of the long-term consequences of T2DM in this vulnerable population are needed.
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Affiliation(s)
- Shan Xing
- 1 Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois , Chicago, Illinois
| | - Todd A Lee
- 1 Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois , Chicago, Illinois
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Kalverdijk LJ, Bachmann CJ, Aagaard L, Burcu M, Glaeske G, Hoffmann F, Petersen I, Schuiling-Veninga CCM, Wijlaars LP, Zito JM. A multi-national comparison of antipsychotic drug use in children and adolescents, 2005-2012. Child Adolesc Psychiatry Ment Health 2017; 11:55. [PMID: 29046716 PMCID: PMC5637352 DOI: 10.1186/s13034-017-0192-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/05/2017] [Indexed: 02/06/2023] Open
Abstract
Over the last decades, an increase in antipsychotic (AP) prescribing and a shift from first-generation antipsychotics (FGA) to second-generation antipsychotics (SGA) among youth have been reported. However, most AP prescriptions for youth are off-label, and there are worrying long-term safety data in youth. The objective of this study was to assess multinational trends in AP use among children and adolescents. A repeated cross-sectional design was applied to cohorts from varied sources from Denmark, Germany, the Netherlands, the United Kingdom (UK) and the United States (US) for calendar years 2005/2006-2012. The annual prevalence of AP use was assessed, stratified by age group, sex and subclass (FGA/SGA). The prevalence of AP use increased from 0.78 to 1.03% in the Netherlands' data, from 0.26 to 0.48% in the Danish cohort, from 0.23 to 0.32% in the German cohort, and from 0.1 to 0.14% in the UK cohort. In the US cohort, AP use decreased from 0.94 to 0.79%. In the US cohort, nearly all ATP dispensings were for SGA, while among the European cohorts the proportion of SGA dispensings grew to nearly 75% of all AP dispensings. With the exception of the Netherlands, AP use prevalence was highest in 15-19 year-olds. So, from 2005/6 to 2012, AP use prevalence increased in all youth cohorts from European countries and decreased in the US cohort. SGA were favoured in all countries' cohorts.
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Affiliation(s)
- Luuk J. Kalverdijk
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Lise Aagaard
- Life Science Team, IP & Technology, Bech-Bruun Law Firm, Copenhagen, Denmark
| | - Mehmet Burcu
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD USA
| | - Gerd Glaeske
- 0000 0001 2297 4381grid.7704.4Division of Health Long-term Care and Pensions, University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Bremen, Germany
| | - Falk Hoffmann
- 0000 0001 1009 3608grid.5560.6Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Irene Petersen
- 0000000121901201grid.83440.3bDepartment of Primary Care and Population Health, University College London, London, UK
| | | | - Linda P. Wijlaars
- 0000000121901201grid.83440.3bDepartment of Primary Care and Population Health, University College London, London, UK ,0000000121901201grid.83440.3bPopulation, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Julie M. Zito
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD USA
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Abstract
This study examined psychotropic medication use among 7901 children aged 1-17 with autism spectrum disorder (ASD) in five health systems, comparing to matched cohorts with no ASD. Nearly half (48.5 %) of children with ASD received psychotropics in the year observed; the most common classes were stimulants, alpha-agonists, or atomoxetine (30.2 %), antipsychotics (20.5 %), and antidepressants (17.8 %). Psychotropic treatment was far more prevalent among children with ASD, as compared to children with no ASD (7.7 % overall), even within strata defined by the presence or absence of other psychiatric diagnoses. The widespread use of psychotropics we observed, particularly given weak evidence supporting the effectiveness of these medications for most children with ASD, highlights challenges in ASD treatment and the need for greater investment in its evaluation.
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Abidi S, Mian I, Garcia-Ortega I, Lecomte T, Raedler T, Jackson K, Jackson K, Pringsheim T, Addington D. Canadian Guidelines for the Pharmacological Treatment of Schizophrenia Spectrum and Other Psychotic Disorders in Children and Youth. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:635-647. [PMID: 28764561 PMCID: PMC5593251 DOI: 10.1177/0706743717720197] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Schizophrenia spectrum and other psychotic disorders often have their onset in adolescence. The sequelae of these illnesses can negatively alter the trajectory of emotional, cognitive, and social development in children and youth if left untreated. Early and appropriate interventions can improve outcomes. This article aims to identify best practices in the pharmacotherapy management of children and youth with schizophrenia spectrum disorders. METHODS A systematic search was conducted for published guidelines for schizophrenia and schizophrenia spectrum disorders in children and youth (under age 18 years). Recommendations were drawn from the National Institute for Health and Care Excellence guidelines on psychosis and schizophrenia in children and youth (2013 and 2015 updates). Current guidelines were adopted using the ADAPTE process, which includes consensus ratings by a panel of experts. RESULTS Recommendations identified covered a range of issues in the pharmacotherapy management of children and youth with schizophrenia spectrum disorders. Further work in this area is warranted as we continue to further understand their presentation in the developing brain. CONCLUSIONS Canadian guidelines for the pharmacotherapy management of children and youth with schizophrenia spectrum disorders are essential to assist clinicians in treating this vulnerable population. Ongoing work in this area is recommended.
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Affiliation(s)
- Sabina Abidi
- 1 Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
| | - Irfan Mian
- 2 Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Tania Lecomte
- 4 Department of Psychology, University of Montreal, Montreal, Quebec
| | - Thomas Raedler
- 5 Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
| | - Kevin Jackson
- 6 Schizophrenia Society of Alberta, Lethbridge, Alberta
| | - Kim Jackson
- 6 Schizophrenia Society of Alberta, Lethbridge, Alberta
| | - Tamara Pringsheim
- 7 Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
| | - Donald Addington
- 7 Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
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Impact of risperidone on leptin and insulin in children and adolescents with autistic spectrum disorders. Clin Biochem 2017; 50:678-685. [DOI: 10.1016/j.clinbiochem.2017.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/12/2017] [Accepted: 02/02/2017] [Indexed: 01/09/2023]
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Rafaniello C, Sessa M, Bernardi FF, Pozzi M, Cheli S, Cattaneo D, Baldelli S, Molteni M, Bernardini R, Rossi F, Clementi E, Bravaccio C, Radice S, Capuano A. The predictive value of ABCB1, ABCG2, CYP3A4/5 and CYP2D6 polymorphisms for risperidone and aripiprazole plasma concentrations and the occurrence of adverse drug reactions. THE PHARMACOGENOMICS JOURNAL 2017; 18:422-430. [PMID: 28719598 DOI: 10.1038/tpj.2017.38] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/06/2017] [Accepted: 06/07/2017] [Indexed: 01/07/2023]
Abstract
We investigated in ninety Caucasian pediatric patients the impact of the main polymorphisms occurring in CYP3A, CYP2D6, ABCB1 and ABCG2 genes on second-generation antipsychotics plasma concentrations, and their association with the occurrence of adverse drug reactions. Patients with the CA/AA ABCG2 genotype had a statistically significant lower risperidone plasma concentration/dose ratio (Ct/ds) (P-value: 0.007) and an higher estimated marginal probability of developing metabolism and nutrition disorders as compared to the ABCG2 c.421 non-CA/AA genotypes (P-value: 0.008). Multivariate analysis revealed that the ABCG2 c.421 CA/AA genotype was found associated to a higher hazard (P-value: 0.004) of developing adverse drug reactions classified as metabolism and nutrition disorders. The ABCB1 2677TT/3435TT genotype had a statistically significant lower aripiprazole Ct/ds if compared with patients with others ABCB1 genotypes (P-value: 0.026). Information obtained on ABCB1 and ABCG2 gene variants may result useful to tailor treatments with these drugs in Caucasian pediatric patients.
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Affiliation(s)
- C Rafaniello
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | - M Sessa
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | - F F Bernardi
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | - M Pozzi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - S Cheli
- Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Unit of Clinical Pharmacology, CNR Institute of Neuroscience, University of Milan, Milan, Italy
| | - D Cattaneo
- Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Unit of Clinical Pharmacology, CNR Institute of Neuroscience, University of Milan, Milan, Italy
| | - S Baldelli
- Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Unit of Clinical Pharmacology, CNR Institute of Neuroscience, University of Milan, Milan, Italy
| | - M Molteni
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - R Bernardini
- Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, School of Medicine, University of Catania, Catania, Italy
| | - F Rossi
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | - E Clementi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy.,Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Unit of Clinical Pharmacology, CNR Institute of Neuroscience, University of Milan, Milan, Italy
| | - C Bravaccio
- Department of Translational Medical Sciences, Section of Neuropsychiatry, University "Federico II", Naples, Italy
| | - S Radice
- Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Unit of Clinical Pharmacology, CNR Institute of Neuroscience, University of Milan, Milan, Italy
| | - A Capuano
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
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Chow ES, Zangeneh-Kazemi A, Akintan O, Chow-Tung E, Eppel A, Boylan K. Prescribing Practices of Quetiapine for Insomnia at a Tertiary Care Inpatient Child and Adolescent Psychiatry Unit: A Continuous Quality Improvement Project. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2017; 26:98-103. [PMID: 28747932 PMCID: PMC5510938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 04/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine the prescribing practices of quetiapine for insomnia at a tertiary care child and adolescent psychiatric inpatient unit. METHOD A retrospective chart review was conducted on all admissions in 2013 involving night-time only prescription of quetiapine. We examined patient demographics, discharge diagnoses, physician's written indications for prescriptions, and maximum doses used. If used for insomnia only, we noted any documentation of past sedative trials, concurrent prescriptions of other sedative agents, whether quetiapine was started in hospital or continued as a part of a community regimen, and whether quetiapine was continued on discharge. RESULTS Of 720 admissions, 83 (11.5%) involved the prescription of night-time only quetiapine, and 47 of the 83 (57%) were for insomnia only. Of patients prescribed quetiapine for insomnia only, most common discharge diagnoses were anxiety disorder (35%), depressive disorder (27%), eating disorder (27%), and Cluster B/borderline personality traits/disorder (25%). Mean age was 15.4 years; mean maximum dose was 41.2 mg. Quetiapine was often started during admission (89.5%) and continued on discharge (66%). About 40% of these cases involved concurrent prescription of other sedative agents. Most patients (81%) had no documented history of prior sedative trials. CONCLUSIONS Quetiapine is used not infrequently for the management of insomnia in adolescents in tertiary mental health settings. We highlight the nuances associated with the prescription of quetiapine for the treatment of insomnia in the unique setting of the child and adolescent psychiatric inpatient unit, emphasizing the importance of weighing short-term use with potential long-term adverse consequences if continued in the community setting.
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Affiliation(s)
- Elaine Stephanie Chow
- Psychiatry Resident, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Azadeh Zangeneh-Kazemi
- Psychiatry Resident, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Olabode Akintan
- Child and Adolescent Psychiatrist and Assistant Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Elizabeth Chow-Tung
- Clinical Pharmacist, Child & Youth Mental Health, McMaster Children’s Hospital, Hamilton, Ontario
| | - Alan Eppel
- Psychiatrist and Clinical Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Khrista Boylan
- Child and Adolescent Psychiatrist and Assistant Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
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Tai MH, Lee B, Onukwugha E, Zito JM, Reeves GM, dosReis S. Impact of Coordinated Behavioral Health Management on Quality Measures of Antipsychotic Use. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 45:174-185. [DOI: 10.1007/s10488-017-0807-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Barclay RP, Penfold RB, Sullivan D, Boydston L, Wignall J, Hilt RJ. Decrease in Statewide Antipsychotic Prescribing after Implementation of Child and Adolescent Psychiatry Consultation Services. Health Serv Res 2017; 52:561-578. [PMID: 28297075 DOI: 10.1111/1475-6773.12539] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To learn if a quality of care Medicaid child psychiatric consultation service implemented in three different steps was linked to changes in statewide child antipsychotic utilization. DATA SOURCES/STUDY SETTING Washington State child psychiatry consultation program primary data and Medicaid pharmacy division antipsychotic utilization secondary data from July 1, 2006, through December 31, 2013. STUDY DESIGN Observational study in which consult program data were analyzed with a time series analysis of statewide antipsychotic utilization. DATA COLLECTION/EXTRACTION METHODS All consultation program database information involving antipsychotics was compared to Medicaid pharmacy division database information involving antipsychotic utilization. PRINCIPAL FINDINGS Washington State's total child Medicaid antipsychotic utilization fell from 0.51 to 0.25 percent. The monthly prevalence of use fell by a mean of 0.022 per thousand per month following the initiation of elective consults (p = .004), by 0.065 following the initiation of age/dose triggered mandatory reviews (p < .001), then by another 0.022 following the initiation of two or more concurrent antipsychotic mandatory reviews (p = .001). High-dose antipsychotic use fell by 57.8 percent in children 6- to 12-year old and fell by 52.1 percent in teens. CONCLUSIONS Statewide antipsychotic prescribing for Medicaid clients fell significantly at different rates following each implementation step of a multilevel consultation and best-practice education service.
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Affiliation(s)
| | - Robert B Penfold
- Department of Health Services Research, University of Washington, Group Health Research Institute, Seattle, WA
| | - Donna Sullivan
- Washington State Prescription Drug Program, Washington State Health Care Authority, Olympia, WA
| | | | - Julia Wignall
- Seattle Children's Hospital PAL Program, Seattle, WA
| | - Robert J Hilt
- Seattle Children's Hospital PAL Program, Seattle, WA
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Sagreiya H, Chen YR, Kumarasamy NA, Ponnusamy K, Chen D, Das AK. Differences in Antipsychotic-Related Adverse Events in Adult, Pediatric, and Geriatric Populations. Cureus 2017; 9:e1059. [PMID: 28465867 PMCID: PMC5409818 DOI: 10.7759/cureus.1059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
In recent years, antipsychotic medications have increasingly been used in pediatric and geriatric populations, despite the fact that many of these drugs were approved based on clinical trials in adult patients only. Preliminary studies have shown that the “off-label” use of these drugs in pediatric and geriatric populations may result in adverse events not found in adults. In this study, we utilized the large-scale U.S. Food and Drug Administration (FDA) Adverse Events Reporting System (AERS) database to look at differences in adverse events from antipsychotics among adult, pediatric, and geriatric populations. We performed a systematic analysis of the FDA AERS database using MySQL by standardizing the database using structured terminologies and ontologies. We compared adverse event profiles of atypical versus typical antipsychotic medications among adult (18-65), pediatric (age < 18), and geriatric (> 65) populations. We found statistically significant differences between the number of adverse events in the pediatric versus adult populations with aripiprazole, clozapine, fluphenazine, haloperidol, olanzapine, quetiapine, risperidone, and thiothixene, and between the geriatric versus adult populations with aripiprazole, chlorpromazine, clozapine, fluphenazine, haloperidol, paliperidone, promazine, risperidone, thiothixene, and ziprasidone (p < 0.05, with adjustment for multiple comparisons). Furthermore, the particular types of adverse events reported also varied significantly between each population for aripiprazole, clozapine, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (Chi-square, p < 10-6). Diabetes was the most commonly reported side effect in the adult population, compared to behavioral problems in the pediatric population and neurologic symptoms in the geriatric population. We also found discrepancies between the frequencies of reports in AERS and in the literature. Our analysis of the FDA AERS database shows that there are significant differences in both the numbers and types of adverse events among these age groups and between atypical and typical antipsychotics. It is important for clinicians to be mindful of these differences when prescribing antipsychotics, especially when prescribing medications off-label.
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Affiliation(s)
| | - Yi-Ren Chen
- Department of Neurosurgery, Stanford University Medical Center
| | | | | | - Doris Chen
- Internal Medicine, Stanford University Medical Center
| | - Amar K Das
- Healthcare and Life Sciences, IBM T.J. Watson Research Center
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Traitements médicamenteux reçus par les enfants, adolescents et jeunes adultes avec trouble du spectre autistique en France : un état des lieux basé sur l’expérience parentale. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.neurenf.2016.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Edelsohn GA, Karpov I, Parthasarathy M, Hutchison SL, Castelnovo K, Ghuman J, Schuster JM. Trends in Antipsychotic Prescribing in Medicaid-Eligible Youth. J Am Acad Child Adolesc Psychiatry 2017; 56:59-66. [PMID: 27993230 DOI: 10.1016/j.jaac.2016.10.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/10/2016] [Accepted: 10/18/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine trends in the use of antipsychotic medication in Medicaid-eligible youth from 2008 to 2013 and the factors associated with this use. METHOD Youth aged 0 to 17 years with at least one claim indicating antipsychotic medication use were identified from the network of a behavioral health managed care organization (BHMCO). Demographic and clinical variables were derived from state eligibility data and service claims data from the BHMCO. Overall and specific prevalence rates of antipsychotic drug use were calculated over the course of 6 years (2008-2013). The probability of antipsychotic use during 2013 was further explored with logistic regression that included demographic and diagnostic groups. RESULTS The overall trend in prevalence for antipsychotics for youth decreased from 49.52 per 1,000 members in 2008 to 30.54 in 2013 (p < .0001). Although rates decreased for all age groups, the rate per 1,000 members in 2013 for the youngest children was 3.79, versus 39.23 for 6- to 12-year-olds and 64.33 for 13- to 17-year-olds. Controlling for demographic and clinical variables, children 0 to 5 years old were 79% less likely to be prescribed antipsychotic medications compared to the oldest youth, 13 to 17 years of age (p < .0001). Rates were higher for males versus females regardless of age (odds ratio [95% CI] =1.48 [1.36-1.62], p < .0001). Children with a diagnosis of attention-deficit/hyperactivity disorder were less likely to be prescribed antipsychotics compared to those with diagnoses of autism spectrum disorder, bipolar disorder, psychoses, and depression. CONCLUSION Prevalence rates decreased significantly over time for all socio-demographic groups. The largest decrease was observed for the youngest children, ages 0 to 5 years, with a rate in 2013 under half the rate for 2008. Clinical, policy, and managed care implications are discussed.
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Affiliation(s)
- Gail A Edelsohn
- Community Care Behavioral Health Organization, UPMC Insurance Division, Pittsburgh.
| | - Irina Karpov
- Community Care Behavioral Health Organization, UPMC Insurance Division, Pittsburgh
| | - Meghna Parthasarathy
- Community Care Behavioral Health Organization, UPMC Insurance Division, Pittsburgh
| | - Shari L Hutchison
- Community Care Behavioral Health Organization, UPMC Insurance Division, Pittsburgh
| | - Kim Castelnovo
- Community Care Behavioral Health Organization, UPMC Insurance Division, Pittsburgh
| | - Jaswinder Ghuman
- Community Care Behavioral Health Organization, UPMC Insurance Division, Pittsburgh
| | - James M Schuster
- Community Care Behavioral Health Organization, UPMC Insurance Division, Pittsburgh; Behavioral Health and Medicaid Services, Behavioral Health Integration, UPMC Insurance Division and University of Pittsburgh School of Medicine
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Huskamp HA, Horvitz-Lennon M, Berndt ER, Normand SLT, Donohue JM. Patterns of Antipsychotic Prescribing by Physicians to Young Children. Psychiatr Serv 2016; 67:1307-1314. [PMID: 27417891 PMCID: PMC5133161 DOI: 10.1176/appi.ps.201500224] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Antipsychotic use among young children has grown rapidly despite a lack of approval by the U.S. Food and Drug Administration (FDA) for broad use in this age group. Characteristics of physicians who prescribed antipsychotics to young children were identified, and prescribing patterns involving young children and adults were compared. METHODS Physician-level prescribing data from IMS Health's Xponent database were linked with American Medical Association Masterfile data and analyzed. The sample included all U.S. psychiatrists and a random sample of 5% of family medicine physicians who wrote at least ten antipsychotic prescriptions per year from 2008 to 2011 (N=31,713). Logistic and hierarchical binomial regression models were estimated to examine physician prescribing for children ages zero to nine, and the types and numbers of ingredients used for children versus adults ages 20 to 64 were compared. RESULTS Among antipsychotic prescribers, 42.2% had written at least one antipsychotic prescription for young children. Such prescribing was more likely among physicians age ≤39 versus ≥60 (odds ratio [OR]=1.70) and physicians in rural versus nonrural areas (OR=1.11) and was less likely among males (OR=.93) and graduates of a top-25 versus a lower-ranked U.S. medical school (OR=.87). Among physicians who prescribed antipsychotics to young children and adults, 75.0% of prescriptions for children and 35.7% of those for adults were for drugs with an FDA-approved indication for that age. Fewer antipsychotic agents were prescribed for young children (median=2) versus adults (median=7). CONCLUSIONS Prescribing antipsychotics for young children was relatively common, but prescribing patterns differed between young children and adults.
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Affiliation(s)
- Haiden A Huskamp
- Dr. Huskamp and Dr. Normand are with the Department of Health Care Policy, Harvard Medical School, Boston (e-mail: ). Dr. Horvitz-Lennon is with the RAND Corporation, Boston. Dr. Berndt is with the MIT Sloan School of Management, Cambridge, Massachusetts. Dr. Donohue is with the Health Policy and Management Department, Graduate School of Public Health, University of Pittsburgh, Pittsburgh
| | - Marcela Horvitz-Lennon
- Dr. Huskamp and Dr. Normand are with the Department of Health Care Policy, Harvard Medical School, Boston (e-mail: ). Dr. Horvitz-Lennon is with the RAND Corporation, Boston. Dr. Berndt is with the MIT Sloan School of Management, Cambridge, Massachusetts. Dr. Donohue is with the Health Policy and Management Department, Graduate School of Public Health, University of Pittsburgh, Pittsburgh
| | - Ernst R Berndt
- Dr. Huskamp and Dr. Normand are with the Department of Health Care Policy, Harvard Medical School, Boston (e-mail: ). Dr. Horvitz-Lennon is with the RAND Corporation, Boston. Dr. Berndt is with the MIT Sloan School of Management, Cambridge, Massachusetts. Dr. Donohue is with the Health Policy and Management Department, Graduate School of Public Health, University of Pittsburgh, Pittsburgh
| | - Sharon-Lise T Normand
- Dr. Huskamp and Dr. Normand are with the Department of Health Care Policy, Harvard Medical School, Boston (e-mail: ). Dr. Horvitz-Lennon is with the RAND Corporation, Boston. Dr. Berndt is with the MIT Sloan School of Management, Cambridge, Massachusetts. Dr. Donohue is with the Health Policy and Management Department, Graduate School of Public Health, University of Pittsburgh, Pittsburgh
| | - Julie M Donohue
- Dr. Huskamp and Dr. Normand are with the Department of Health Care Policy, Harvard Medical School, Boston (e-mail: ). Dr. Horvitz-Lennon is with the RAND Corporation, Boston. Dr. Berndt is with the MIT Sloan School of Management, Cambridge, Massachusetts. Dr. Donohue is with the Health Policy and Management Department, Graduate School of Public Health, University of Pittsburgh, Pittsburgh
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Abstract
This study aimed to describe the frequency of off-label prescriptions of psychopharmacological drugs in a child and adolescent psychiatric setting. A cross-sectional study was conducted on November 1, 2014, including all inpatients and outpatients at the Mental Health Centre for Child and Adolescent Psychiatry, Capital Region of Denmark, aged 0 to 17 years receiving medical treatment with antidepressants, antipsychotic agents, benzodiazepines, melatonin and/or attention deficit hyperactivity disorder (ADHD) medication. We included a total of 5555 prescriptions representing 2932 patients. The main findings were that 32.3% of all prescriptions were off-label, and 41.6% of subjects received at least 1 off-label prescription. The most frequent off-label category was low age, 72.2%, meaning that the drug was not approved for the age group of the patient. The off-label rates for each drug class were as follows: melatonin, 100%; antipsychotic agents, 95.6%; benzodiazepines, 72.5%; antidepressants, 51.1%; and ADHD medication, 2.7%. Prescription of 2 or more psychopharmacological drugs per patient was common (31.5%). The group of subjects with 4 or more prescriptions (n = 36) was characterized by a higher frequency of inpatients, older age, and a different distribution of diagnoses. This study found a frequent use of off-label prescriptions when treating children and adolescents with psychopharmacological drugs other than ADHD medication. In addition, prescription of more than 1 psychotropic drug is common. These findings support the need for extending the evidence base for psychopharmacologic treatment in children and adolescents.
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49
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Murphy AL, Gardner DM, Kisely S, Cooke CA, Kutcher SP, Hughes J. System struggles and substitutes: A qualitative study of general practitioner and psychiatrist experiences of prescribing antipsychotics to children and adolescents. Clin Child Psychol Psychiatry 2016; 21:634-648. [PMID: 26614572 PMCID: PMC5094295 DOI: 10.1177/1359104515617518] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There are significant controversies regarding rising antipsychotic prescription trends in children and adolescents. Many pharmacoepidemiology trend studies have been published, and interpretations of these data are helpful in explaining what is happening in prescribing practices, but not why these patterns exist. There is a lack of qualitative data in this area, and the experience of prescribing antipsychotics to children and adolescents has not been adequately researched. We conducted a qualitative study using an interpretive phenomenological analysis of physicians' experiences of antipsychotic prescribing to children and adolescents. Prescribers participated in individual interviews and a focus group. We used a staged approach for data analysis of transcriptions. In all, 11 physicians including psychiatrists and general practitioners participated in our study. We identified themes related to context, role and identity, and decision-making and filtering Struggles with health system gaps were significant leading to the use of antipsychotics as substitutes for other treatments. Physicians prescribed antipsychotics to youth for a range of indications and had significant concerns regarding adverse effects. Our results provide knowledge regarding the prescribers' experience of antipsychotics for children and adolescents. Important gaps exist within the health system that are creating opportunities for the initiation and continued use of these agents.
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Affiliation(s)
- Andrea L Murphy
- College of Pharmacy, Dalhousie University, Canada .,Department of Psychiatry, Dalhousie University, Canada
| | - David M Gardner
- College of Pharmacy, Dalhousie University, Canada.,Department of Psychiatry, Dalhousie University, Canada
| | - Steve Kisely
- School of Population Health, University of Queensland, Australia
| | | | - Stanley P Kutcher
- Department of Psychiatry, Dalhousie University, Canada.,Sun Life Financial Chair in Adolescent Mental Health, Dalhousie University and IWK Health Centre, Canada
| | - Jean Hughes
- School of Nursing, Dalhousie University, Canada
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50
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Lo Cascio N, Saba R, Hauser M, Vernal DL, Al-Jadiri A, Borenstein Y, Sheridan EM, Kishimoto T, Armando M, Vicari S, Fiori Nastro P, Girardi P, Gebhardt E, Kane JM, Auther A, Carrión RE, Cornblatt BA, Schimmelmann BG, Schultze-Lutter F, Correll CU. Attenuated psychotic and basic symptom characteristics in adolescents with ultra-high risk criteria for psychosis, other non-psychotic psychiatric disorders and early-onset psychosis. Eur Child Adolesc Psychiatry 2016; 25:1091-102. [PMID: 26921232 DOI: 10.1007/s00787-016-0832-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
Abstract
While attenuated psychotic symptoms (APS) and basic symptoms (BS) are the main current predictors of psychosis in adults, studies in adolescents are scarce. Thus, we (1) described the prevalence and severity of positive, negative, disorganization, general, and basic symptoms in adolescent patients at ultra-high risk for psychosis (UHR), with other non-psychotic psychiatric disorders (PC) and with early-onset psychosis (EOP); and (2) investigated BS criteria in relation to UHR criteria. Sixty-nine 12-18-year-old adolescents (15.3 ± 1.7 years, female = 58.0 %, UHR = 22, PC = 27, EOP = 20) were assessed with the structured interview for prodromal syndromes (SIPS) and the schizophrenia proneness instrument-child and youth version (SPI-CY). Despite similar current and past 12-month global functioning, both UHR and EOP had significantly higher SIPS total and subscale scores compared to PC, with moderate-large effect sizes. Expectedly, UHR had significantly lower SIPS positive symptom scores than EOP, but similar SIPS negative, disorganized, and general symptom scores. Compared to PC, both EOP and UHR had more severe basic thought and perception disturbances, and significantly more often met cognitive disturbances criteria (EOP = 50.0 %, UHR = 40.9 %, PC = 14.8 %). Compared to UHR, both EOP and PC significantly less often met cognitive-perceptive BS criteria (EOP = 35.0 %, UHR = 68.2 %, PC = 25.9 %). BS were significantly more prevalent in both EOP and UHR than PC, and UHR were similar to EOP in symptom domains. Given the uncertain outcome of adolescents at clinical high-risk of psychosis, future research is needed to determine whether the combined assessment of early subjective disturbances with observable APS can improve the accuracy of psychosis prediction.
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Affiliation(s)
- Nella Lo Cascio
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy.,Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Riccardo Saba
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Marta Hauser
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Ditte Lammers Vernal
- Research Unit for Child and Adolescent Psychiatry, Aalborg University Hospital, North Denmark Region, Denmark
| | - Aseel Al-Jadiri
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA
| | - Yehonatan Borenstein
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA
| | - Eva M Sheridan
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA
| | - Taishiro Kishimoto
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA.,School of Medicine, Keio University, Tokyo, Japan
| | - Marco Armando
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefano Vicari
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Paolo Fiori Nastro
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Eva Gebhardt
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - John M Kane
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA.,Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Andrea Auther
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA
| | - Ricardo E Carrión
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Barbara A Cornblatt
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph U Correll
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA. .,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA. .,The Feinstein Institute for Medical Research, Manhasset, NY, USA. .,Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
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