Overzealous prescribing of medications

Trends in prescribing of psychotropic medications for inpatient adolescents in Israel: a 10 years retrospective analysis

We examined the trends in prescribing psychotropic drugs to children and adolescents within an inpatients adolescent psychiatric ward in Israel. Data of 414 subjects, ranging from 12- to 22-year-old, covering the years 1997, 2002 and 2007, was examined retrospectively. Analyzed variables included the number and type of drug prescriptions per patient at discharge, the subjects' age at discharge and the number of diagnoses per patient at discharge. Analysis of variance (ANOVA) with repeated measures was used to evaluate changes between the three calendar years, along the 10-year study period, while Pearson χ(2) test was performed for categorical variables. Over the study period the mean age at discharge decreased significantly, by about a year and a half, the mean number of diagnoses increased significantly, from 1.6 to 2.4 diagnoses per patient and the total number of drugs prescribed at discharge increased significantly from 1.48 to 1.93 per patient. Overall, the number of patients who were prescribed mood stabilizers increased by 14%, those who were prescribed antidepressants increased by almost 24%, almost 16% in antipsychotics prescriptions and 51.5% in prescriptions of atypical antipsychotics. Typical antipsychotic prescriptions decreased by 35.5% and accordingly, the number of patients who were prescribed agents for the treatment of extra-pyramidal side effects decreased by almost 24%. Due to a low number of inpatients with attention deficit and hyperactivity disorder (ADHD), no significant statistical conclusion could be drawn regarding trends in psychostimulant prescriptions. Our findings agree with other published studies from the last two decades. The growing use of psychotropic agents in children and adolescents merit a continuous concern with regard to their effects on the developing brain and impact on quality of life and to authorizing these drugs for use in specific young age subgroups.

Justifiable Psychopharmacology or Overzealous Prescription? Examining Parental Reports of Lifetime Prescription Histories of Psychiatrically Hospitalised Children

BACKGROUND

  This research investigated parent reports of pre-admission psychotropic medication histories of psychiatrically hospitalised children in the United States. The emphasis was on identifying factors related to potentially overzealous medication use.

METHOD

  Diagnosis, insurance type, and demographics for 170 consecutive admissions were assessed via research case conference and chart review. An extreme group of children with lengthy medication histories (n = 20) was also identified, and prescription and diagnostic patterns for this group were compared to other medicated children in the sample (n = 100). Cumulative medication history, rather than specific polypharmacy, was examined.

RESULTS

  Psychopharmacotherapy was common (71%). Privately insured children, children with previous psychiatric hospitalisations, and children with Oppositional Defiant Disorder (ODD), Attention Deficit Hyperactivity Disorder (ADHD), and the specific comorbidities of ODD/ADHD, and ODD/Parent Child Relational Problems had more past medication trials. Depressed children had fewer. Analyses of the extreme group suggest that young, privately insured, oppositional children with parent-child relationship problems were at highest risk for overmedication (including multiple trials of stimulants, as well as mood stabilisers, central adrenergic agonists, and antipsychotics).

CONCLUSIONS

  Results raise important questions about the role of health care pressures on clinical practice in the United States.