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Gallinella F, Trotta F, Fortinguerra F. Impact of COVID-19 pandemic on prescription of psychotropic medications in the Italian paediatric population during 2020. Ital J Pediatr 2024; 50:102. [PMID: 38764095 PMCID: PMC11103882 DOI: 10.1186/s13052-024-01670-5] [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] [Received: 01/19/2024] [Accepted: 05/04/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND There is a global perception that psychotropic utilization in children and adolescents is increasing, especially with the onset of COVID-19 pandemic. Available literature data on paediatric psychotropic medication prescriptions in Italy are limited to one or few regions and not updated. The aim of this study was to provide updated data on psychotropic prescriptions referred to the whole Italian paediatric population, as overall and by subgroups of medications and to evaluate if the COVID-19 pandemic during 2020 had an impact on prescription rates. METHODS A descriptive study on psychotropic drug utilization in children and adolescents (< 18 years) resident in all Italian regions during 2020 was performed. Patients registered in the Pharmaceutical Prescriptions database with at least one prescription/dispensing of a psychotropic medication (antipsychotics-N05A), (antidepressants-N06A) and (psychostimulants-N06BA) during the study period were considered. The indicators used were the prescription rate (number of prescriptions per 1000 children) and prevalence of use (proportion of the paediatric population with at least one prescription in the relevant year). RESULTS During the 2020 the prevalence of psychotropic drug use in the paediatric population was 0.3%, increased of 7.8% if compared to 2019. The same trend was observed for the prescription rate, which recorded an average of 28.2 per 1000 children with an increase of 11.6% if compared to previous year, representing the 0.6% of the overall drug use in this age group. The data showed a growing trend prescription by age, reaching the peak in adolescents aged 12-17 years old, with a prescription rate of 65 per 1000 children and a prevalence of 0.71%. Considering the subgroups of psychotropic medications, the highest prevalence of use was found for antipsychotic drugs, received by the 0.19% of the paediatric population during 2020. CONCLUSIONS Psychotropic drug utilization in children and adolescents has grown during 2020 in Italy and worldwide, raising alarms from health care clinicians and patient advocates about the increase of burden of mental diseases in paediatric population during the COVID-19 pandemic. A more systematic monitoring of the use of psychotropic medications should be implemented in all countries for collecting relevant information about children and adolescents taking psychotropic drugs, in order to address the present and the future of the mental health of the paediatric population.
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Affiliation(s)
| | - Francesco Trotta
- Italian Medicines Agency (AIFA), Via del Tritone, 181, Rome, 00187, Italy
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Zhu M, Ferrara M, Tan W, Shang X, Syed S, Zhang L, Qin Q, Hu X, Rohrbaugh R, Srihari VH, Liu Z. Drug-naïve first-episode schizophrenia spectrum disorders: Pharmacological treatment practices in inpatient units in Hunan Province, China. Early Interv Psychiatry 2021; 15:1010-1018. [PMID: 32924286 PMCID: PMC8359180 DOI: 10.1111/eip.13046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/08/2020] [Accepted: 08/30/2020] [Indexed: 12/12/2022]
Abstract
AIM This study describes antipsychotic prescription patterns for drug-naïve inpatients diagnosed with first-episode schizophrenia-spectrum (FES) disorders and factors associated with practices deviating from China's current guidelines. METHODS All inpatients aged 7 to 45 years experiencing a first episode of schizophrenia-spectrum disorder with a duration of untreated illness of less than 18 months and admitted between 1 August 2016 and 1 August 2017 to one of eight psychiatric hospitals in Hunan were included. Demographics, clinical characteristics and prescriptions at discharge were collected from electronic medical records. Logistic regression and random forest methods were used to model relationships between demographic and clinical factors and deviations from China's guidelines. RESULTS Of the 602 inpatients included in the study, 598 (99.3%) were prescribed antipsychotics, and no patients were discharged on long-acting injectable antipsychotics. Polypharmacy (more than one antipsychotic prescribed) was present in 121 (20.2%) participants. Clozapine was prescribed to 45 (7.5%) patients. Adults receiving polypharmacy were more likely to be prescribed high-dose antipsychotics than those receiving a single antipsychotic. Minors under 13 years of age were more likely to receive polypharmacy and unapproved antipsychotics than those older than 13 years. CONCLUSIONS Our findings suggest that most of the inpatients were prescribed a single antipsychotic at discharge, consistent with China's guidelines. Minors with FES and patients discharged on polypharmacy and clozapine may require more intense monitoring and management. With the current implementation of China's National Mental Health Working Plan, these results will assist decision-makers in allocating resources and conducting reforms to facilitate best practice treatment for FES.
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Affiliation(s)
- Mengran Zhu
- Department of PsychiatrySecond Xiangya Hospital of Central South UniversityChangshaChina
- Department of PsychiatryYale University, School of MedicineNew HavenConnecticutUSA
- Program for Specialized Treatment Early in Psychosis (STEP)Connecticut Mental Health CenterNew HavenConnecticutUSA
| | - Maria Ferrara
- Department of PsychiatryYale University, School of MedicineNew HavenConnecticutUSA
- Program for Specialized Treatment Early in Psychosis (STEP)Connecticut Mental Health CenterNew HavenConnecticutUSA
| | - Wenjian Tan
- Department of PsychiatrySecond Xiangya Hospital of Central South UniversityChangshaChina
| | - Xingbo Shang
- Yale Systems Biology Institute and Department of Biomedical EngineeringYale UniversityNew HavenConnecticutUSA
| | - Sumaiyah Syed
- Department of PsychiatryYale University, School of MedicineNew HavenConnecticutUSA
- Program for Specialized Treatment Early in Psychosis (STEP)Connecticut Mental Health CenterNew HavenConnecticutUSA
| | - Li Zhang
- Department of PsychiatrySecond Xiangya Hospital of Central South UniversityChangshaChina
| | - Qilin Qin
- Department of NeurosurgerySecond Xiangya Hospital of Central South UniversityChangshaChina
| | - Xinran Hu
- Department of PsychiatryYale University, School of MedicineNew HavenConnecticutUSA
| | - Robert Rohrbaugh
- Department of PsychiatryYale University, School of MedicineNew HavenConnecticutUSA
| | - Vinod H. Srihari
- Department of PsychiatryYale University, School of MedicineNew HavenConnecticutUSA
- Program for Specialized Treatment Early in Psychosis (STEP)Connecticut Mental Health CenterNew HavenConnecticutUSA
| | - Zhening Liu
- Department of PsychiatrySecond Xiangya Hospital of Central South UniversityChangshaChina
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Abstract
Objective: To review the use of aripiprazole in children and adolescents. Methods: Medline and Embase databases were systematically searched using the keywords aripiprazole and child or adolescent over the period from 2000 to 2019. The initial screen yielded 163 publications, from which 99 studies were reviewed. Results: Aripiprazole is one of the most widely prescribed atypical antipsychotics. Like others, its use in children and adolescents is becoming commonplace and occurs in off-label indications. Aripiprazole has proven efficacy for several indications in children and adolescents, including schizophrenia, bipolar disorder, Tourette's syndrome, and behavioral impairments associated with autism and intellectual disability. Adverse effects are more important in children and adolescents than adults, particularly weight gain, drowsiness, extrapyramidal effects, and metabolic effects, even though the latter may appear less important than with other atypical antipsychotics. Severe adverse effects often occur in multiple-prescription settings. At present, postprescription monitoring is very poor. Conclusion: Aripiprazole has proven efficacy for several indications in children and adolescents. However, its use requires clinical and paraclinical monitoring to assess the occurrence of adverse events that may challenge the benefit/risk ratio. In addition, off-label prescriptions should be limited, as they appear to account for a significant proportion of aripiprazole use worldwide.
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Affiliation(s)
- Nicolas Coustals
- Department of Child and Adolescent Psychiatry, APHP, Groupe Hospitalier Pitié-Salpêtrière, Université Sorbonne, Paris, France
| | - Marie-Line Ménard
- Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France.,CoBTek, EA7276, University of Côte d'Azur, Nice, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, APHP, Groupe Hospitalier Pitié-Salpêtrière, Université Sorbonne, Paris, France.,Institut des Systèmes Intelligents et Robotiques, CNRS UMR 7222, Université Sorbonne, Paris, France
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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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Piovani D, Clavenna A, Bonati M. Prescription prevalence of psychotropic drugs in children and adolescents: an analysis of international data. Eur J Clin Pharmacol 2019; 75:1333-1346. [DOI: 10.1007/s00228-019-02711-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/25/2019] [Indexed: 12/14/2022]
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Waszak PM, Zagożdżon P, Pierucka M, Kubanek A. Antipsychotic Medication Prescribing Trends in a Pediatric Population in Northern Poland 2008-2012. J Child Adolesc Psychopharmacol 2018; 28:631-636. [PMID: 30048153 DOI: 10.1089/cap.2017.0154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES In recent years antipsychotics have been increasingly used in the population of children and adolescents. The objective of this article is to profile the use of antipsychotic medications in a pediatric population in Poland based on data from the Pomeranian region (Northern Poland). METHODS The study was based on National Health Fund data about prescription drug reimbursement between 2008 and 2012. A patient database was created using ID to analyze specific patterns and information about individuals using antipsychotics. Percentage population indicators were calculated using official demographic reports. RESULTS An increased number of overall prescriptions was observed since 2008, with a subsequent decline to its lowest number in 2012. The population with at least one antipsychotic-filled prescription per year has grown in the same time. The annual rate has increased from 0.26% to 0.31% of the general population between 0 and 17 years of age in the Pomeranian region. We observed an increasing number of females and the 0- to 4-year-old receiving antipsychotic prescriptions. The population share of prescribed first-generation antipsychotics exceeded the share of second-generation antipsychotics (SGAs). The use of SGAs increased from 38% to 44% of all prescriptions, during the observation period. The most frequently prescribed drugs were Risperidone (26.7%) and Chlorprothixene (21.7%). CONCLUSIONS The study revealed that the prescribing patterns of antipsychotics increased in the Polish pediatric population and concerned more patients from the youngest group. The high prevalence of such early exposure to antipsychotics should focus more attention on drug safety in this population.
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Affiliation(s)
- Przemysław M Waszak
- 1 Department of Hygiene and Epidemiology, Medical University of Gdansk , Gdansk, Poland .,2 Department of Developmental Psychiatry, Psychotic and Geriatric Disorders, Medical University of Gdansk , Gdansk, Poland
| | - Paweł Zagożdżon
- 1 Department of Hygiene and Epidemiology, Medical University of Gdansk , Gdansk, Poland
| | - Magdalena Pierucka
- 1 Department of Hygiene and Epidemiology, Medical University of Gdansk , Gdansk, Poland
| | - Alicja Kubanek
- 3 Department of Occupational, Metabolic, and Internal Diseases, Medical University of Gdansk , Gdansk, Poland
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Setyawan J, Fridman M, Grebla R, Harpin V, Korst LM, Quintero J. Variation in Presentation, Diagnosis, and Management of Children and Adolescents With ADHD Across European Countries. J Atten Disord 2018; 22:911-923. [PMID: 26246588 DOI: 10.1177/1087054715597410] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To characterize differences in presentation, diagnosis, and management of children/adolescents with ADHD in six European countries. METHOD Physicians abstracted clinical records for patients aged 6 to 17 years, diagnosed from 2004 to 2007 and treated for ≥2 years. Documentation included impairment due to core ADHD symptoms and additional ADHD symptoms/behaviors at diagnosis, diagnostic approach, and treatment modality. RESULTS Study included 779 patients treated by 340 physicians. Prevalence of ADHD subtypes (inattention, hyperactivity/impulsivity, or combined) was similar across countries. Mean scores for core and noncore symptom impairment varied and were highest in Italy and the United Kingdom. Variability was noted in diagnostic approach; 95% of physicians in the Netherlands used Diagnostic and Statistical Manual of Mental Disorders (4th edition) criteria versus 10% in Germany. Differences were reported for initial treatment modality, treatment switching, and physician-reported treatment outcomes. CONCLUSION European countries varied in diagnostic approaches and practice management of children/adolescents with ADHD.
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Abbas S, Ihle P, Adler JB, Engel S, Günster C, Linder R, Lehmkuhl G, Schübert I. Psychopharmacological Prescriptions in Children and Adolescents in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:396-403. [PMID: 27374377 DOI: 10.3238/arztebl.2016.0396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/18/2016] [Accepted: 02/18/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND In view of the well-known increase in prescriptions of stimulants for children and adolescents over the last 20 years, it is important to study trends in the prevalence and incidence of the use of other psychotropic drugs by this age group as well, to enable an early response to potential problems in the current care situation. METHODS We used nationwide data from German statutory health insurance funds (Allgemeine Ortskrankenkasse [AOK], all insurees; Techniker Kranken - kasse [TK], a 50% randomized sample) concerning all insurees aged 0-17 years (5.0 million people in 2012) to study trends in the prevalence and incidence of psychotropic medication use as well as initially prescribing medical specialties over the period 2004-2012, both for the overall group of psychotropic drugs and for selected subgroups of drugs. RESULTS From 2004 to 2012, the prevalence of psychotropic drug prescriptions (not including herbal and homeopathic substances) for children and adolescents rose from 19.6 to 27.1 per 1000 individuals. Marked rises were seen for stimulants (10.5 to 19.1 per 1000) and antipsychotic drugs (2.3 to 3.1 per 1000), while the prevalence of antidepressant prescriptions remained constant at about 2 per 1000. The rates of new prescriptions from 2006 to 2012 were generally constant or decreasing; for the overall group of (non-herbal, nonhomeopathic) psychotropic drugs, the rate of new prescriptions fell from 9.9 to 8.7 per 1000. There was a trend toward the issuance of new prescriptions by medical specialists, rather than by family physicians and pediatricians. CONCLUSION The observed increased prevalence of psychotropic drug use among children and adolescents appears to be due not to an increased rate of initial prescriptions for these drugs, but rather to a rise in the number of patients who, once having received such drugs, were given further prescriptions for them in the years that followed.
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Affiliation(s)
- Sascha Abbas
- PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, Scientific Institute of the AOK (WIdO, Wissenschaftliches Institut der AOK), Berlin, Scientific Institute of the TK for Benefit and Efficiency in Health Care (WINEG, Wissenschaftliches Institut der TK für Nutzen und Effizienz im Gesundheitswesen), Hamburg
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Schröder C, Dörks M, Kollhorst B, Blenk T, Dittmann RW, Garbe E, Riedel O. Extent and risks of antidepressant off-label use in children and adolescents in Germany between 2004 and 2011. Pharmacoepidemiol Drug Saf 2017; 26:1395-1402. [DOI: 10.1002/pds.4289] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/01/2017] [Accepted: 07/18/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Carsten Schröder
- Department of Clinical Epidemiology; Leibniz Institute for Prevention Research and Epidemiology - BIPS; Bremen Germany
| | - Michael Dörks
- Department of Health Services Research; Carl von Ossietzky University Oldenburg; Oldenburg Germany
| | - Bianca Kollhorst
- Department of Biometry and Data Management; Leibniz Institute for Prevention Research and Epidemiology - BIPS; Bremen Germany
| | - Tilo Blenk
- Department of Clinical Epidemiology; Leibniz Institute for Prevention Research and Epidemiology - BIPS; Bremen Germany
| | - Ralf W. Dittmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim; University of Heidelberg; Mannheim Germany
| | - Edeltraut Garbe
- Department of Clinical Epidemiology; Leibniz Institute for Prevention Research and Epidemiology - BIPS; Bremen Germany
| | - Oliver Riedel
- Department of Clinical Epidemiology; Leibniz Institute for Prevention Research and Epidemiology - BIPS; Bremen Germany
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Bonnot O, Dufresne M, Herrera P, Michaud E, Pivette J, Chaslerie A, Sauvaget A, Vigneau C. Influence of socioeconomic status on antipsychotic prescriptions among youth in France. BMC Psychiatry 2017; 17:82. [PMID: 28241816 PMCID: PMC5330013 DOI: 10.1186/s12888-017-1232-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 02/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent studies analysing the trends in antipsychotic (AP) prescriptions for children and adolescents have raised concerns regarding the influence of socioeconomic status. Previous findings have also shown variable prescription rates for first-generation (FG) and second-generation (SG) APs. METHOD Our objectives were to assess the proportion of patients from low-income families receiving APs and the most commonly prescribed APs in France. We conducted a descriptive analysis of AP drugs dispensed during a 1-year period (July 1, 2013-June 30, 2014) in a northwestern region of France with 941,857 subjects less than 18 years old. All data were extracted from an exhaustive, individual and anonymous social security database. We obtained each subject's socioeconomic status (by identifying their affiliation with a specific social security program) and also collected sociodemographic data, drug type, prescribing and dispensing dates and amount, and prescriber type (e.g., hospital physician, general practitioner, psychiatrist, paediatrician). RESULTS There were two main novel findings. First, we found that the proportion of patients with AP prescriptions was nearly ten times higher in low-income families than in the general population: 35.9% of CMU-C patients compared to 3.7% in all of Pays de la Loire (X 2 = 7875.1, p < 0.001). Additionally, we found a higher rate of FGAP than SGAP prescriptions (65% vs. 57%). CONCLUSIONS Our study suggests two types of AP misuse that could provide interesting targets for public healthcare interventions. First, our results strongly suggest an over-representation of patients from low-income families. Low-income families primarily resided in areas with low physician density and appeared to receive drugs to treat their conditions more frequently than other individuals. This increased prescription rate is a public health issue, potentially requiring political action. Second, the use of FGAPs did not adhere to the latest recommendations for drug use in this population, and this discrepancy should be addressed with informational campaigns targeted to medical practitioners.
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Affiliation(s)
- Olivier Bonnot
- Department of Child and Adolescent Psychiatry, University Hospital of Nantes, Nantes, France. .,Department of Child and Adolescent Psychiatry, University of Nantes, CHU de Nantes, 55 rue St Jacques, 44 000, Nantes, France.
| | - Mélanie Dufresne
- 0000 0004 0472 0371grid.277151.7Department of Pharmacology, University Hospital of Nantes, Nantes, France
| | - Paula Herrera
- 0000 0004 0472 0371grid.277151.7Department of Child and Adolescent Psychiatry, University Hospital of Nantes, Nantes, France ,Medical Department, French National Health Insurance (DRSM), Nantes, France
| | - Emmanuelle Michaud
- 0000 0001 2205 5940grid.412191.eGrupo de Investigación en Neurociencias NeURos, Universidad del Rosario, Bogota, Colombia
| | - Jacques Pivette
- 0000 0001 2205 5940grid.412191.eGrupo de Investigación en Neurociencias NeURos, Universidad del Rosario, Bogota, Colombia
| | - Anicet Chaslerie
- 0000 0001 2205 5940grid.412191.eGrupo de Investigación en Neurociencias NeURos, Universidad del Rosario, Bogota, Colombia
| | - Anne Sauvaget
- 0000 0004 0472 0371grid.277151.7Department of Psychiatry, University Hospital of Nantes, Nantes, France
| | - Caroline Vigneau
- 0000 0004 0472 0371grid.277151.7Department of Pharmacology, University Hospital of Nantes, Nantes, France
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Schröder C, Dörks M, Kollhorst B, Blenk T, Dittmann RW, Garbe E, Riedel O. Outpatient antidepressant drug use in children and adolescents in Germany between 2004 and 2011. Pharmacoepidemiol Drug Saf 2016; 26:170-179. [PMID: 27868277 DOI: 10.1002/pds.4138] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 11/11/2022]
Abstract
PURPOSE Recent studies on the utilization of antidepressant drugs in minors are scarce, methodologically limited, and do not factor in off-label use sufficiently. Beyond that, little is known about the short treatment durations that have been observed for many young antidepressant users. The present study examined antidepressant use in pediatric patients aged 0 to 17 years over time, investigated changes regarding the prescribed drugs, analyzed underlying diagnoses, and assessed the rate of off-label use. METHODS We used claims data of roughly two million individuals to calculate annual prevalence and incidence rates of antidepressant prescriptions for the years 2004 to 2011. Analyses were stratified by age, sex, and drug type. For antidepressant users, numbers of prescriptions, frequencies of disorders/diseases, and specialties of the prescribing physicians were examined. The share of off-label prescriptions was calculated for each year. RESULTS The prescription prevalence of antidepressants ranged between 1.7 and 2.1 per 1000 minors. The use of tricyclic antidepressants decreased from 0.9 to 0.6 prescriptions per 1000 minors, while the use of selective serotonin reuptake inhibitors increased from 0.5 to 1.1. Of the patients with an antidepressant prescription, 46.4% only received one prescription. Depression was by far the most frequent diagnosis among all antidepressant users as well as among subjects with only one prescription. In 2011, 36.3% of all prescriptions were off-label. CONCLUSIONS The high proportion of single prescriptions, even in patients with a diagnosed depression, and the high rate of off-label use are particularly noteworthy and should be further investigated in future studies. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Carsten Schröder
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Michael Dörks
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Bianca Kollhorst
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Tilo Blenk
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Ralf W Dittmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Edeltraut Garbe
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Oliver Riedel
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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Psychotropic medicine prescriptions in Italian youths: a multiregional study. Eur Child Adolesc Psychiatry 2016; 25:235-45. [PMID: 26016693 DOI: 10.1007/s00787-015-0726-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
The aim of the study was to evaluate the trend of paediatric psychotropic drug prescriptions in Italy. Data sources were regional, outpatient prescription databases. Seven Italian regions, covering 50 % of the Italian population, provided data from 2006 to 2011. Prevalence and incidence of prescriptions by age and gender were evaluated for psychotropic, antidepressant, antipsychotic, and attention-deficit/hyperactivity disorders (ADHD) medications. The hospital admission rate for psychiatric conditions was calculated, also at the local health unit (LHU) level. The presence of trends in prescription prevalence and incidence during the 6 year period was assessed. Finally, the correlation between prevalence, prescription, hospital admission rates, latitude, longitude, and average annual income at the LHU level was also investigated. In 2011, 8834 youths received at least one psychotropic drug prescription, with a prevalence of 1.76 ‰ (95 % CI 1.72-1.80). The incidence of new psychotropic drug users was 1.03 ‰ (1.00-1.06). The prevalence of antidepressants was 1.02 ‰ (0.99-1.04), while that of antipsychotics was 0.70 ‰ (0.68-0.72), and that of ADHD medications 0.19 ‰ (0.18-0.21). The psychotropic drug prevalence increased with increasing age. Males were more exposed to psychotropic drugs than females (AUC0-17 male/female = 1.23). Antipsychotics were the most prescribed psychotropic drugs in males, while antidepressants were in females. Between-region prevalence ranged from 1.56 to 2.17 ‰. The overall prevalence of psychotropic drug from 2006 to 2011 was stable (χ(t)2 ≤ 0.001, p = 0.97). No correlation was found between prevalence and the variables investigated. Psychotropic drug prescription was very limited and stable. No geographical patterns were found.
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Bachmann CJ, Lempp T, Glaeske G, Hoffmann F. Antipsychotic prescription in children and adolescents: an analysis of data from a German statutory health insurance company from 2005 to 2012. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:25-34. [PMID: 24606780 DOI: 10.3238/arztebl.2014.0025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 10/14/2013] [Accepted: 10/14/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite sparse documentation of their long-term therapeutic effects and side effects, antipsychotic drugs have come to be prescribed more frequently for children and adolescents in recent years, both in the USA and in Europe. No current data are available about antipsychotic prescriptions for this age group in Germany. METHODS Data from the largest statutory health insurance fund in Germany (BARMER GEK) were studied to identify antipsychotic prescriptions for children and adolescents (age 0-19 years) from 2005 to 2012 and analyze them with respect to age, sex, drug prescribed, prescribing medical specialty, and any observable secular trends. RESULTS The percentage of children and adolescents receiving a prescription for an antipsychotic drug rose from 0.23% in 2005 to 0.32% in 2012. In particular, atypical antipsychotic drugs were prescribed more frequently over time (from 0.10% in 2005 to 0.24% in 2012). The rise in antipsychotic prescriptions was particularly marked among 10- to 14-year-olds (from 0.24% to 0.43%) and among 15- to 19-year-olds (from 0.34% to 0.54%). The prescribing physicians were mostly either child and adolescent psychiatrists or pediatricians; the most commonly prescribed drugs were risperidone and pipamperone. Risperidone was most commonly prescribed for patients with hyperkinetic disorders and conduct disorders. CONCLUSION In Germany as in other industrialized countries, antipsychotic drugs have come to be prescribed more frequently for children and adolescents in ecent years. The German figures, while still lower than those from North America, are in the middle range of figures from European countries. The causes of the increase should be critically examined; if appropriate, the introduction of prescribing guidelines of a more restrictive nature could be considered.
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Affiliation(s)
- Christian J Bachmann
- Department of Child and Adolescent Psychiatry, Philipps University, Marburg, Department of Child and Adolescent Psychiatry and Psychotherapy, Frankfurt am Main University Hospital, Department of Health Economics, Health Policy and Health Services Research, Centre for Social Policy Research (ZeS), University of Bremen
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Abstract
OBJECTIVE The objective of this study was to analyze the initial treatment with antipsychotics (APs) and its changes during the first year of treatment in patients visited in specialized child and adolescent psychiatry departments. METHODS Participants were 265 patients, aged 4 to 17 years, who attended consecutively at 4 different centers and were naive of AP or quasi-naive (less than 30 days since the beginning of AP treatment). Type of AP, dosage, and concomitant medication were registered at baseline, 1, 3, 6, and 12 months after beginning the treatment with AP. RESULTS At baseline, the patients' mean age was 14.4 (2.9) years, and 145 (54.7%) patients were males. Antipsychotics were more prescribed in the following: schizophrenia spectrum disorders (30.2%), disruptive behavior disorders (DBDs) (18.9%), bipolar disorders (14.3%), depressive disorders (12.8%), and eating disorders (11.7%). A total of 93.2% of the patients were on an off-label indication of AP. Risperidone was the AP most prescribed in all the assessments, but differences were observed in the type of AP according to diagnosis. Thus, risperidone was significantly most prescribed in patients with DBD and olanzapine was most prescribed in patients with eating disorders. Olanzapine and quetiapine were the second-generation APs (SGAs) most prescribed after risperidone, and haloperidol was the most prescribed first-generation AP. Up to 8.3% of patients during the follow-up were on AP polypharmacy. Almost 16% patients had a change in its AP treatment during the follow-up, and the main switch was from one SGA to another. CONCLUSIONS Second-generation APs were the APs most prescribed in our sample and approximately 93% of the patients used AP off-label. Risperidone was the most common AP used above all in patients with DBD, whereas olanzapine was most prescribed in patients with eating disorders. Antipsychotic polypharmacy and switch rates were low during the follow-up.
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Clavenna A, Cartabia M, Sequi M, Costantino MA, Bortolotti A, Fortino I, Merlino L, Bonati M. Burden of psychiatric disorders in the pediatric population. Eur Neuropsychopharmacol 2013; 23:98-106. [PMID: 22561004 DOI: 10.1016/j.euroneuro.2012.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 04/13/2012] [Accepted: 04/14/2012] [Indexed: 11/19/2022]
Abstract
In order to estimate the burden of mental disorders in a representative Italian pediatric population, an epidemiological study was performed using three administrative databases: a drug prescription, a hospital discharge form, and an outpatient ambulatory visit database. The population target was 1,616,268 children and adolescents under 18 years living in the Lombardy Region, Italy. A youth was defined as a case if during 2008 he/she received at least one psychotropic drug prescription or was hospitalized for a psychiatric disorder (International Classification of Disease codes 290-319), or attended a child neuropsychiatric outpatient unit for a visit and/or a psychological intervention or rehabilitation at least once. Epileptic children were excluded. In all, 63,550 youths (39.3 per 1000; 95%CI 39.1-39.7‰) were identified as users of health care resources for a putative mental disorder. The prevalence was higher in boys than in girls (47.0‰ versus 31.3‰) and the highest value was recorded in children 8 years old (60.2‰). A total of 59,987 youths (37.1‰) attended a child and adolescent neuropsychiatry service at least once, 3605 (2.2‰) were admitted to hospital, and 2761 (1.7‰) received at least one psychotropic drug prescription, 57% of which did not attend a child neuropsychiatry service. In all, 14,741 youths (23.1% of users) had a disorder that required a high intensity of care (e.g. recurrent prescriptions for drugs and/or ambulatory care). The proportion of youths who received care for mental disorders in the Lombardy Region seems lower than in other countries. However, the fact that many children were prescribed psychotropic drugs without the supervision of a child psychiatrist is a reason for concern.
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Affiliation(s)
- Antonio Clavenna
- Laboratory for Mother and Child Health, Department of Public Health, Mario Negri Institute for Pharmacological Research, Milan, Italy.
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Prescription drug dispensing profiles for one million children: a population-based analysis. Eur J Clin Pharmacol 2012; 69:581-8. [DOI: 10.1007/s00228-012-1343-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022]
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Hoffmann F, Glaeske G, Petermann F, Bachmann CJ. Outpatient treatment in German adolescents with depression: an analysis of nationwide health insurance data. Pharmacoepidemiol Drug Saf 2012; 21:972-9. [PMID: 22639197 DOI: 10.1002/pds.3295] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 03/27/2012] [Accepted: 04/25/2012] [Indexed: 11/05/2022]
Abstract
PURPOSE Data on medical treatment of adolescents with depression are scarce. This study aimed to examine outpatient health services utilisation of depressive disorders in adolescents. METHODS Data of a statutory health insurance company were analysed and outpatients from 12 to 18 years old with diagnosed depression during a 1-year period (2009) were identified. For this cohort, the prescription of antidepressants and psychotherapy was evaluated with respect to age and sex. RESULTS A total of 4295 patients (41.2% males; mean age, 15.5 years) matched the inclusion criteria. Of the patients, 29.7% consulted a child and adolescent psychiatrist. A total of 59.6% were treated with psychotherapy only, 9.6% were treated with a combination of psychotherapy and antidepressants, and 1.9% received only antidepressants. For 28.8% of patients, no specific depression-related treatment was prescribed. A total of 1357 packages of antidepressants were analysed, of which fluoxetine (24.4% of prescriptions), citalopram (14.0%), and mirtazapine (9.7%) were the most frequently prescribed substances. Regarding substance classes, selective serotonin reuptake inhibitors (SSRIs; 55.6%), tricyclic antidepressants (TCAs; 17.9%), and hypericum (St. John's wort; 8.5%) were most common. CONCLUSIONS Although the underlying data were coded for insurance purposes, which might result in some data impreciseness, this naturalistic study furnishes evidence that outpatient treatment of adolescents with depressive disorders in Germany only partly complies with guideline recommendations for first-line treatment: Although the prescriptions of SSRI for adolescent depression have risen over recent years, still, a quarter of antidepressant prescriptions for adolescents with depression were TCA or hypericum. Therefore, dissemination of knowledge on state-of-the-art treatment for adolescent depression remains a major educational goal.
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Affiliation(s)
- Falk Hoffmann
- Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research, University of Bremen, Bremen, Germany.
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