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O'Brien MJ, Pauls AM, Cates AM, Larson PD, Zorn AN. Psychotropic Medication Use and Polypharmacy Among Children and Adolescents Initiating Intensive Behavioral Therapy for Severe Challenging Behavior. J Pediatr 2024; 271:114056. [PMID: 38615943 DOI: 10.1016/j.jpeds.2024.114056] [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: 11/20/2023] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To evaluate the prevalence, trends, and factors associated with psychotropic medication use and polypharmacy among children and adolescents initiating intensive behavioral therapy for severe challenging behavior over a 10-year period. STUDY DESIGN In this retrospective observational study, we examined data from caregiver interviews and patient medical records on the number and types of psychotropic medications prescribed to patients initiating intensive behavioral therapy between January 1, 2013, and December 31, 2022. Trends in medication use and polypharmacy across the 10-year period were analyzed using regression analysis, while differences in demographics and clinical factors for patients with use and polypharmacy were analyzed using nonparametric statistical analysis with odds ratios presented for significant factors. RESULTS Data from all 302 pediatric patients initiating intensive behavioral therapy across the 10-year period were analyzed. Among all patients and all years, 83.8% were taking at least 1 psychotropic medication and 68.2% experienced polypharmacy. There were no changes in the prevalence of use, mean number of medications taken, or polypharmacy across the 10-year period. Patients diagnosed with attention-deficit/hyperactivity disorder or anxiety disorder, as well as those exhibiting self-injurious behavior had higher use of psychotropic medication and polypharmacy and were taking more medications overall. CONCLUSIONS Psychotropic medication use and polypharmacy were extremely high for children and adolescents with severe challenging behavior, but use and polypharmacy did not change over the 10-year period of data collection. Further research is needed to establish the generality of these findings to other regions of the US.
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Affiliation(s)
- Matthew J O'Brien
- The University of Iowa, Iowa City, IA; The University of Iowa Stead Family Department of Pediatrics, Iowa City, IA.
| | | | | | - Priya D Larson
- The University of Iowa, Iowa City, IA; The University of Iowa Department of Child and Adolescent Psychiatry, Iowa City, IA
| | - Alithea N Zorn
- The University of Iowa, Iowa City, IA; Center for Public Health Statistics, Iowa City, IA; College of Public Health, Iowa City, IA
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Zhaojian W, Meizhu J, Jun H, Shanshan G, Jiping H, Zhigang Z, Ying G, Cao L. Trends and off-label utilization of antipsychotics in children and adolescents from 2016 to 2021 in China: a real-world study. Child Adolesc Psychiatry Ment Health 2024; 18:77. [PMID: 38907356 PMCID: PMC11193198 DOI: 10.1186/s13034-024-00766-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/06/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Global antipsychotic usage, including off-label prescriptions, has increased in recent decades. However, trends in China, particularly for children and adolescents, remain unclear. This study explored these trends from 2016 to 2021 and identified factors associated with off-label prescriptions. METHODS In this retrospective study, we analyzed on-label and off-label prescriptions based on drug information approved by the China National Medical Products Administration. To identify factors associated with off-label prescriptions, we conducted multivariate logistic regression analysis. RESULTS Our study included 48,258 antipsychotic prescriptions, 52.4% (25,295) of which were prescriptions for males. Of these, 61.7% (29,813) were off-label. Over time, the number of antipsychotics and the percentage of off-label prescriptions for children and adolescents overall increased from 2016 to 2021. The use of atypical antipsychotics increased, whereas that of typical antipsychotics decreased. For off-label usage, all of the factors in our study were associated with off-label usage, including age, sex, year, region, department, reimbursement, antipsychotic type, drug expense, number of polypharmacy and diagnoses. Additionally, tiapride (15.8%) and aripiprazole (18.6%) were the most common typical and atypical antipsychotics, respectively. For pediatric diseases, common diagnoses included mood or affective disorders (31.7%) and behavioral and emotional disorders, with onset usually occurring in childhood and adolescence (29.1%). Furthermore, a depressive state was the most common diagnosis for which antipsychotic polypharmacy was used for treatment. CONCLUSION In this retrospective study, off-label antipsychotic prescriptions were common, with trends generally increasing among children and adolescents from 2016 to 2021. However, there is a lack of evidence supporting off-label usage, thus emphasizing the need for studies on the efficacy and safety of these treatments.
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Affiliation(s)
- Wang Zhaojian
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Jiang Meizhu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nan Si Huan Xi Lu, Fengtai District, 100050, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Hong Jun
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Guo Shanshan
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nan Si Huan Xi Lu, Fengtai District, 100050, Beijing, China
| | - Huo Jiping
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nan Si Huan Xi Lu, Fengtai District, 100050, Beijing, China
| | - Zhao Zhigang
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nan Si Huan Xi Lu, Fengtai District, 100050, Beijing, China
| | - Gong Ying
- Department of Pharmacy, Dongfang Hospital, Beijing University of Chinese Medicine, No. 6, Phase 1, Fangxingyuan, Fangzhuang, Fengtai District, Beijing, China.
| | - Li Cao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nan Si Huan Xi Lu, Fengtai District, 100050, Beijing, China.
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Menard ML, Auby P, Cruzel C, Cohen D, Bonnot O, Askenazy F, Thümmler S. Publisher Correction: Emergence of psychiatric adverse events during antipsychotic treatment in AP-naïve children and adolescents. Child Adolesc Psychiatry Ment Health 2023; 17:37. [PMID: 36899438 PMCID: PMC9999490 DOI: 10.1186/s13034-023-00580-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Affiliation(s)
- Marie-Line Menard
- Department of Child and Adolescent Psychiatry, University, Children's Hospitals of Nice CHU- Lenval, 57 Avenue de La Californie, 06200, Nice, France.
| | - Philippe Auby
- Department of Child and Adolescent Psychiatry, University, Children's Hospitals of Nice CHU- Lenval, 57 Avenue de La Californie, 06200, Nice, France.,CoBTek, EA7276, Université Côte d'Azur, Nice, France
| | - Coralie Cruzel
- Department of Clinical Research and Innovation (DRCI), Nice University Hospital, Nice, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, GH Pitié-Salpêtrière, APHP, Paris, France.,CNRS UMR 7222 Institut des Systèmes Intelligents et Robotiques, Pierre & Marie Curie University, Paris, France
| | - Olivier Bonnot
- Department of Child and Adolescent Psychiatry, University Hospital, Nantes, France
| | - Florence Askenazy
- Department of Child and Adolescent Psychiatry, University, Children's Hospitals of Nice CHU- Lenval, 57 Avenue de La Californie, 06200, Nice, France.,CoBTek, EA7276, Université Côte d'Azur, Nice, France
| | - Susanne Thümmler
- Department of Child and Adolescent Psychiatry, University, Children's Hospitals of Nice CHU- Lenval, 57 Avenue de La Californie, 06200, Nice, France.,CoBTek, EA7276, Université Côte d'Azur, Nice, France
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Merino D, Gérard AO, Destere A, Askenazy F, Drici MD, Thümmler S. Antipsychotic Abuse, Dependence, and Withdrawal in the Pediatric Population: A Real-World Disproportionality Analysis. Biomedicines 2022; 10:biomedicines10112972. [PMID: 36428541 PMCID: PMC9687123 DOI: 10.3390/biomedicines10112972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
Antipsychotic drugs (APs) aim to treat schizophrenia, bipolar mania, and behavioral symptoms. In child psychiatry, despite limited evidence regarding their efficacy and safety, APs are increasingly subject to off-label use. Studies investigating addictology-related symptoms in young people being scarce, we aimed to characterize the different patterns of AP misuse and withdrawal in children and adolescents relying on the WHO pharmacovigilance database (VigiBase®, Uppsala Monitoring Centre, Sweden). Using the standardized MedDRA Query 'drug abuse, dependence and withdrawal', disproportionality for each AP was assessed with the reporting odds ratio and the information component. A signal was detected when the lower end of the 95% confidence interval of the information component was positive. Results revealed mainly withdrawal symptoms in infants (under 2 years), intentional misuse in children (2 to 11 years), and abuse in adolescents (12 to 17 years). Olanzapine, risperidone, aripiprazole, and quetiapine were disproportionately reported in all age groups, with quetiapine being subject to a specific abuse signal in adolescents. Thus, in adolescents, the evocation of possible recreational consumption may lead to addiction-appropriate care. Further, in young patients with a history of AP treatment, a careful anamnesis may allow one to identify misuse and its role in the case of new-onset symptoms.
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Affiliation(s)
- Diane Merino
- Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice, CHU-Lenval, 06200 Nice, France
- CoBTek Laboratory, Université Côte d’Azur, 06000 Nice, France
- Pharmacovigilance Center, Department of Pharmacology, University Hospital of Nice, 06000 Nice, France
| | - Alexandre O. Gérard
- Pharmacovigilance Center, Department of Pharmacology, University Hospital of Nice, 06000 Nice, France
| | - Alexandre Destere
- Pharmacovigilance Center, Department of Pharmacology, University Hospital of Nice, 06000 Nice, France
| | - Florence Askenazy
- Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice, CHU-Lenval, 06200 Nice, France
- CoBTek Laboratory, Université Côte d’Azur, 06000 Nice, France
| | - Milou-Daniel Drici
- Pharmacovigilance Center, Department of Pharmacology, University Hospital of Nice, 06000 Nice, France
| | - Susanne Thümmler
- Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice, CHU-Lenval, 06200 Nice, France
- CoBTek Laboratory, Université Côte d’Azur, 06000 Nice, France
- Correspondence:
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