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Wood SJ, Ilomäki J, Gould J, Tan GS, Raven M, Jureidini JN, Grzeskowiak LE. Dispensing of psychotropic medications to Australian children and adolescents before and during the COVID-19 pandemic, 2013-2021: a retrospective cohort study. Med J Aust 2023. [PMID: 37182907 DOI: 10.5694/mja2.51948] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/30/2023] [Accepted: 03/01/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To determine longitudinal patterns of dispensing of antidepressant, anxiolytic, antipsychotic, psychostimulant, and hypnotic/sedative medications to children and adolescents in Australia during 2013-2021. DESIGN Retrospective cohort study; analysis of 10% random sample of Pharmaceutical Benefits Scheme (PBS) dispensing data. PARTICIPANTS, SETTING People aged 18 years or younger dispensed PBS-subsidised psychotropic medications in Australia, 2013-2021. MAIN OUTCOME MEASURES Population prevalence of dispensing of psychotropic medications to children and adolescents, by psychotropic class, gender, and age group (0-6, 7-12, 13-18 years). RESULTS The overall prevalence of psychotropic dispensing to children and adolescents was 33.8 per 1000 boys and 25.2 per 1000 girls in 2013, and 60.0 per 1000 boys and 48.3 per 1000 girls in 2021. The prevalence of psychotropic polypharmacy was 5.4 per 1000 boys and 3.7 per 1000 girls in 2013, and 10.4 per 1000 boys and 8.3 per 1000 girls in 2021. Prevalent dispensing during 2021 was highest for psychostimulants (boys, 44.0 per 1000; girls, 17.4 per 1000) and antidepressants (boys, 20.4 per 1000; girls, 33.8 per 1000). During 2021, the prevalence of dispensing was higher than predicted by extrapolation of 2013-2019 data for many classes, including antidepressants (boys: +6.1%; 95% CI, 1.1-11.1%; girls: +22.2%; 95% CI, 17.4-26.9%), and psychostimulants (boys: +14.5%; 95% CI, 8.0-21.1%; girls: +27.7%; 95% CI, 18.9-36.6%). The increases were greatest for girls aged 13-18 years (antidepressants: +20.3%; 95% CI, 16.9-23.7%; psychostimulants: +39.0%; 95% CI, 27.9-50.0%). CONCLUSIONS The prevalence of both psychotropic dispensing and psychotropic polypharmacy for children and adolescents were twice as high in 2021 as in 2013. The reasons and appropriateness of the marked increases in psychotropic dispensing during the COVID-19 pandemic, particularly to adolescent girls, should be investigated.
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Affiliation(s)
- Stephen J Wood
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC
| | - Jacqueline Gould
- South Australian Health and Medical Research Institute, Adelaide, SA
- Robinson Research Institute, University of Adelaide, Adelaide, SA
| | - George Sq Tan
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
| | - Melissa Raven
- Robinson Research Institute, University of Adelaide, Adelaide, SA
| | - Jon N Jureidini
- Robinson Research Institute, University of Adelaide, Adelaide, SA
| | - Luke E Grzeskowiak
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
- College of Medicine and Public Health, Flinders University, Adelaide, SA
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Jureidini JN, Amsterdam JD, McHenry LB. The citalopram CIT-MD-18 pediatric depression trial: Deconstruction of medical ghostwriting, data mischaracterisation and academic malfeasance. JRS 2016; 28:33-43. [DOI: 10.3233/jrs-160671] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jon N. Jureidini
- Critical and Ethical Mental Health Research Group, University of Adelaide, Adelaide, Australia
| | - Jay D. Amsterdam
- Depression Research Unit, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Leemon B. McHenry
- Department of Philosophy, California State University, Northridge, CA, USA
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Jureidini JN. Let children cry. Med J Aust 2015; 202:418. [PMID: 25929501 DOI: 10.5694/mja15.00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/03/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Jon N Jureidini
- Critical and Ethical Mental Health research group, University of Adelaide, Adelaide, SA, Australia.
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Affiliation(s)
- Jon N Jureidini
- Paediatric Mental Health Training Unit, University of Adelaide, Adelaide, SA, Australia.
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Affiliation(s)
- Jon N Jureidini
- Paediatric Mental Health Training Unit, University of Adelaide, North Adelaide, SA 5006, Australia
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Jureidini JN. Targeted primary care‐based mental health services for young Australians. Med J Aust 2012; 196:627. [DOI: 10.5694/mja12.10535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jon N Jureidini
- Department of Psychological Medicine, Women's and Children's Hospital, Adelaide, SA
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Abstract
Journals are failing in their obligation to ensure that research is fairly represented to their readers, and must act decisively to retract fraudulent publications. Recent case reports have exposed how marketing objectives usurped scientific testing and compromised the credibility of academic medicine. But scant attention has been given to the role that journals play in this process, especially when evidence of research fraud fails to elicit corrective measures. Our experience with The Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) illustrates the nature of the problem. The now-infamous Study 329 of paroxetine in adolescent depression was negative for efficacy on all eight protocol-specified outcomes and positive for harm, but JAACAP published a report of this study that concluded that "paroxetine is generally well tolerated and effective for major depression in adolescents." The journal's editors not only failed to exercise critical judgment in accepting the article, but when shown evidence that the article misrepresented the science, refused either to convey this information to the medical community or to retract the article.
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Affiliation(s)
- Jon N Jureidini
- Discipline of Psychiatry, University of Adelaide, Adelaide, South Australia.
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Tsai AC, Rosenlicht NZ, Jureidini JN, Parry PI, Spielmans GI, Healy D. Aripiprazole in the maintenance treatment of bipolar disorder: a critical review of the evidence and its dissemination into the scientific literature. PLoS Med 2011; 8:e1000434. [PMID: 21559324 PMCID: PMC3086871 DOI: 10.1371/journal.pmed.1000434] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 03/23/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Aripiprazole, a second-generation antipsychotic medication, has been increasingly used in the maintenance treatment of bipolar disorder and received approval from the U.S. Food and Drug Administration for this indication in 2005. Given its widespread use, we sought to critically review the evidence supporting the use of aripiprazole in the maintenance treatment of bipolar disorder and examine how that evidence has been disseminated in the scientific literature. METHODS AND FINDINGS We systematically searched multiple databases to identify double-blind, randomized controlled trials of aripiprazole for the maintenance treatment of bipolar disorder while excluding other types of studies, such as open-label, acute, and adjunctive studies. We then used a citation search to identify articles that cited these trials and rated the quality of their citations. Our evidence search protocol identified only two publications, both describing the results of a single trial conducted by Keck et al., which met criteria for inclusion in this review. We describe four issues that limit the interpretation of that trial as supporting the use of aripiprazole for bipolar maintenance: (1) insufficient duration to demonstrate maintenance efficacy; (2) limited generalizability due to its enriched sample; (3) possible conflation of iatrogenic adverse effects of abrupt medication discontinuation with beneficial effects of treatment; and (4) a low overall completion rate. Our citation search protocol yielded 80 publications that cited the Keck et al. trial in discussing the use of aripiprazole for bipolar maintenance. Of these, only 24 (30%) mentioned adverse events reported and four (5%) mentioned study limitations. CONCLUSIONS A single trial by Keck et al. represents the entirety of the literature on the use of aripiprazole for the maintenance treatment of bipolar disorder. Although careful review identifies four critical limitations to the trial's interpretation and overall utility, the trial has been uncritically cited in the subsequent scientific literature. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Alexander C. Tsai
- Robert Wood Johnson Health and Society Scholars Program, Harvard
University, Cambridge, Massachusetts, United States of America
| | - Nicholas Z. Rosenlicht
- Department of Psychiatry, University of California at San Francisco and
San Francisco Veterans Affairs Medical Center, San Francisco, California, United
States of America
| | - Jon N. Jureidini
- Discipline of Psychiatry, University of Adelaide, Adelaide, South
Australia, Australia
| | - Peter I. Parry
- Child and Adolescent Mental Health Service, Division of Mental Health,
Flinders University, Adelaide, South Australia, Australia
| | - Glen I. Spielmans
- Department of Psychology, Metropolitan State University, St. Paul,
Minnesota, United States of America
| | - David Healy
- Department of Psychological Medicine, Cardiff University, Cardiff, Wales,
United Kingdom
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Jureidini JN, Parry PI, Houen CM, Battersby MW. Bipolar disorder supplement needed broader perspective. Med J Aust 2011; 194:326; author reply 326. [DOI: 10.5694/j.1326-5377.2011.tb02992.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 02/07/2011] [Indexed: 11/17/2022]
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Affiliation(s)
- Leemon B. McHenry
- a Department of Philosophy , California State University , Northridge, Northridge, California, USA
| | - Jon N. Jureidini
- b Discipline of Psychiatry , University of Adelaide , Adelaide, South Australia
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Jureidini JN, McHenry LB, Mansfield PR. Clinical trials and drug promotion: Selective reporting of Study 329. International Journal of Risk and Safety in Medicine 2008. [DOI: 10.3233/jrs-2008-0444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Jureidini JN, McHenry LB, Mansfield PR. Clinical trials and drug promotion: Selective reporting of study 329. International Journal of Risk and Safety in Medicine 2008. [DOI: 10.3233/jrs-2008-0426] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jon N. Jureidini
- Discipline of Psychiatry, University of Adelaide, Adelaide, South Australia
| | - Leemon B. McHenry
- Department of Philosophy, California State University, Northridge, CA, USA
| | - Peter R. Mansfield
- Discipline of General Practice, University of Adelaide, Adelaide, South Australia
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Jureidini JN. Depression in adolescents: Study was not a trial of antidepressants. BMJ 2007; 335:221; author reply 221. [PMID: 17673737 PMCID: PMC1939762 DOI: 10.1136/bmj.39289.575058.be] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mansfield PR, Lexchin J, Wen LS, Grandori L, McCoy CP, Hoffman JR, Ramos J, Jureidini JN. Educating health professionals about drug and device promotion: advocates' recommendations. PLoS Med 2006; 3:e451. [PMID: 17090212 PMCID: PMC1630716 DOI: 10.1371/journal.pmed.0030451] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mansfield and colleagues outline the recommendations from four advocacy groups for improving the education of health professionals on promotion of drugs and devices.
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Jureidini JN, Tonkin A. Suicide and antidepressants in children. Aust Prescr 2005. [DOI: 10.18773/austprescr.2005.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Rogers WA, Mansfield PR, Braunack-Mayer AJ, Jureidini JN. The ethics of pharmaceutical industry relationships with medical students. Med J Aust 2004; 180:411-4. [PMID: 15089733 DOI: 10.5694/j.1326-5377.2004.tb05995.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2003] [Accepted: 02/17/2004] [Indexed: 11/17/2022]
Abstract
Little research has been done on the extent of the relationship between the pharmaceutical industry and medical students, and the effect on students of receiving gifts. Potential harms to patients are documented elsewhere; we focus on potential harms to students. Students who receive gifts may believe that they are receiving something for nothing, contributing to a sense of entitlement that is not in the best interests of their moral development as doctors. Alternatively, students may be subject to recognised or unrecognised reciprocal obligations that potentially influence their decision making. Medical educators have a duty of care to protect students from influence by pharmaceutical companies.
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Affiliation(s)
- Wendy A Rogers
- Department of Medical Education, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
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Abstract
How safe and effective are antidepressants in children and adolescents? The authors of this review have found disturbing shortcomings in the methods and reporting of trials of newer antidepressants in this patient group
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Affiliation(s)
- Jon N Jureidini
- Department of Psychological Medicine, Women's and Children's Hospital, North Adelaide, 5006 SA, Australia.
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Jureidini JN, Tonkin AL. Clinical practice guidelines for depression in young people. Med J Aust 2003; 178:300; author reply 300-2. [PMID: 12633493 DOI: 10.5694/j.1326-5377.2003.tb05205.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2002] [Accepted: 11/04/2002] [Indexed: 11/17/2022]
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Goldwater PN, Braunack-Mayer AJ, Power RG, Henning PH, Gold MS, Donald TG, Jureidini JN, Finlay CF. Childhood tetanus in Australia: ethical issues for a should-be-forgotten preventable disease. Med J Aust 2003; 178:175-7. [PMID: 12580746 DOI: 10.5694/j.1326-5377.2003.tb05136.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2002] [Accepted: 06/06/2002] [Indexed: 11/17/2022]
Abstract
Refusal of a parent to have a child vaccinated against tetanus raised ethical issues for the treating clinicians. The clinicians felt their duty to the child was compromised, but recognised that our society leaves the authority for such decisions with the parents. As there was no reason, other than different beliefs about vaccination, to doubt the parent's care for the child, the clinicians limited their response to providing strong recommendations in favour of vaccination. Other issues raised by this case include community protection, and the costs to the community of treating a vaccine-preventable disease.
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Affiliation(s)
- Paul N Goldwater
- Department of Microbiology and Infectious Diseases, Women's and Children's Hospital, North Adelaide, SA 5006, Australia.
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Jureidini JN, Shafer AT, Donald TG. "Munchausen by proxy syndrome": not only pathological parenting but also problematic doctoring? Med J Aust 2003; 178:130-2. [PMID: 12558485 DOI: 10.5694/j.1326-5377.2003.tb05104.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2002] [Accepted: 09/26/2002] [Indexed: 11/17/2022]
Abstract
Certain social expectations of medicine combine with characteristics of subspecialised technological paediatrics to facilitate the form of child abuse labelled "Munchausen by proxy syndrome". Examining this form of child abuse highlights possible shortcomings of medical practice. The primary medical tasks of diagnosing and curing illness and of preventing suffering are sometimes overridden by other motivations of which doctors may not be fully aware. More open discussion of what motivates health professionals in their work may improve medical practice and lead to a reduced incidence of Munchausen by proxy syndrome.
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Affiliation(s)
- Jon N Jureidini
- Department of Psychological Medicine, Women's and Children's Hospital, 72 King William Road, North Adelaide, Adelaide, SA 5006, Australia.
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Jureidini JN. Epidemic of schizophrenia in children or inappropriate prescribing? Med J Aust 2000; 173:555-6. [PMID: 11194744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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