Antipsychotic treatment has risen rapidly among young people, with antipsychotics now being prescribed in about the same proportion of youth and adult visits to psychiatrists, reveals a national survey. New York researchers used data from the 1993–2009 National Ambulatory Medical Care Surveys to compare national trends in antipsychotic treatment of adults and youths in office-based medical practice. They specifically examined outpatient visits with a prescription of antipsychotic medications between 1993–1998 and 2005–2009.
They found that antipsychotic prescriptions for children 13 years of age and younger grew more than sevenfold (from 0.24 to 1.83 per 100 population) and more than quadrupled among adolescents aged 14 to 20 years (from 0.78 to 3.76 per 100 population). During the same period, antipsychotic prescriptions for adults nearly doubled from 3.25 to 6.18 per 100 population. Not all visits with anti-psychotics mentioned had a mental disorder diagnosis. Among child and adolescent visits with antipsychotic medication mentioned, disruptive behavior disorders were the most common diagnosis (63.0 percent and 33.7 percent, respectively). Among adult visits with antipsychotic medication mentioned, depression (21.2 percent) and bipolar disorder (20.2 percent) were the two most commonly diagnosed disorders.
Only a small proportion of child and adolescent visits included an antipsychotic prescription for a Food and Drug Administration (FDA) clinical indication. For antipsychotics prescribed for a non-FDA indication during child visits, the 3 most common diagnoses were attention-deficit/hyperactivity disorder (17.0 percent), oppositional defiant disorder (11.3 percent), and disruptive behavior disorder not otherwise specified (10.5 percent). For adolescents, the most common diagnoses were bipolar disorder not otherwise specified (14.9 percent), anxiety disorder not otherwise specified (12.6 percent), and attention-deficit/hyperactivity disorder (11.4 percent). For adults, the most common diagnoses were anxiety disorder not otherwise specified (17.7 percent), depression not otherwise specified (10.9 percent), and bipolar disorder not otherwise specified (10.9 percent). The researchers believe that the trends reported in their survey may signal a need to reevaluate clinical practice patterns and strengthen efforts to educate physicians, especially primary care physicians, about the safety and efficacy of antipsychotic medications. The study was supported in part by AHRQ (HS21112).
See "National trends in the office-based treatment of children, adolescents, and adults with antipsychotics," by Mark Olfson, M.D., Carlos Blanco, M.D., Shang-Min Liu, M.S., and others in the August 2012 Archives of General Psychiatry 69, pp. 1247-1256.
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