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Antipsychotic prescriptions rising among youths

A recent study found a rise in the prevalence of antipsychotic prescriptions among pediatric patients and noted which antipsychotics were most commonly used for specific indications.

An increasing trend in prescriptions of antipsychotics among pediatric patients, along with the indications associated with these prescriptions, was recently analyzed in a study published by The Lancet Psychiatry.

Although most antipsychotics are not approved for use in pediatric patients, concerns have arisen over an increase in antipsychotic prescriptions for children and adolescents. Antipsychotics can interact with children’s physical and psychological development, potentially having lasting consequences such as increased cardiometabolic risk.

The 3 antipsychotics approved by the National Institute for Health and Care Excellence for use in pediatric patients arearipiprazole (Abilify; Bristol Myers Squibb), clozapine (Clozaril; Novartis AG), and risperidone (Risperdal; Janssen Pharmaceuticals, Inc).

Aripiprazole was approved for schizophrenia in 2011 and bipolar disorder in 2013, clozapine for adolescent treatment-resistant schizophrenia in 2013, and risperidone for severely aggressive behavior in children aged more than 5 years in 2013.

Studies analyzing the prescriptions of antipsychotics to youths from January 1, 1992, to December 31, 2012, showed a rising rate of antipsychotic prescriptions. There is also little data on the doses and indications of antipsychotic prescriptions in pediatric patients.

Investigators conducted a cohort study to evaluate the trends of antipsychotic prescriptions for children and adolescents in England from January 1, 2000, to December 31, 2019. Data was gathered from the Clinical Practice Research Datalink (CPRD), containing electronic records from participating primary care practices in England.

Participants were aged 3 to 18 years and had CPRD records available during the study period. Antipsychotic use in participants was defined as the prescription of 1 or more typical or atypical antipsychotic listed in the British National Formulary. 

The association between CPRD prescriptions and indications was determined through an algorithm developed by investigators. Records from within 6 months before and after the first prescription were used to determine possible indications. These indications were independently categorized by 2 psychiatrists, who then discussed a ranking priority for prescriptions.

Indications were ranked by priority in the following order: non-affective psychosis, affective psychosis, autism spectrum disorder (ASD), conduct disorders, obsessive-compulsive disorders, tic disorders, eating disorders, anxiety disorders including post-traumatic stress disorder, depression, attention-deficit/hyperactivity disorder (ADHD), nausea, other mental illnesses, and other indications.

Other variables identified included participant sex, age, general practice region, and Index of Multiple Deprivation. Participants were categorized into age groups and could transition to new age groups during the follow-up period.

There were 7,217,098 children evaluated in the study. Among this population, 243,529 antipsychotic prescriptions across 26 antipsychotics were recorded for individuals aged 3 to 18 years. Of these, 225,710 were atypical and 17,819 were typical. Risperidone, aripiprazole, quetiapine (Seroquel; AstraZeneca), and olanzapine (Zyprexa; LillyMedical) were the most commonly prescribed antipsychotics.

An increase in the prevalence of prescriptions was observed, from a rate of 0.057% in 2000 to 0.105% in 2019. The highest rate of prescriptions was 0.119% in 2017. Older groups often saw a higherannual prevalence of antipsychotic prescriptions, with adolescents aged 12 to 14 years seeing the greatest relative increase.

ASD was recorded as the most likely indication for antipsychotic prescriptions, followed by non-affective psychosis, anxiety disorders, ADHD, depression, and conduct disorders. The most common prescriptions for most indications were risperidone, except for quetiapine to treat depression and olanzapine to treat eating disorders.

Investigators concluded that authorities in England should observe trends on antipsychotic use in young people, and that future guidelines should reassess the safety and efficacy of these prescriptions.

Reference

Radojčić MR, Pierce M, Hope H, Senior M, Taxiarchi VP, Trefan L, et al. Trends in antipsychotic prescribing to children and adolescents in England: cohort study using 2000–19 primary care data. The Lancet Psychiatry. 2023. doi:10.1016/S2215-0366(22)00404-7