Treatment of Young People With Antipsychotic Medications in the United States | Adolescent Medicine | JAMA Psychiatry | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.236.187.155. Please contact the publisher to request reinstatement.
1.
Olfson  M, Blanco  C, Wang  S, Laje  G, Correll  CU.  National trends in the mental health care of children, adolescents, and adults by office-based physicians.  JAMA Psychiatry. 2014;71(1):81-90.PubMedGoogle ScholarCrossref
2.
Findling  RL, Nyilas  M, Fornes  RA,  et al.  Acute treatment of pediatric bipolar I disorder, manic or mixed episode, with aripiprazole: a randomized, double-blind, placebo-controlled study.  J Clin Psychiatry. 2009;70(10):1441-1451.PubMedGoogle ScholarCrossref
3.
Tohen  M, Kryzhanovskaya  L, Carlson  G,  et al.  Olanzapine versus placebo in the treatment of adolescents with bipolar mania.  Am J Psychiatry. 2007;164(10):1547-1556.PubMedGoogle ScholarCrossref
4.
Findling  RL, Robb  A, Nyilas  M,  et al.  A multiple-center, randomized, double-blind, placebo-controlled study of oral aripiprazole for treatment of adolescents with schizophrenia.  Am J Psychiatry. 2008;165(11):1432-1441.PubMedGoogle ScholarCrossref
5.
McCracken  JT, McGough  J, Shah  B,  et al; Research Units on Pediatric Psychopharmacology Autism Network.  Risperidone in children with autism and serious behavioral problems.  N Engl J Med. 2002;347(5):314-321.PubMedGoogle ScholarCrossref
6.
Marcus  RN, Owen  R, Kamen  L,  et al.  A placebo-controlled, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder.  J Am Acad Child Adolesc Psychiatry. 2009;48(11):1110-1119.PubMedGoogle ScholarCrossref
7.
Matone  M, Localio  R, Huang  YS, dosReis  S, Feudtner  C, Rubin  D.  The relationship between mental health diagnosis and treatment with second-generation antipsychotics over time: a national study of US Medicaid-enrolled children.  Health Serv Res. 2012;47(5):1836-1860.PubMedGoogle ScholarCrossref
8.
Olfson  M, Blanco  C, Liu  SM, Wang  S, Correll  CU.  National trends in the office-based treatment of children, adolescents, and adults with antipsychotics.  Arch Gen Psychiatry. 2012;69(12):1247-1256.PubMedGoogle ScholarCrossref
9.
Alexander  GC, Gallagher  SA, Mascola  A, Moloney  RM, Stafford  RS.  Increasing off-label use of antipsychotic medications in the United States, 1995-2008.  Pharmacoepidemiol Drug Saf. 2011;20(2):177-184.PubMedGoogle ScholarCrossref
10.
Tarricone  I, Ferrari Gozzi  B, Serretti  A, Grieco  D, Berardi  D.  Weight gain in antipsychotic-naive patients: a review and meta-analysis.  Psychol Med. 2010;40(2):187-200.PubMedGoogle ScholarCrossref
11.
Correll  CU, Manu  P, Olshanskiy  V, Napolitano  B, Kane  JM, Malhotra  AK.  Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents.  JAMA. 2009;302(16):1765-1773.PubMedGoogle ScholarCrossref
12.
Kreider  AR, Matone  M, Bellonci  C,  et al.  Growth in the concurrent use of antipsychotics with other psychotropic medications in Medicaid-enrolled children.  J Am Acad Child Adolesc Psychiatry. 2014;53(9):960-970.e2.PubMedGoogle ScholarCrossref
13.
De Hert  M, Dobbelaere  M, Sheridan  EM, Cohen  D, Correll  CU.  Metabolic and endocrine adverse effects of second-generation antipsychotics in children and adolescents: a systematic review of randomized, placebo controlled trials and guidelines for clinical practice.  Eur Psychiatry. 2011;26(3):144-158.PubMedGoogle ScholarCrossref
14.
Bartelink  IH, Rademaker  CMA, Schobben  AF, van den Anker  JN.  Guidelines on paediatric dosing on the basis of developmental physiology and pharmacokinetic considerations.  Clin Pharmacokinet. 2006;45(11):1077-1097.PubMedGoogle ScholarCrossref
15.
Costa  LG, Steardo  L, Cuomo  V.  Structural effects and neurofunctional sequelae of developmental exposure to psychotherapeutic drugs: experimental and clinical aspects.  Pharmacol Rev. 2004;56(1):103-147.PubMedGoogle ScholarCrossref
16.
Moran-Gates  T, Grady  C, Shik Park  Y, Baldessarini  RJ, Tarazi  FI.  Effects of risperidone on dopamine receptor subtypes in developing rat brain.  Eur Neuropsychopharmacol. 2007;17(6-7):448-455.PubMedGoogle ScholarCrossref
17.
Choi  YK, Moran-Gates  T, Gardner  MP, Tarazi  FI.  Effects of repeated risperidone exposure on serotonin receptor subtypes in developing rats.  Eur Neuropsychopharmacol. 2010;20(3):187-194.PubMedGoogle ScholarCrossref
18.
Mandell  DJ, Unis  A, Sackett  GP.  Post-drug consequences of chronic atypical antipsychotic drug administration on the ability to adjust behavior based on feedback in young monkeys.  Psychopharmacology (Berl). 2011;215(2):345-352.PubMedGoogle ScholarCrossref
19.
Bardgett  ME, Franks-Henry  JM, Colemire  KR,  et al.  Adult rats treated with risperidone during development are hyperactive.  Exp Clin Psychopharmacol. 2013;21(3):259-267.PubMedGoogle ScholarCrossref
20.
Gleason  MM, Egger  HL, Emslie  GJ,  et al.  Psychopharmacological treatment for very young children: contexts and guidelines.  J Am Acad Child Adolesc Psychiatry. 2007;46(12):1532-1572.PubMedGoogle ScholarCrossref
21.
Crystal  S, Olfson  M, Huang  C, Pincus  H, Gerhard  T.  Broadened use of atypical antipsychotics: safety, effectiveness, and policy challenges.  Health Aff (Millwood). 2009;28(5):w770-w781. doi:10.1377/hlthaff.28.5.w770.PubMedGoogle ScholarCrossref
22.
Castle  L, Aubert  RE, Verbrugge  RR, Khalid  M, Epstein  RS.  Trends in medication treatment for ADHD.  J Atten Disord. 2007;10(4):335-342.PubMedGoogle ScholarCrossref
23.
Penfold  RB, Stewart  C, Hunkeler  EM,  et al.  Use of antipsychotic medications in pediatric populations: what do the data say [published correction appears in Curr Psychiatry Rep. 2014;16(2):432]?  Curr Psychiatry Rep. 2013;15(12):426.PubMedGoogle ScholarCrossref
24.
Vitiello  B, Correll  C, van Zwieten-Boot  B, Zuddas  A, Parellada  M, Arango  C.  Antipsychotics in children and adolescents: increasing use, evidence for efficacy and safety concerns.  Eur Neuropsychopharmacol. 2009;19(9):629-635.PubMedGoogle ScholarCrossref
25.
Correll  CU.  Antipsychotic use in children and adolescents: minimizing adverse effects to maximize outcomes.  J Am Acad Child Adolesc Psychiatry. 2008;47(1):9-20.PubMedGoogle ScholarCrossref
26.
Agency for Healthcare Research and Quality.  MEPS-HC panel design and data collection process.http://meps.ahrq.gov/survey_comp/hc_data_collection.jsp. Accessed January 10, 2015.
27.
Pathak  P, West  D, Martin  BC, Helm  ME, Henderson  C.  Evidence-based use of second-generation antipsychotics in a state Medicaid pediatric population, 2001-2005.  Psychiatr Serv. 2010;61(2):123-129.PubMedGoogle ScholarCrossref
28.
Zito  JM, Safer  DJ, de Jong-van den Berg  LT,  et al.  A three-country comparison of psychotropic medication prevalence in youth.  Child Adolesc Psychiatry Ment Health. 2008;2(1):26.PubMedGoogle ScholarCrossref
29.
Murphy  AL, Gardner  DM, Cooke  C, Kisely  S, Hughes  J, Kutcher  SP.  Prescribing trends of antipsychotics in youth receiving income assistance: results from a retrospective population database study.  BMC Psychiatry. 2013;13:198.PubMedGoogle ScholarCrossref
30.
Moffitt  TE.  Adolescence-limited and life-course–persistent antisocial behavior: a developmental taxonomy.  Psychol Rev. 1993;100(4):674-701.PubMedGoogle ScholarCrossref
31.
Snyder  HN.  Arrest in the United States, 1990-2010. US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. NJC 239423. http://www.bjs.gov/content/pub/pdf/aus9010.pdf. Published October 2012. Accessed January 12, 2015.
32.
Aman  MG, De Smedt  G, Derivan  A, Lyons  B, Findling  RL; Risperidone Disruptive Behavior Study Group.  Double-blind, placebo-controlled study of risperidone for the treatment of disruptive behaviors in children with subaverage intelligence.  Am J Psychiatry. 2002;159(8):1337-1346.PubMedGoogle ScholarCrossref
33.
Findling  RL, Aman  MG, Eerdekens  M, Derivan  A, Lyons  B; Risperidone Disruptive Behavior Study Group.  Long-term, open-label study of risperidone in children with severe disruptive behaviors and below-average IQ.  Am J Psychiatry. 2004;161(4):677-684.PubMedGoogle ScholarCrossref
34.
Monahan  KC, Steinberg  L, Cauffman  E, Mulvey  EP.  Trajectories of antisocial behavior and psychosocial maturity from adolescence to young adulthood.  Dev Psychol. 2009;45(6):1654-1668.PubMedGoogle ScholarCrossref
35.
Steinberg  L.  A social neuroscience perspective on adolescent risk-taking.  Dev Rev. 2008;28(1):78-106.PubMedGoogle ScholarCrossref
36.
Pedersen  CB, Mors  O, Bertelsen  A,  et al.  A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders.  JAMA Psychiatry. 2014;71(5):573-581.PubMedGoogle ScholarCrossref
37.
Kuehner  C.  Gender differences in unipolar depression: an update of epidemiological findings and possible explanations.  Acta Psychiatr Scand. 2003;108(3):163-174.PubMedGoogle ScholarCrossref
38.
Freeman  VG, Rathore  SS, Weinfurt  KP, Schulman  KA, Sulmasy  DP.  Lying for patients: physician deception of third-party payers.  Arch Intern Med. 1999;159(19):2263-2270.PubMedGoogle ScholarCrossref
39.
Anderson  SL, Vande Griend  JP.  Quetiapine for insomnia: a review of the literature.  Am J Health Syst Pharm. 2014;71(5):394-402.PubMedGoogle ScholarCrossref
40.
Jensen  PS, Buitelaar  J, Pandina  GJ, Binder  C, Haas  M.  Management of psychiatric disorders in children and adolescents with atypical antipsychotics: a systematic review of published clinical trials.  Eur Child Adolesc Psychiatry. 2007;16(2):104-120.PubMedGoogle ScholarCrossref
41.
Aman  MG, Bukstein  OG, Gadow  KD,  et al.  What does risperidone add to parent training and stimulant for severe aggression in child attention-deficit/hyperactivity disorder?  J Am Acad Child Adolesc Psychiatry. 2014;53(1):47-60.e1.PubMedGoogle ScholarCrossref
42.
Merikangas  KR, He  JP, Burstein  M,  et al.  Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A).  J Am Acad Child Adolesc Psychiatry. 2010;49(10):980-989.PubMedGoogle ScholarCrossref
43.
Nelson  JC, Papakostas  GI.  Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials.  Am J Psychiatry. 2009;166(9):980-991.PubMedGoogle ScholarCrossref
44.
Maher  AR, Maglione  M, Bagley  S,  et al.  Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis.  JAMA. 2011;306(12):1359-1369.PubMedGoogle ScholarCrossref
45.
Eyberg  SM, Nelson  MM, Boggs  SR.  Evidence-based psychosocial treatments for children and adolescents with disruptive behavior.  J Clin Child Adolesc Psychol. 2008;37(1):215-237.PubMedGoogle ScholarCrossref
46.
David-Ferdon  C, Kaslow  NJ.  Evidence-based psychosocial treatments for child and adolescent depression.  J Clin Child Adolesc Psychol. 2008;37(1):62-104.PubMedGoogle ScholarCrossref
47.
March  J, Silva  S, Petrycki  S,  et al; Treatment for Adolescents With Depression Study (TADS) Team.  Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial.  JAMA. 2004;292(7):807-820.PubMedGoogle ScholarCrossref
48.
Silverman  WK, Pina  AA, Viswesvaran  C.  Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents.  J Clin Child Adolesc Psychol. 2008;37(1):105-130.PubMedGoogle ScholarCrossref
49.
American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity.  Consensus development conference on antipsychotic drugs and obesity and diabetes.  Diabetes Care. 2004;27(2):596-601.PubMedGoogle ScholarCrossref
Original Investigation
September 2015

Treatment of Young People With Antipsychotic Medications in the United States

Author Affiliations
  • 1Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
  • 2Division of Epidemiology, New York State Psychiatric Institute, New York
  • 3School of Management, Yale University, New Haven, Connecticut
  • 4Office of Science Policy, Planning, and Communications, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
JAMA Psychiatry. 2015;72(9):867-874. doi:10.1001/jamapsychiatry.2015.0500
Abstract

Importance  Despite concerns about rising treatment of young people with antipsychotic medications, little is known about trends and patterns of their use in the United States.

Objective  To describe antipsychotic prescription patterns among young people in the United States, focusing on age and sex.

Design, Setting, and Participants  A retrospective descriptive analysis of antipsychotic prescriptions among patients aged 1 to 24 years was performed with data from calendar years 2006 (n = 765 829), 2008 (n = 858 216), and 2010 (n = 851 874), including a subset from calendar year 2009 with service claims data (n = 53 896). Data were retrieved from the IMS LifeLink LRx Longitudinal Prescription database, which includes approximately 60% of all retail pharmacies in the United States. Denominators were adjusted to generalize estimates to the US population.

Main Outcomes and Measures  The percentage of young people filling 1 or more antipsychotic prescriptions during the study year by sex and age group (younger children, 1-6 years; older children, 7-12 years; adolescents, 13-18 years; and young adults, 19-24 years) was calculated. Among young people with antipsychotic use, percentages with specific clinical psychiatric diagnoses and 1 or more antipsychotic prescriptions from a psychiatrist and from a child and adolescent psychiatrist were also determined.

Results  The percentages of young people using antipsychotics in 2006 and 2010, respectively, were 0.14% and 0.11% for younger children, 0.85% and 0.80% for older children, 1.10% and 1.19% for adolescents, and 0.69% and 0.84% for young adults. In 2010, males were more likely than females to use antipsychotics, especially during childhood and adolescence: 0.16% vs 0.06% for younger children, 1.20% vs 0.44% for older children, 1.42% vs 0.95% for adolescents, and 0.88% vs 0.81% for young adults. Among young people treated with antipsychotics in 2010, receiving a prescription from a psychiatrist was less common among younger children (57.9%) than among other age groups (range, 70.4%-77.9%). Approximately 29.3% of younger children treated with antipsychotics in 2010 received 1 or more antipsychotic prescriptions from a child and adolescent psychiatrist. Among young people with claims for mental disorders in 2009 who were treated with antipsychotics, the most common diagnoses were attention-deficit/hyperactivity disorder in younger children (52.5%), older children (60.1%), and adolescents (34.9%) and depression in young adults (34.5%).

Conclusions and Relevance  Antipsychotic use increased from 2006 to 2010 for adolescents and young adults but not for children aged 12 years or younger. Peak antipsychotic use in adolescence, especially among boys, and clinical diagnosis patterns are consistent with management of developmentally limited impulsive and aggressive behaviors rather than psychotic symptoms.

×