Among Teens, Antipsychotics May Be Too Common

Antipsychotic drugs regularly prescribed to young patients without psychotic disorders

(RxWiki News) Mental illness consists of an array of complex and hard-to-pin-down disorders, but avoiding misdiagnosis can be crucial to treating it properly.

A new study found that many young patients with conditions like attention deficit disorders or anxiety were prescribed antipsychotic medications not specifically approved to treat these conditions.

“The findings suggest to me that greater access is needed for child and adolescent psychiatric services as well as psychosocial services for young people who are struggling with disruptive behaviors,” said lead study author Mark Olfson, MD, of Columbia University in New York, in an interview with dailyRx News.

Psychosis is a mental disorder characterized by a disconnection from reality.

Dr. Olfson and team found that fewer prescriptions for antipsychotic drugs were written for patients age 12 and under — but more were written for teenage and young adult patients. Many of these prescriptions were also not written by psychiatrists and few children received psychiatric help in the form of counseling or other services.

As a result, many of these children were not diagnosed with a particular psychiatric condition, although they were given drugs meant to help with mental disorders, according to Dr. Olfson and team.

Dr. Olfson and team found that these drugs were most often prescribed to adolescent boys, often for disruptive behavior or acting out — behaviors which may be caused by disorders like attention deficit hyperactivity disorder rather than by true psychosis.

While antipsychotics may help with the aggression that accompanies many conditions, this is not how they were approved to be used.

Dr. Olfson and team pointed out that the danger of antipsychotic drugs for young patients is that they can cause brain changes, weight gain or high fat levels in the body.

These researchers looked at antipsychotic drugs given to young patients in 2006, 2008 and 2010. They used a prescription database that included about 60 percent of all retail pharmacies in the US.

In 2006, about 0.14 percent of these prescriptions were used at least once for children aged 1 to 6. This number went down to 0.11 percent in 2012. For children aged 7 to 12, use also went down from 0.85 percent in 2006 to 0.80 percent in 2012.

However, use went up from 1.10 percent in 2006 to 1.19 percent in 2012 for teens aged 13 to 18. It also went up from 0.69 percent to 0.84 percent for young adults aged 19 to 24.

In an editorial about this study, Christoph U. Correll, MD, of North Shore-LIJ Health System in New York, and Joseph C. Blader, PhD, of the University of Texas Health Science Center at San Antonio, wrote that while psychiatrists should be consulted whenever possible, doctors are often faced with families in crisis and usually do the best they can under those conditions.

"The majority of youth receiving antipsychotics did not have a mental disorder diagnosis, 39 percent of children and 39 percent of adolescents were not prescribed the antipsychotic by a child and adolescent psychiatry specialist, and less than 25 percent received a psychotherapeutic intervention," Dr. Correll told dailyRx News, in an interview. "Families should ask if an antipsychotic prescription is necessary and what lower-risk alternatives exist."

The study and editorial were published July 1 in the journal JAMA Psychiatry.

The National Institutes of Health, Yale University and Columbia University funded this research.

Dr. Correll disclosed past funding from many pharmaceutical companies, such as Pfizer and Takeda.

Review Date: 
June 30, 2015