Children Are Probably Getting the Right Antipsychotics - Pacific Standard

Children Are Probably Getting the Right Antipsychotics

A study suggests that antipsychotics are being prescribed appropriately for children and adolescents. Follow-up care, however, still needs work.
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(Photo: Sukanto Debnath/Flickr)

(Photo: Sukanto Debnath/Flickr)

Antipsychotics for kids are on the rise, it seems. According to one study, prescriptions for children aged 10 to 19 more than doubled between 2001 and 2010, raising concerns that the drugs were being overused and perhaps misused. That's perhaps doubly true for children on Medicaid, where the rate of antipsychotic prescriptions is around twice that for children covered by private insurance.

So are all these prescriptions a problem? Maybe not, say the authors of a new report. While follow-up care isn't what it should be, most of the drugs seem to be prescribed appropriately.

Fears about overusing antipsychotic drugs stem largely from the fact that they are often prescribed off-label—that is, for illnesses other than the ones they've been designed to treat. There are also concerns about the medications' side effects, which include weight gain and metabolic disorders. Still, those concerns only become a problem if doctors are making serious errors in choosing medications for their patients, or are failing to watch out for potentially dangerous side effects.

While only about 27 percent of the prescriptions were written to treat specific, on-label illnesses such as schizophrenia or bipolar disorder, the researchers found that 92 percent met best-practice guidelines for off-label use.

To investigate, David Rettew, an associate professor of psychiatry and pediatrics at the University of Vermont, and colleagues sent surveys to Vermont doctors who'd prescribed antipsychotic drugs to children under 18. Usually, such surveys are a lousy way to get data—few people return them, and those who do are not likely to be representative of the group being studied—but this one came with a twist. Conducted by Vermont's Medicaid authorities, the survey acted as a kind of prior authorization: Doctors were required to complete the surveys in order to continue prescribing antipsychotics to their patients. As a result, doctors returned about 80 percent of the surveys, one for each patient in their care.

While only about 27 percent of the prescriptions were written to treat specific, on-label illnesses such as schizophrenia or bipolar disorder, the researchers found that 92 percent met best-practice guidelines for off-label use defined by the American Academy of Child and Adolescent Psychiatry.

On the other hand, only about half of patients—57 percent of those treated by psychiatrists and about a third of those treated by non-psychiatrists—abided by the guidelines pertaining to follow-up care, mostly because doctors weren't always checking on side effects. About five in six kids, for example, didn't get proper check-ups on their weight and other potential signs of metabolic disorders.

Despite those concerns, the findings "do not indicate that this class of medication is being used casually or in a 'knee-jerk' manner," the team argues in Pediatrics; for most patients, doctors are using medications appropriately. What deficiencies that do exist may result in part because only around half of those taking an antipsychotic were under the care of the doctor who had originally written the prescription. That suggests that better training, especially for non-psychiatrist pediatricians in charge of maintaining care, "could help ensure that antipsychotic medications are being used most safely and effectively," the researchers write.

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