Use of Antipsychotics Doubles for Low-Income Kids

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Use of Antipsychotics Doubles for Low-Income Kids

 

 

 

Source:

http://www.medicinenet.com/script/main/art.asp?articlekey=38262

 

Sources for article below: William O. Cooper, M.D., associate

professor,

pediatrics, Vanderbilt University Medical Center, Nashville, Tenn.;

Melvin

Oatis, M.D., assistant professor, clinical psychiatry, New York

University Child

Study Center, New York City; Aug. 3, 2004, Archives of Pediatric

Adolescent

Medicine

 

 

 

Use of Antipsychotics Doubles for Low-Income Kids

 

By Amanda Gardner

HealthDay Reporter

WEDNESDAY, Aug. 4 (HealthDayNews) -- The use of antipsychotic drugs

among

low-income children in Tennessee nearly doubled between 1996 and 2001,

a new

study finds.

 

The increase, seen largely among children diagnosed with

attention-deficit/hyperactivity disorder (ADHD), conduct disorder and

affective

disorders such as depression, has experts worried that young people

who are not

psychotic are being prescribed antipsychotic drugs for which there is

no data on

safety or effectiveness.

 

" The medicine certainly has hardly been studied at all in kids, " said

Dr.

William Cooper, an associate professor of pediatrics at Vanderbilt

University in

Nashville. His report appears in the Aug. 3 issue of the Archives of

Pediatric

Adolescent Medicine.

 

Newer antipsychotic medications are approved for use in children with

illnesses

such as psychosis or Tourette syndrome. Other than that, the effect of

their use

is largely an unknown, at least in this population, Cooper said.

 

Cooper started noticing an increase in the number of young patients he

was

seeing who were taking newer generation antipsychotics in the late

1990s.

 

This led him to conduct an analysis of children aged 2 through 18 who

were

enrolled in TennCare, Tennessee's program for Medicaid enrollees and

uninsured

individuals. Patient files included demographic information as well as

prescription information. Files on about 300,000 children and

adolescents were

available for each year from 1996 to 2001.

 

The proportion of TennCare children who were started on antipsychotics

nearly

doubled in six years, from 23 per 10,000 children in 1996 to 45 per

10,000

children in 2001. The increases were most dramatic among those aged 6

to 12 (a

93 percent rise) and those aged 13 to 18 (a 116 percent increase). Use

among

preschool children increased 61 percent.

 

The use of the drugs for behavioral problems associated with ADHD and

mood

disorders more than doubled. Teens had a threefold increase in the use

of these

drugs for ADHD and conduct disorder, meaning that nearly one in every

100

adolescents covered under the program was taking antipsychotics for

these

reasons, the study found.

 

Part of the explanation for the increase may have been the

introduction, in the

1990s, of a new generation of antipsychotics that included clozapine,

risperidone, olanzapine, quetiapine fumarate and ziprasidone

hydrochloride,

which may be perceived as safer by some physicians. Older

antipsychotics such as

Haldol had severe neurological side effects and were reserved for

those who

absolutely had to have them.

 

" In the mid-1990s there were some newer antipsychotics which were as

powerful

but didn't have the side effects, so people began to think maybe these

are

safe, " Cooper said. " It turns out you really are trading neurologic

side effects

for other side effects, including obesity, type 2 diabetes and,

rarely, heart

arrhythmia. From preliminary studies, it looks as if those problems

[side

effects] are more pronounced in kids. "

 

Another concern, according to Cooper, is that the newer drugs weren't

designed

for treating problems such as ADHD, although there is some evidence

they may

help with severe disruptive behavior, he added.

 

Dr. Melvin Oatis, an assistant professor of clinical psychiatry at New

York

University Child Study Center in New York City, said he has also

noticed an

increase in the use of these drugs for children and teens who aren't

psychotic.

 

When they are prescribed to a non-psychotic child, " it's because of a

severe

conduct disorder, a child who sets fires, is cruel to cats, skips

school,

someone who is headed towards trouble, " he said. " Those are the kids

that we

would give antipsychotic medication to sooner in the hopes that it is

going to

thwart some of their misbehaviors. "

 

Antipsychotic drugs may also be given to children who are autistic and

in danger

of harming themselves or their caregivers, Oatis said. " Giving them

antipsychotics has been very beneficial in terms of controlling

behavior, " he

said.

 

But, he added, he could not say if the increase he is seeing among his

patients

in New York City is similar in any way to the one Cooper noticed among

his

Tennessee population.

 

Whether the drugs are beneficial or not, to Cooper the point is still

clear. " We

need to study these medications, " he said.

 

In the meantime, he is starting research to see if the same

drug-prescription

patterns can be observed nationally among insured children.

 

 

SOURCES: William O. Cooper, M.D., associate professor, pediatrics,

Vanderbilt

University Medical Center, Nashville, Tenn.; Melvin Oatis, M.D.,

assistant

professor, clinical psychiatry, New York University Child Study

Center, New York

City; Aug. 3, 2004, Archives of Pediatric Adolescent Medicine