Co-occurring psychiatric diagnoses and psychotropic medication use by Medicaid patient younger than 18 diagnosed with Gilles de la Tourette Syndrome

Objective: Profile children and adolescents diagnosed with Gilles de la Tourette's (GTS) in 4 state Medicaid programs, identifying co-occurring psychiatric diagnoses and rates of psychotropic medication use.

Methods: Retrospective, observational design using personal summary and claims data from the Medicaid Analytic Extract files for 1999-2000 in California (CA), Florida (FL), New Jersey (NJ), New York (NY), and Texas (TX), with a minimum of one full year of eligibility.

Results: In this group (N=1342), 54% of identified cases are under 13. More than 4/5 are boys (83%). Compared to others their age, children and adolescents with GTS are much more likely to be white (58% vs. 26%), and less likely to have had a period in foster care during the observation window (10% vs. 17%).

Elevated rates of co-occurring diagnosis are found for several psychiatric conditions, including bipolar disorder (9%), attention deficit disorder (56%), conduct disorder (20%), major depressive disorder (9%), and anxiety disorder (20%). Psychotropic medication use is common, with more than half receiving an antipsychotic (53%), and almost half an antidepressant (48%).

Discussion: Both co-occurring psychiatric diagnosis, and exposure to psychopharmacological therapy are common among children and adolescents with GTS. The predominance of whites may reflect race differences in the basis of eligibility, with more non-whites participation based on economic reasons, as well as possible race differences in case identification and pathways to care. Further research is needed to investigate conformity to optimal care patterns, off-label uses of psychotropics, and unmet need for pharmacological and psychosocial care.