Psychotherapeutic Medication Prevalence in Medicaid-insured Preschoolers

Objective: To update knowledge of the prevalence of use of psychotherapeutic medications in preschoolers with Medicaid insurance as requested by the Best Pharmaceuticals for Children Act of 2002 (BPCA). Methods: Prescription, enrollment and outpatient visit data from 7 state Medicaid programs (CMS produced MAX administrative claims files) were used to identify 274,518 youths continuously enrolled in 2001 and aged 2-4 on January 1, 2001. Annual prevalence of use was defined as one or more dispensed prescriptions for a psychotherapeutic medication and adjusted for anticonvulsant and anxiolytic/sedative/hypnotic use according to ICD-9 diagnostic groupings. Seven classes of psychotherapeutic drugs were included in the analysis and subclasses were made for 5 of them: stimulants (methylphenidate, amphetamine); antipsychotics (conventional vs. atypical); antidepressants (SSRI, TCA, and other); anxiolytic/sedative/hypnotics (ASH) (clonazepam/diazepam; other benzodiazepines; non-benzodiazepine ASH and hydroxyzine); anticonvulsants (mood stabilizers; other), lithium and alpha-agonists. Only anticonvulsant users with a psychiatric diagnosis were included in the estimate of psychotherapeutic medication prevalence and ASH use was similarly adjusted. Unadjusted psychotherapeutic prevalence and the 95% confidence intervals were determined. We fit a generalized linear model with a logarithmic link function and a binomial error distribution to estimate prevalence ratios and to adjust for covariates (age, race, and gender). Results: 2.30% (CI=2.24, 2.36) of preschoolers received one or more dispensings for a psychotherapeutic medication in 2001, approximately doubling the usage since comparable youth from 2 state Medicaid programs were studied in 1995. Boys were 2.4 times more likely than girls to receive psychotherapeutic medication. Whites were 4 times more likely than Hispanics and twice as likely as Blacks to receive medication for psychiatric or behavioral conditions. Since the mid-1990s, usage increased especially for atypical antipsychotics and antidepressants. The prominent use of anticonvulsants (78.8%) and anxiolytic/sedative/hypnotic drugs (91.4%) in those with no psychiatric diagnosis but with other medical diagnoses shows that much use therein reflects treatment for seizures rather than mood stabilization and for minor medical conditions rather than psychiatric disorders. The influence of chronic medical conditions on psychotherapeutic drug prevalence will also be presented. Conclusions: Preschool psychotherapeutic medication use increased across ages 2-4 for stimulants, antipsychotics, and antidepressants reflecting use for psychiatric/behavioral disorders. However, the use of anxiolytic/sedative/hypnotics and anticonvulsants was more stable across these years suggesting medical usage. Additional research to assess benefits and risks of psychotherapeutic drugs is needed, particularly when such usage is off-label for both psychiatric and non-psychiatric conditions.