Antipsychotic Medication Use in Community-based Youth: Trends and Implications for Improving Drug Safety

Objective: This presentation aims to inform a broad public health audience on trends in the use of antipsychotic medications (ATPs) for the treatment of children and adolescents in community-based populations. Methods: Ten year trends (1997-2006), emphasizing atypical ATPs in a mid-Atlantic Method: Antipsychotic use in US children will be presented in terms of the following dimensions: 1) Ten year trends (1997-2006), in prevalence of use of atypical antipsychotics for a mid-Atlantic state Medicaid-insured population, < 20 years of age. Unadjusted rates of use among those with 10-12 months of enrollment in the baseline year (1997) and the final year (2006) and stratified by age group, gender, race/ethnicity, Medicaid-eligibility group and region of residence. Results: Data from a multivariable analysis adjusted for key covariates show a 4-fold increase in use from 1997 to 2006. The findings will be presented in the context of the following developments: a. Growth in information on the risk of serious adverse events e.g. weight gain, gynecomastia, and metabolic syndrome which can lead to cardiac and blood sugar abnormalities not well known as yet in the pediatric population (Calarge et al. 2009; Correll et al. 2009). b. Adverse drug event (ADE) reporting from the FDA database of voluntary reports to the AERS, Adverse Event Reporting System. c. FDA changes in product labeling of atypical antipsychotics with respect to warnings on serious adverse events, e.g. quetiapine combinations. Discussion: Recommendations: i. Need for outcomes in privately insured youth vs. Medicaid-insured youth. ii. Need for written consent of the caregiver after assessing the family stability & caregiver's ability with complex medication regimens iii. Give caregivers simple guides to monitor the benefit(s) and adverse events. iv. Electronic medical records need to require: 1. Baseline health status including standard laboratory plasma levels (SMAC-20) when an antipsychotic is initiated; EKG, if appropriate; weight and height. 2. Baseline functional status and major target symptoms. 3. Regular lab values to assess abnormalities related to known metabolic risks, e.g. glycosylated hemoglobin; liver function tests; etc. 4. Reasons for discontinuation of the medication in terms of: a. Ineffectiveness b. Adverse events that interfered with functioning c. Possible drug interaction d. Refused treatment against medical advice e. Other reasons, e.g. parent preference