1. Home>
2. Specialties>
3. Pediatrics and Adolescent Medicine>
4. Summary and Comment

Increasing Use of Second-Generation Antipsychotics in Children and Adolescents

Office visits by children and adolescents that included prescriptions for antipsychotics increased sixfold in the last decade.

Pediatricians are often in a position to monitor and renew prescriptions for second-generation antipsychotic medications prescribed by psychiatrists. Currently, these medications include clozapine, olanzapine, quetiapine, and risperidone. However, the FDA has not approved their use in children. To examine national trends in outpatient antipsychotic treatment of children and adolescents, researchers used data from an annual survey of a nationally representative sample of visits to office-based physicians.

The estimated number of office visits by children and adolescents (younger than 21) that included antipsychotic medications increased about sixfold, from 201,000 in 1993 to 1,224,000 in 2002. From 2000 to 2002, 92% of visits that involved prescriptions for an antipsychotic included a second-generation medication. The number of such visits was significantly higher for males and non-Hispanic white youth. Most antipsychotic prescriptions (84%) were provided by psychiatrists; 18% of visits to a psychiatrist involved antipsychotic treatment. Psychotherapy was documented in only 36% of visits that included an antipsychotic prescription. The most frequent mental health diagnoses were disruptive behavior disorders (38%), mood disorders (32%), pervasive developmental disorders or mental retardation (17%), and psychotic disorders (14%). Among patients who were prescribed an antipsychotic, one third were simultaneously prescribed an antidepressant and one third were prescribed a mood stabilizer.

Comment: The sixfold increase in antipsychotic prescriptions for children and adolescents in the past decade is a result of the availability of newer, second-generation antipsychotics that are associated with less sedation, fewer extrapyramidal and anticholinergic effects, and a lower risk for tardive dyskinesia. Other contributing factors include a wider range of target behaviors for treatment, declining access and duration of inpatient psychiatric treatment, a scarcity of empirically supported nonpharmacologic treatments, and limited use of psychotherapy.

Second-generation antipsychotics are not without significant side effects, including weight gain, hyperlipidemia, and insulin resistance leading to diabetes mellitus. Adverse metabolic effects of some second-generation antipsychotics may be more severe in children and adolescents than in adults. Recent empirical studies have demonstrated the efficacy and safety of risperidone for treatment of disruptive symptoms in children with autistic spectrum disorder, disruptive behavior disorder, and mental retardation. Their current widespread use calls for more controlled studies of second-generation antipsychotic medications in children and adolescents.

Pediatricians should try to work closely with mental health professionals who prescribe off-label antipsychotic medications and should be cautious about prescribing without ongoing consultation. We can also advocate for these patients by ensuring that every effort has been made to engage the child/adolescent and family in some form of behavioral therapy or psychotherapy. In some cases, this form of advocacy may reduce or eliminate the need for an antipsychotic medication.

— Martin T. Stein, MD

Published in Journal Watch Pediatrics and Adolescent Medicine July 12, 2006

Citation(s):

Olfson M et al. National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Arch Gen Psychiatry 2006 Jun; 63:679-85.

• Original article (Subscription may be required)
• Medline abstract (Free)