Hostname: page-component-7479d7b7d-qs9v7 Total loading time: 0 Render date: 2024-07-10T17:43:28.652Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychotropic prescribing patterns among adolescents in Northern Ireland presenting with psychotic symptoms during a 5-year period

Published online by Cambridge University Press:  10 April 2015

G. Woods ,
C. Shannon ,
G. Davidson ,
K. Hoy ,
D. Lewis ,
L. Tumelty  and
C. Mulholland
G. Woods*
Affiliation:
Ards Community Hospital, Church Street, Newtownards, BT23 4AS, United Kingdom
C. Shannon
Affiliation:
Ards Community Hospital, Church Street, Newtownards, BT23 4AS, United Kingdom
G. Davidson
Affiliation:
Ards Community Hospital, Church Street, Newtownards, BT23 4AS, United Kingdom
K. Hoy
Affiliation:
Ards Community Hospital, Church Street, Newtownards, BT23 4AS, United Kingdom
D. Lewis
Affiliation:
Ards Community Hospital, Church Street, Newtownards, BT23 4AS, United Kingdom
L. Tumelty
Affiliation:
Ards Community Hospital, Church Street, Newtownards, BT23 4AS, United Kingdom
C. Mulholland
Affiliation:
Ards Community Hospital, Church Street, Newtownards, BT23 4AS, United Kingdom
*
*Address for correspondence: Dr G. Woods, Consultant Psychiatrist, Ards Community Hospital, Church Street, Newtownards, BT23 4AS, United Kingdom. (Email: gary.woods@setrust.hscni.net)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To report new prescriptions of psychotropic medications among adolescents presenting with new onset psychotic symptoms during a 5-year period.

Methods

The Northern Ireland Early Onset Psychosis Study is a naturalistic longitudinal observational study of patients with an early onset first psychotic episode. All patients aged <18 years presenting to specialist mental health services across Northern Ireland with new onset psychotic symptoms between 2001 and 2006 were recruited (n=113). Clinical case notes were analysed retrospectively for details of subsequent treatment with psychotropic medications.

Results

A total of 100 patients (88.5%) were prescribed some form of psychotropic medication. Over three-quarters of patients received an antipsychotic as their first medication. Risperidone (45.8%), olanzapine (24.0%) and chlorpromazine (12.5%) were the most commonly prescribed first-line antipsychotic medications. Of a total of 160 antipsychotic prescriptions, 81 (50.6%) were off-label. Prescriptions were most likely to have been deemed off-label owing to medications not being licensed in under-18s (71.6% of off-label prescriptions) but other reasons were medications being used outside licensed age ranges (23.5%) and outside licensed indications (4.9%).

Conclusions

This is the first study examining psychotropic prescribing patterns in a complete sample of all children and adolescents presenting with early onset psychotic episodes in a single geographical area. The observation of risperidone as the most commonly prescribed antipsychotic was in keeping with previous studies in child and adolescent populations. Rates of off-label prescribing were lower than previously observed although our study was the first to investigate off-label prescribing solely in children and adolescents presenting with psychotic symptoms.

Keywords

Adolescentsantipsychoticschildrenoff-labelpsychosispsychotropics
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 33 , Issue 1 , March 2016 , pp. 13 - 20
Copyright
© College of Psychiatrists of Ireland 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aparasu, RR, Bhatara, V (2005). Antipsychotic prescribing trends among youths, 1997–2002. Psychiatric Services 56, 904.Google Scholar
Aparasu, RR, Bhatara, V (2007). Patterns and determinants of antipsychotic prescribing in children and adolescents, 2003-2004. Current Medical Research and Opinion 23, 49–56.Google Scholar
Baldwin, D, Kosky, N (2007). Off-label prescribing in psychiatric practice. Advances in Psychiatric Treatment 13, 414–422.Google Scholar
Barrett, SL, Mulholland, CC, Cooper, SJ, Rushe, TM (2009). Patterns of neurocognitive impairment in first-episode bipolar disorder and schizophrenia. British Journal of Psychiatry 195, 67–72.Google Scholar
Castro-Fornieles, J, Parellada, M, Soutullo, CA, Baeza, I, Gonzalez-Pinto, A, Graell, M, Paya, B, Moreno, D, de la Serna, E, Arango, C (2008). Antipsychotic treatment in child and adolescent first-episode psychosis: a longitudinal naturalistic approach. Journal of Child and Adolescent Psychopharmacology 18, 327–336.Google Scholar
Cooper, WO, Arbogast, PG, Ding, H, Hickson, GB, Fuchs, DC, Ray, WA (2006). Trends in prescribing of antipsychotic medication for US children. Ambulatory Pediatrics 6, 79–83.Google Scholar
Cooper, WO, Hickson, GB, Fuchs, C, Arbogast, PG, Ray, WA (2004). New users of antipsychotic medications among children enrolled in TennCare. Archives of Pediatrics & Adolescent Medicine 158, 753–759.Google Scholar
Doerry, UA, Kent, L (2003). Prescribing practices of community child and adolescent psychiatrists. Psychiatric Bulletin 27, 407–410.Google Scholar
Duff, G (2003). Safety of seroxat (paroxetine) in children and adolescents under 18 years- contraindication in the treatment of depressive illness (http://www.mhra.gov.uk/home/groups/pl-p/documents/websiteresources/con019507.pdf). Accessed 22 April 2012.Google Scholar
Hafner, H, Maurer, K, Loffler, W, Fatkenheuer, B, An Der Heiden, W, Riecher-Rossler, A, Behrens, S, Gattaz, WF (1994). The epidemiology of early schizophrenia. Influence of age and gender on onset and early course. The British Journal of Psychiatry. Supplement 23, 29–38.CrossRefGoogle Scholar
Harrison, JL, Cluxton-Keller, F, Gross, D (2012). Antipsychotic medication prescribing trends in children and adolescents. Journal of Pediatric Health Care 26, 139–145.Google Scholar
Haw, C, Stubbs, J (2010). Off-label psychotropic prescribing for young persons in medium security. Journal of Psychopharmacology 24, 1491–1498.Google Scholar
IBM Corp (2010). IBM SPSS Statistics for Macintosh, Version 19.0. Armonk. NY: IBM Corp. Google Scholar
National Institute for Health and Care Excellence (2002 a). Guidance on the Use of Newer (Atypical) Antipsychotic Drugs for the Treatment of Schizophrenia. TA43. National Institute for Health and Care Excellence: London.Google Scholar
National Institute for Health and Care Excellence (2002 b). Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. CG1. National Institute for Health and Care Excellence: London.Google Scholar
Noguera, A, Ballesta, P, Baeza, I, Arango, C, de la Serna, E, Gonzalez-Pinto, A, Parellada, M, Graell, M, Moreno, C, Otero, S, Castro-Fornieles, J (2013). Twenty-four months of antipsychotic treatment in children and adolescents with first psychotic episode: discontinuation and tolerability. Journal of Clinical Psychopharmacology 33, 463–471.Google Scholar
Olfson, M, Blanco, C, Liu, L, Moreno, C, Laje, G (2006). National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Archives of General Psychiatry 63, 679–685.CrossRefGoogle ScholarPubMed
Otasowie, J, Duffy, R, Freeman, J, Hollis, C (2010). Antipsychotic prescribing practice among child psychiatrists and community paediatricians. The Psychiatrist 34, 126–129.Google Scholar
Paediatric Formulary Committee (2007). British National Formulary for Children 2007. British Medical Association, The Royal Pharmaceutical Society of Great Britain, The Royal College of Paediatrics and Child Health, and The Neonatal and Paediatric Pharmacists Group: London.Google Scholar
Pappadopulos, E, Jensen, PS, Schur, SB, MacIntyre, JC, Ketner, S, Van Orden, K (2002). ‘Real world’ atypical antipsychotic prescribing practices in public child and adolescent inpatient settings. Schizophrenia Bulletin 28, 111–121.Google Scholar
Pogge, DL, Singer, MB, Harvey, PD (2005). Rates and predictors of adherence with atypical antipsychotic medication: a follow-up study of adolescent inpatients. Journal of Child and Adolescent Psychopharmacology 15, 901–912.Google Scholar
Rani, F, Murray, ML, Byrne, PJ, Wong, ICK (2008). Epidemiologic features of antipsychotic prescribing to children and adolescents in primary care in the United Kingdom. Pediatrics 121, 1002–1009.Google Scholar
Shireman, TI, Olson, BM, Dewan, NA (2002). Patterns of antidepressant use among children and adolescents. Psychiatric Services 53, 1444–1450.CrossRefGoogle ScholarPubMed
Sivaprasad, L, Hassan, T, Handy, S (2006). Survey of atypical antipsychotic use by child and adolescent psychiatrists. Child and Adolescent Mental Health 11, 164–167.Google Scholar
Stigler, KA, Potenza, MN, Posey, DJ, McDougle, CJ (2004). Weight gain associated with atypical antipsychotic use in children and adolescents: prevalence, clinical relevance and management. Paediatric Drugs 6, 33–44.CrossRefGoogle ScholarPubMed
Thomas, CR, Holzer, CE (2006). The continuing shortage of child and adolescent psychiatrists. Journal of the American Academy of Child Adolescent Psychiatry 45, 1023–1031.Google Scholar
Turkington, A, Mulholland, CC, Rushe, TM, Anderson, R, McCaul, R, Barrett, SL, Barr, RS, Cooper, SJ (2009). Impact of persistent substance misuse on 1-year outcome in first-episode psychosis. British Journal of Psychiatry 195, 242–248.Google Scholar
Verdoux, H, Tournier, M, Begaud, B (2010). Antipsychotic prescribing trends: a review of pharmaco-epidemiological studies. Acta Psychiatrica Scandinavica 121, 4–10.Google Scholar
Weller, IVD, Ashby, D, Brook, R, Chambers, MGA, Chick, JD, Drummond, C, Ebmeier, KP, Gunnell, DJ, Hawking, H, Mukaetova-Ladinska, E, O’Tierney, E, Taylor, RJ, York, A Zwi, M (2004). Report of the CSM expert working group in the safety of selective serotonin reuptake inhibitor antidepressants (http://www.mhra.gov.uk/home/groups/pl-p/documents/drugsafetymessage/con019472.pdf). Accessed 22 April 2012.Google Scholar
Whittington, CJ, Kendall, T, Fonaghy, P, Cottrell, D, Cotgrove, A, Boddington, E (2004). Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet 363, 1341–1345.Google Scholar