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Original Investigation |

Treatment of Young People With Antipsychotic Medications in the United States

Mark Olfson, MD, MPH1,2; Marissa King, PhD3; Michael Schoenbaum, PhD4
[+] Author Affiliations
1Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
2Division of Epidemiology, New York State Psychiatric Institute, New York
3School of Management, Yale University, New Haven, Connecticut
4Office of Science Policy, Planning, and Communications, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
JAMA Psychiatry. 2015;72(9):867-874. doi:10.1001/jamapsychiatry.2015.0500.
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Importance  Despite concerns about rising treatment of young people with antipsychotic medications, little is known about trends and patterns of their use in the United States.

Objective  To describe antipsychotic prescription patterns among young people in the United States, focusing on age and sex.

Design, Setting, and Participants  A retrospective descriptive analysis of antipsychotic prescriptions among patients aged 1 to 24 years was performed with data from calendar years 2006 (n = 765 829), 2008 (n = 858 216), and 2010 (n = 851 874), including a subset from calendar year 2009 with service claims data (n = 53 896). Data were retrieved from the IMS LifeLink LRx Longitudinal Prescription database, which includes approximately 60% of all retail pharmacies in the United States. Denominators were adjusted to generalize estimates to the US population.

Main Outcomes and Measures  The percentage of young people filling 1 or more antipsychotic prescriptions during the study year by sex and age group (younger children, 1-6 years; older children, 7-12 years; adolescents, 13-18 years; and young adults, 19-24 years) was calculated. Among young people with antipsychotic use, percentages with specific clinical psychiatric diagnoses and 1 or more antipsychotic prescriptions from a psychiatrist and from a child and adolescent psychiatrist were also determined.

Results  The percentages of young people using antipsychotics in 2006 and 2010, respectively, were 0.14% and 0.11% for younger children, 0.85% and 0.80% for older children, 1.10% and 1.19% for adolescents, and 0.69% and 0.84% for young adults. In 2010, males were more likely than females to use antipsychotics, especially during childhood and adolescence: 0.16% vs 0.06% for younger children, 1.20% vs 0.44% for older children, 1.42% vs 0.95% for adolescents, and 0.88% vs 0.81% for young adults. Among young people treated with antipsychotics in 2010, receiving a prescription from a psychiatrist was less common among younger children (57.9%) than among other age groups (range, 70.4%-77.9%). Approximately 29.3% of younger children treated with antipsychotics in 2010 received 1 or more antipsychotic prescriptions from a child and adolescent psychiatrist. Among young people with claims for mental disorders in 2009 who were treated with antipsychotics, the most common diagnoses were attention-deficit/hyperactivity disorder in younger children (52.5%), older children (60.1%), and adolescents (34.9%) and depression in young adults (34.5%).

Conclusions and Relevance  Antipsychotic use increased from 2006 to 2010 for adolescents and young adults but not for children aged 12 years or younger. Peak antipsychotic use in adolescence, especially among boys, and clinical diagnosis patterns are consistent with management of developmentally limited impulsive and aggressive behaviors rather than psychotic symptoms.

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Percentage of Male and Female Population With Antipsychotic Medication Use by Sex and Age, United States, 2010
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