Clinicians are following best practice guidelines only half of the time when they are giving antipsychotic medications to children, according to a study in Vermont published in Pediatrics. And the prescriptions were for FDA-approved indications for the drugs only one-fourth of the time.
The University of Vermont researchers investigated all cases of antipsychotic medication prescription for Medicaid-insured children in Vermont in half of 2012, and got an 80% response to their survey from clinicians.
“Overall, the clinical indication for an antipsychotic prescription followed best practice guidelines 91.7% of the time, with overall best practice guidelines followed at a rate of 50.1%,” they wrote. “An FDA indication was followed in 27.2% of cases.”
They stated that the medications “were typically used only after other pharmacologic and nonpharmacologic treatments were ineffective,” but then noted that “previous treatment with cognitive-behavioral therapy was uncommon (15.5%).” Many physicians were diverting from best practices by not regularly monitoring the impacts of the drugs on children’s metabolisms, blood glucose and cholesterol.
“Part of our concern is that these medicines may be getting pulled out too early in the treatment planning for things like oppositional behavior, ahead of things like behavioral therapy that could be tried first,” the lead author said on PsychCentral.
Antipsychotics For Poor Kids Are Booming, It’s Time To Look At Prescriber Decision-Making (Science 2.0, March 2, 2015)
Why Are More Kids on Antipsychotics? (PsychCentral, March 3, 2015)
Rettew, David C., Jeanne Greenblatt, Jody Kamon, Diane Neal, Valerie Harder, Richard Wasserman, Patricia Berry, Charles D. MacLean, Nancy Hogue, and William McMains. “Antipsychotic Medication Prescribing in Children Enrolled in Medicaid.” Pediatrics, March 2, 2015, peds.2014–2260. doi:10.1542/peds.2014-2260. (Abstract)