Prescribing trends of antipsychotics in youth receiving income assistance: results from a retrospective population database study
Tóm tắt
Prescribing of antipsychotics (AP) to young people has increased in the last decade internationally. We aimed to characterize AP prescribing in a population of low-income youth in Nova Scotia, Canada. We conducted a population database study of AP prescription claims and health services utilization by young people aged 25 years and younger receiving drug benefits through the publicly funded Pharmacare program between October 1, 2000 to September 30, 2007. Four percent (1715/43888) of youth receiving Pharmacare benefits filled AP prescriptions. The use of second generation antipsychotics (SGAs) significantly increased (p < 0.0001) in all age groups except 0-5 year olds, whereas first generation antipsychotic use significantly decreased. Pharmacare beneficiaries aged 21-25 years represented 45.2% of AP users. The majority (66%) of youth filling AP prescriptions had 2 or more psychiatric diagnoses. Most youth (76%) filled prescriptions for only one type of AP during the study period. Psychotic disorders were the most common indication for AP use except with risperidone, in which ADHD was the most likely reason for use. Co-prescribing of psychotropics was prevalent with antidepressants and mood stabilizers prescribed in 42% and 27% of AP users, respectively. General practitioners (GPs) prescribed incident APs most often (72%) followed by psychiatrists (16%). The age- and gender-adjusted rate of death was higher in AP users as compared to the age-matched general population of Nova Scotia. SGA use increased significantly over seven years in a cohort of 0 to 25 years olds receiving Pharmacare benefits. Off-label use of APs was prevalent with ADHD and other non-psychotic disorders being common reasons for AP use. GPs initiated most AP prescriptions. Co-prescribing of other psychotropics, especially antidepressants and mood stabilizers, was prevalent even in younger age strata. This study raises further questions about AP prescribing in those 25 years of age and under, especially given the range of diagnoses and psychotropic co-prescribing.
Tài liệu tham khảo
Aparasu RR, Bhatara V: Antipsychotic prescribing trends among youths, 1997-2002. Psychiatr Serv. 2005, 56 (8): 904-10.1176/appi.ps.56.8.904.
Alessi-Severini S, Biscontri RG, Collins DM, Sareen J, Enns MW: Ten years of antipsychotic prescribing to children: a Canadian population-based study. Can J Psychiatr. 2012, 57 (1): 52-58.
Aparasu RR, Bhatara V: Patterns and determinants of antipsychotic prescribing in children and adolescents, 2003-2004. Curr Med Res Opin. 2007, 23 (1): 49-56. 10.1185/030079906X158075.
Cooper WO, Hickson GB, Fuchs C, Arbogast PG, Ray WA: New users of antipsychotic medications among children enrolled in TennCare. Arch Pediatr Adolesc Med. 2004, 158: 753-759. 10.1001/archpedi.158.8.753.
Cooper WO, Arbogast PG, Ding H, Hickson GB, Fuchs DC, Ray WA: Trends in prescribing of antipsychotic medications for US children. Ambul Pediatr. 2006, 6 (2): 79-83. 10.1016/j.ambp.2005.11.002.
Goodwin R, Gould MS, Blanco C, Olfson M: Prescription of psychotropic medications to youths in office-based practice. Psychiatr Serv. 2001, 52 (8): 1081-1087. 10.1176/appi.ps.52.8.1081.
Khaled LA, Ahmed F, Brogan T, Fearnley J, Graham J, MacLeod S, McCormack J: Prescription medicine use by one million Canadian children. Paedetr Child Health. 2003, 8 (SupplA): 6A-56A.
Patel NC, Sanchez RJ, Johnsrud MT, Crismon ML: Trends in antipsychotic use in a Texas Medicaid population of children and adolescents: 1996 to 2000. J Child Adolesc Psychopharmacol. 2002, 12 (3): 221-229. 10.1089/104454602760386905.
Zito JM, Safer DJ, dosReis S, Gardner JF, Boles M, Lynch F: Trends in the prescribing of psychotropic medications to preschoolers. JAMA. 2000, 283 (8): 1025-1030. 10.1001/jama.283.8.1025.
Zito JM, Safer DJ, dosReis S, Riddle MA: Racial disparity in psychotropic medications prescribed for youths with Medicaid insurance in Maryland. J Am Acad Child Adolesc Psychiatr. 1998, 37 (2): 179-184. 10.1097/00004583-199802000-00010.
Zito JM, Safer DJ, Riddle MA, Johnson RE, Speedie SM, Fox M: Prevalence variations in psychotropic treatment of children. J Child Adolesc Psychopharmacol. 1998, 8 (2): 99-105. 10.1089/cap.1998.8.99.
Vitiello B, Correll C, van Zwieten-Boot B, Zuddas A, Parellada M, Arango C: Antipsychotics in children and adolescents: increasing use, evidence for efficacy and safety concerns. Eur Neuropsychopharmacol. 2009, 19 (9): 629-635. 10.1016/j.euroneuro.2009.04.008.
Schirm E, Tobi H, Zito JM, den Berg LT d J-v: Psychotropic medication in children: a study from the Netherlands. Pediatrics. 2001, 108 (2): E25-10.1542/peds.108.2.e25.
Pringsheim T, Lam D, Patten SB: The pharmacoepidemiology of antipsychotic medications for Canadian children and adolescents: 2005-2009. J Child Adolesc Psychopharmacol. 2011, 21 (6): 537-543. 10.1089/cap.2010.0145.
Patel NC, Crismon ML, Shafer A: Diagnoses and antipsychotic treatment among youths in a public mental health system. Ann Pharmacother. 2006, 40 (2): 205-211. 10.1345/aph.1G203.
Patel NC, Crismon ML, Hoagwood K, Jensen PS: Unanswered questions regarding atypical antipsychotic use in aggressive children and adolescents. J Child Adolesc Psychopharmacol. 2005, 15 (2): 270-284. 10.1089/cap.2005.15.270.
Patel NC, Crismon ML, Hoagwood K, Johnsrud MT, Rascati KL, Wilson JP, Jensen PS: Trends in the use of typical and atypical antipsychotics in children and adolescents. J Am Acad Child Adolesc Psychiatr. 2005, 44 (6): 548-556. 10.1097/01.chi.0000157543.74509.c8.
Pappadopulos E, Jensen PS, Schur SB, MacIntyre JC, Ketner S, Van Orden K, Sverd J, Sardana S, Woodlock D, Schweitzer R, Rube D: "Real world" atypical antipsychotic prescribing practices in public child and adolescent inpatient settings. Schizophr Bull. 2002, 28 (1): 111-121. 10.1093/oxfordjournals.schbul.a006913.
Panagiotopoulos C, Ronsley R, Elbe D, Davidson J, Smith DH: First do no harm: promoting an evidence-based approach to atypical antipsychotic use in children and adolescents. J Can Acad Child Adolesc Psychiatr. 2010, 19 (2): 124-137.
Olfson M, Blanco C, Liu L, Moreno C, Laje G: National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Arch Gen Psychiatr. 2006, 63 (6): 679-685. 10.1001/archpsyc.63.6.679.
Malone RP, Sheikh R, Zito JM: Novel antipsychotic medications in the treatment of children and adolescents. Psychiatr Serv. 1999, 50 (2): 171-174.
Harrison-Woolrych M, Garcia-Quiroga J, Ashton J, Herbison P: Safety and usage of atypical antipsychotic medicines in children: a nationwide prospective cohort study. Drug Saf. 2007, 30 (7): 569-579. 10.2165/00002018-200730070-00002.
Procedures for obtaining access to PHRU data. http://www.phru.dal.ca/services/guidelines.cfm,
WHO: Collaborating Centre for Drug Statistics and Methodology. ATC/DDD Index. 2013, http://www.whocc.no/atc_ddd_index/,
Lawrence D, Jablensky AV, Holman CD, Pinder TJ: Mortality in Western Australian psychiatric patients. Soc Psychiatr Psychiatr Epidemiol. 2000, 35 (8): 341-347. 10.1007/s001270050248.
Gardner DM, Murphy AL, O'Donnell H, Centorrino F, Baldessarini RJ: International consensus study of antipsychotic dosing. Am J Psychiatr. 2010, 167 (6): 686-693. 10.1176/appi.ajp.2009.09060802.
Kutcher S, McLuckie A: Evergreen: A child and youth mental health framework for Canada. Paediatr Child Health. 2011, 16 (7): 388-
Institute of Medicine: Safe and effective medicines for children: pediatric studies conducted under the best pharmaceuticals for children act and the pediatric research equity act. 2012, Washington, DC: The National Academic Press
Patten SB, Waheed W, Bresee L: A review of pharmacoepidemiologic studies of antipsychotic use in children and adolescents. Can J Psychiatr. 2012, 57 (12): 717-721.
Lawrence D, Kisely S, Pais J: The epidemiology of excess mortality in people with mental illness. Can J Psychiatr. 2010, 55 (12): 752-760.
Kisely S: Excess mortality from chronic physical disease in psychiatric patients-the forgotten problem. Can J Psychiatr. 2010, 55 (12): 749-751.
Kisely S, Campbell LA, Wang Y: Treatment of ischaemic heart disease and stroke in individuals with psychosis under universal healthcare. Br J Psychiatr. 2009, 195 (6): 545-550. 10.1192/bjp.bp.109.067082.
Kisely S, Cox M, Campbell LA, Cooke C, Gardner D: An epidemiologic study of psychotropic medication and obesity-related chronic illnesses in older psychiatric patients. Can J Psychiatr. 2009, 54 (4): 269-274.
Kisely S, Guthrie E, Creed F, Tew R: Predictors of mortality and morbidity following admission with chest pain. J R Coll Physicians Lond. 1997, 31 (2): 177-183.
Kisely S, Sadek J, MacKenzie A, Lawrence D, Campbell LA: Excess cancer mortality in psychiatric patients. Can J Psychiatr. 2008, 53 (11): 753-761.
Kisely S, Smith M, Lawrence D, Cox M, Campbell LA, Maaten S: Inequitable access for mentally ill patients to some medically necessary procedures. CMAJ. 2007, 176 (6): 779-784.
Kisely S, Smith M, Lawrence D, Maaten S: Mortality in individuals who have had psychiatric treatment: population-based study in Nova Scotia. Br J Psychiatr. 2005, 187: 552-558. 10.1192/bjp.187.6.552.
Kisely SR: The relationship between admission to hospital with chest pain and psychiatric disorder. Aust N Z J Psychiatr. 1998, 32 (2): 172-179. 10.3109/00048679809062726.
Kisely S, Quek LH, Pais J, Lalloo R, Johnson NW, Lawrence D: Advanced dental disease in people with severe mental illness: systematic review and meta-analysis. Br J Psychiatr. 2011, 199 (3): 187-193. 10.1192/bjp.bp.110.081695.
Mangalore R, Knapp M: Equity in mental health. Epidemiol Psichiatr Soc. 2006, 15 (4): 260-266. 10.1017/S1121189X00002141.
Saxena S, Thornicroft G, Knapp M, Whiteford H: Resources for mental health: scarcity, inequity, and inefficiency. Lancet. 2007, 370 (9590): 878-889. 10.1016/S0140-6736(07)61239-2.
Dewa CS, Goering P: Lessons learned from trends in psychotropic drug expenditures in a canadian province. Psychiatr Serv. 2001, 52 (9): 1245-1247. 10.1176/appi.ps.52.9.1245.
Dewa CS, Remington G, Herrmann N, Fearnley J, Goering P: How much are atypical antipsychotic agents being used, and do they reach the populations who need them? A Canadian experience. Clin Ther. 2002, 24 (9): 1466-1476. 10.1016/S0149-2918(02)80050-9.
Domino ME, Frank RG, Rosenheck R: The Diffusion of New Antipsychotic Medications and Formulary Policy. Schizophr Bull. 2003, 29 (1): 95-104. 10.1093/oxfordjournals.schbul.a006995.
O'Reilly DJ, Goeree RA, Tarride JE, James C, Parfrey PS: The unintended (and costly) effects due to the introduction of an unrestricted reimbursement policy for atypical antipsychotic medications in a Canadian public prescription drug program: 1996/97 to 2005/06. Can J Clin Pharmacol. 2009, 16 (2): e346-e359.
BC Children's Hospital: Provincial Mental Health Metabolic Program. http://www.bcchildrens.ca/Services/ChildYouthMentalHlth/ProgramsAndServices/ProvMHMetabolicProg/default.htm,
Pringsheim T, Panagiotopoulos C, Davidson J, Ho J, CAMESA guideline group: Evidence-based recommendations for monitoring safety of second generation antipsychotics in children and youth. J Can Acad Child Adolesc Psychiatr. 2011, 20 (3): 218-233.
Ferver K, Burton B, Jesilow P: The use of claims data in healthcare research. Open Publ Health J. 2009, 2: 11-24. 10.2174/1874944500902010011.
Katz LY, Au W, Singal D, Brownell M, Roos N, Martens PJ, Chateau D, Enns MW, Kozyrskyj AL, Sareen J: Suicide and suicide attempts in children and adolescents in the child welfare system. CMAJ. 2011, 183 (17): 1977-1981.
U.S. Food and Drug Administration: FDA Approves Risperdal for Two Psychiatric Conditions in Children and Adolescents. 2007, http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108969.htm,
Zito JM, Safer DJ, de Jong-van den Berg LT, Janhsen K, Fegert JM, Gardner JF, Glaeske G, Valluri SC: A three-country comparison of psychotropic medication prevalence in youth. Child Adolesc Psychiatr Ment Health. 2008, 2 (1): 26-10.1186/1753-2000-2-26.
Maheux B, Gilbert A, Haley N, Frappier JY: Adolescent care. Part 2: communication and referral practices of family physicians caring for adolescents with mental health problems. Can Fam Physician. 2006, 52 (11): 1442-1443.
Fleury MJ, Bamvita JM, Farand L, Aube D, Fournier L, Lesage A: GP group profiles and involvement in mental health care. J Eval Clin Pract. 2012, 18 (2): 396-403. 10.1111/j.1365-2753.2010.01597.x.
The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/13/198/prepub