Antipsychotic Use Patterns among Children, Adolescents, and Adults

Antipsychotic medications are being used increasingly to treat adults and children in the United States and are among the most commonly prescribed and costly classes of medications. The FDA has approved the use of antipsychotic medications as primary treatment for adults with schizophrenia and bipolar disorder and as adjunctive treatment for major depressive disorder.

For children and adolescents, antipsychotics are indicated to treat irritability associated with autistic disorder for those 5 to 16 years of age, for tics and vocal utterances of Tourette syndrome and bipolar mania for patients 10 to 17 years of age, and for schizophrenia for patients 13 to 17 years of age.

In office-based practices, the range of mental disorders treated with antipsychotic medications has broadened. The proportion of second-generation antipsychotic medications prescribed for the treatment of schizophrenia has decreased from 51% in 1995-1996 to 24% in 2007-2008. During the same time period, the use of antipsychotic medications to treat anxiety disorders in adults and youths has nearly doubled. Attention-deficit hyperactivity disorder and other disruptive disorders account for 37.8% of antipsychotic use in young people.

Researchers designed a study to compare national trends and patterns in antipsychotic use in office-based medical practices [Arch Gen Psych 2012;69(12):1247-1256].

The main outcome measures were visits with a prescription for antipsychotic medications. The 3 age groups were (1) children, 0-13 years; (2) adolescents, 14-20 years; and (3) adults, ≥21 years.

On a per capita basis, office-based antipsychotic visits increased among all 3 age groups; the increases were more prevalent for adults than for adolescents and were least prevalent for children. During the time period 2005-2009, the estimated number of antipsychotic visits per 100 adults was significantly greater for women compared with men; the reverse was true among children.

Among the 3 age groups, visits with a prescription of antipsychotic medications per 100 persons between 1993-1998 and 2005-2009 increased; among children, the increase was from 0.24 to 1.83, among adolescents, from 0.78 to 3.76, and among adults, from 3.25 to 6.18. The proportion of total visits that included a prescription for antipsychotic medication increased from 0.16% to 1.07% for youths and from 0.88% to 1.73% for adults.

The most common diagnoses in child and adolescent antipsychotic visits were disruptive behavior disorders (63.0% and 33.7%, respectively). Among adults, the most common diagnoses were depression (21.2%) and bipolar disorder (20.2%) in antipsychotic visits.

The most frequently prescribed antipsychotic medications among children were risperidone (42.1%), aripiprazole (28.0%), quetiapine (19.2%), and olanzapine (4.4%). Among adolescents, the proportions were aripiprazole (29.0%), quetiapine (26.8%), risperidone (23.0%), and olanzapine (9.3%). Among adults, the proportions were quetiapine (32.6%), risperidone (16.9%), olanzapine (15.2%), and aripiprazole (13.8%).

“On a population basis, adults make considerably more medical visits with a prescription of antipsychotics than do adolescents or children. Yet antipsychotic treatment has increased especially rapidly among young people, and, recently, antipsychotics have been prescribed in approximately the same proportion of youth and adult visits to psychiatrists.”