Leading Drug Epidemiologist Endorses New Pyschotropic Guidelines For Youth

Main Category: Psychology / Psychiatry
Also Included In: Endocrinology
Article Date: 10 Oct 2009 - 2:00 PDT

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Increased use and promotion of psychotropic drugs to U.S. children and adolescents in the past 20 years has led to a "welcomed" set of new guidelines for clinicians to insure better child safety and reduce the risk of inappropriate prescriptions, according to a professor at the University of Maryland, Baltimore.

Julie M. Zito, PhD, a professor at the university's School of Pharmacy, said that the new "Practice Parameter on the Use of Psychotropic Medication in Children and Adolescents" published in the September 2009 issue of the Journal of the American Academy of Child and Adolescent is "a welcome addition because it presents a more comprehensive framework for medication treatment. Most authoritative opinion has rested largely on evidence for effectiveness and safety from short-term published proprietary clinical trials."

Psychotropic medications act on the central nervous system to alter thinking, emotion or behavior temporarily. But their impact on improved functioning for youth (e.g. advancing academic performance and improving social relationships) are not well established. The purpose of the new parameter is to promote the appropriate and safe use of psychotropic medications in children and adolescents with psychiatric disorders by emphasizing the best practice principles that underlie medication prescribing, according to the journal article.

In a commentary in the October 2009 edition of the Brown University's Child and Adolescent Psychopharmacology monthly newsletter, Zito and Daniel Safer, MD, associate professor, Johns Hopkins University School of Medicine, wrote that scientific evidence for effectiveness and safety is based on "short-term published proprietary clinical trials." Principles in the new parameter "happily" take a wider framework, they wrote, "emphasizing the context of care in terms of psychosocial treatments, family characteristics, and the school environment."

Zito and Safer underscore the parameter's call for caution to ensure that: drug regimens are not too complex for the family environment (e.g., in terms of parent understanding or economic stress); a poor response to the initial medication trial is reassessed; there is a clear rationale for using medication combinations, implying avoidance unless it can be adequately justified and monitored.

However, "After reviewing this thoughtful, noble effort, two looming questions remain: 1) When will we empirically establish the benefit of following such good practices (i.e., research outcomes in population-based cohorts of community-treated youth)and 2) Why not then make this a standard of practice? Why be ambivalent about quality standards?"

Zito has published many studies on the increased use of psychotropic drugs in youth. In a study of healthcare claims data in the year 2000 by patients under the age of 19, Zito and colleagues found that 6.7 percent of American children had been prescribed some form of psychotropic medication, compared to 2.9 percent of Dutch children and 2 percent of German children.

In another study, the team examined records from Texas children with Medicaid coverage, the latest in a series of analyses of state Medicaid records, and found that foster care youth received at least three times more psychotropic drugs than comparable children in poor families. In addition, they found that psychotropic medication combinations are frequently used to treat youth in foster care, a disturbing finding because in many instances, the effectiveness and safety of the pharmaceuticals in these complex combinations have not been established for youth.

Source: University of Maryland Baltimore