Prescribing antipsychotics for children and adolescents
Increasing numbers of children and adolescents are being given antipsychotic drugs in Germany, as Christian Bachmann and colleagues found out in a study published in the current issue of Deutsches Arzteblatt International (Dtsch Arztebl Int 2014; 111(3): 25 - 40). The authors used routine insurance data of the Barmer GEK statutory health insurance company to analyze antipsychotic prescriptions for this age group from 2005 to 2012.
The percentage of children and adolescents receiving a prescription for an antipsychotic drug over the course of one calendar year rose from 0.23% to 0.32%. The rise was most marked among 10- to 14-year-olds (from 0.24% to 0.43%) and 15- to 19-year-olds (from 0.34% to 0.54%). In particular, there was an increase in prescriptions for atypical antipsychotics (from 0.10% to 0.24%). The most commonly prescribed substances were risperidone, pipamperone, quetiapine, and tiapride. These figures for Germany are low in comparison with figures from the USA, but are in the middle range of figures from European countries.
Only a small number of antipsychotic drugs have been approved for use in children and adolescents; in this age group, antipsychotic drugs are often given off label. The authors point out that antipsychotic drugs can cause side effects including extrapyramidal motor symptoms (early and tardive dyskinesia, akathisia), weight gain, and hyperlipidemia. The older approved drugs can also have major adverse effects. Thus, the indication for an antipsychotic drug should be determined by a child and adolescent psychiatrist, or other expert for behavioral disorders in this age group, after careful consideration of the risks and benefits. If this is done, the prescription of an antipsychotic drug can be justifiable, as long as the patient is carefully monitored for the appearance of undesired effects.