National Trends in Child and Adolescent Psychotropic Polypharmacy in Office-Based Practice, 1996-2007

doi:10.1016/j.jaac.2010.07.007

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 49, Issue 10, October 2010, Pages 1001-1010

https://doi.org/10.1016/j.jaac.2010.07.007 Get rights and content

Objective

To examine patterns and recent trends in multiclass psychotropic treatment among youth visits to office-based physicians in the United States.

Method

Annual data from the 1996-2007 National Ambulatory Medical Care Surveys were analyzed to examine patterns and trends in multiclass psychotropic treatment within a nationally representative sample of 3,466 child and adolescent visits to office-based physicians in which a psychotropic medication was prescribed.

Results

There was an increase in the percentage of child visits in which psychotropic medications were prescribed that included at least two psychotropic classes. Across the 12 year period, multiclass psychotropic treatment rose from 14.3% of child psychotropic visits (1996-1999) to 20.2% (2004-2007) (adjusted odds ratio [AOR] = 1.89, 95% confidence interval [CI] = 1.22-2.94, p < .01). Among medical visits in which a current mental disorder was diagnosed, the percentage with multiclass psychotropic treatment increased from 22.2% (1996-1999) to 32.2% (2004-2007) (AOR = 2.23, 95% CI = 1.42-3.52, p < .001). Over time, there were significant increases in multiclass psychotropic visits in which ADHD medications, antidepressants, or antipsychotics were prescribed, and a decrease in those visits in which mood stabilizers were prescribed. There were also specific increases in co-prescription of ADHD medications and antipsychotic medications (AOR = 6.22, 95% CI = 2.82-13.70, p < .001) and co-prescription of antidepressant and antipsychotic medications (AOR = 5.77, 95% CI = 2.88-11.60, p < .001).

Conclusions

Although little is known about the safety and efficacy of regimens that involve concomitant use of two or more psychotropic agents for children and adolescents, multiclass psychotropic pharmacy is becoming increasingly common in outpatient practice.

Section snippets

Sample

Data were drawn from 12 consecutive years of the US National Ambulatory Medical Care Survey (NAMCS; http://www.cdc.gov/nchs/ahcd/about_ahcd.htm) from 1996 to 2007. NAMCS is a multistage probability survey of visits to office-based physicians of all medical specialties engaged primarily in direct patient care. The survey response rate varied from 62.9% to 77.1% (median = 67.7%). A systematic random sample of visits to each physician was drawn during a randomly selected 1-week period (N =

Overall Patterns and Clinical Correlates of Child Psychotropic Treatment

Between 1996 and 2007, 8.8% (N = 3,466) of 27,979 youth visits to US office-based physicians were associated with prescription of a psychotropic medication from the five classes described above. A majority of these psychotropic visits (70.7%) were associated with a mental disorder diagnosis. Among psychotropic visits, the most common current diagnostic category carried was disruptive behavior disorders, which included ADHD (49.2%), followed by mood disorders (21.5%), anxiety disorders (5.6%),

Discussion

The findings of this study should be interpreted in the context of several limitations. First, despite adjustment for several visit and patient characteristics, including diagnosis, insurance, and physician speciality, we cannot exclude the possibility that the trends reflect residual confounding due to unmeasured differences among patient groups across survey years. Second, it is also not possible to determine previous clinical response to single-class psychotropic regimens or measure the

References (67)

R.L. Findling et al.
A double-blind pilot study of risperidone in the treatment of conduct disorder
J Am Acad Child Adolesc Psychiatry
(2000)
K.D. Wagner et al.
A double-blind, randomized, placebo-controlled trial of divalproex extended-release in the treatment of bipolar disorder in children and adolescents
J Am Acad Child Adolesc Psychiatry
(2009)
M. Olfson et al.
National trends in the use of psychotropic medications by children
J Am Acad Child Adolesc Psychiatry
(2002)
D.J. Feeney et al.
Risperidone and tardive dyskinesia
J Am Acad Child Adolesc Psychiatry
(1996)
G.A. Carlson et al.
The effects of methylphenidate and lithium on attention and activity level
J Am Acad Child Adolesc Psychiatry
(1992)
J. Gonzalez-Heydrich et al.
Retrospective study of hepatic enzyme elevations in children treated with olanzapine, divalproex, and their combination
J Am Acad Child Adolesc Psychiatry
(2003)
V. Kafantaris et al.
Adjunctive antipsychotic treatment of adolescents with bipolar psychosis
J Am Acad Child Adolesc Psychiatry
(2001)
R.L. Findling et al.
Combination lithium and divalproex sodium in pediatric bipolar symptom restabilization
J Am Acad Child Adolesc Psychiatry
(2006)
E.J. Costello et al.
The developmental epidemiology of anxiety disorders: phenomenology, prevalence, and comorbidity
Child Adolesc Psychiatr Clin North Am
(2005)
D.A.G. Drabick et al.
Source-specific oppositional defiant disorder: comorbidity and risk factors in referred elementary schoolboys
J Am Acad Child Adolesc Psychiatry
(2007)

J.L. Goren et al.

When is antipsychotic polypharmacy supported by research evidence?Implications for QI

Jt Comm J Qual Patient Saf

(2008)

Practice parameter on the use of psychotropic medication in children and adolescents

J Am Acad Child Adolesc Psychiatry

(2009)

J.M. Swanson et al.

Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment

J Am Acad Child Adolesc Psychiatry

(2002)

J.A. Bridge et al.

Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials

JAMA

(2007)

Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) randomized controlled trial

JAMA

(2004)

J.T. Walkup et al.

Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety

N Eng J Med

(2008)

L. Sikich et al.

Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizoaffective disorder: findings from the Treatment of Early-Onset Schizophrenia Spectrum disorders (TEOSS) study

Am J Psychiatry

(2008)

R.L. Findling et al.

A multiple-center, randomized, double-blind, placebo-controlled study of oral aripiprazole for treatment of adolescents with schizophrenia

Am J Psychiatry

(2008)

M.N. Pavuluri et al.

Effectiveness of lamotrigine in maintaining symptom control in pediatric bipolar disorder

J Child Adolesc Psychopharmacol

(2009)

K.D. Wagner et al.

A double-blind, randomized, placebo-controlled trial of oxcarbazepine in the treatment of bipolar disorder in children and adolescents

Am J Psychiatry

(2006)

C.U. Correll et al.

Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents

JAMA

(2009)

M. Olfson et al.

National trends in the outpatient treatment of children and adolescents with antipsychotic drugs

Arch Gen Psychiatry

(2006)

M. Olfson et al.

National trends in the treatment of attention deficit hyperactivity disorder

Am J Psychiatry

(2003)

J.M. Zito et al.

Psychotropic practice patterns for youth: a 10-year perspective

Arch Pediatr Adolesc Med

(2003)

J.M. Zito et al.

Trends in the prescribing of psychotropic medications to preschoolers

JAMA

(2000)

C. Moreno et al.

National trends in the outpatient diagnosis and treatment of bipolar disorder in youth

Arch Gen Psychiatry

(2007)

M. Olfson et al.

Outpatient treatment of child and adolescent depression in the United States

Arch Gen Psychiatry

(2003)

A.K. George et al.

Acute myocardial infarction in a young male on methyphenidate, bupropion, and erythromycin

J Child Adolesc Psychopharmacol

(2005)

S. Jaworowski et al.

Concomitant use of atomoxetine and OROS methylphenidate in a 10-year-old child suffering from attention-deficit/hyperactivity disorder with comorbid bipolar disorder and Tourette syndrome

J Child Adolesc Psychopharmacol

(2006)

M. Schertz et al.

Seizures induced by the combination treatment of methylphenidate and sertraline

J Child Adolesc Psychopharmacol

(2006)

F.N. Emiroglu et al.

Adjunctive olanzapine treatment in bipolar adolescents responding insufficiently to mood stabilizersFour case reports

Eur Child Adolesc Psychiatry

(2006)

S. Pathak et al.

Adjunctive quetiapine for treatment-resistent adolescent major depressive disorder: a case series

J Child Adolesc Psychopharmacol

(2005)

W.R. Marchand et al.

Quetiapine adjunctive and monotherapy for pediatric bipolar disorder: a retrospective chart review

J Child Adolesc Psychopharmacol

(2004)

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: This work was supported by AHRQU18 HS016097 and NIHT32 MH016434.

: The authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

: Disclosure: Dr. Olfson, in the past 5 years, has received investigator initiated grants from AstraZeneca, Bristol-Myers Squibb, and Eli Lilly and Co. He has served on the speakers' bureau for Janssen Pharmaceutica, and as a consultant to Pfizer, AstraZeneca, Eli Lilly and Co., and Bristol-Myers Squibb. Dr. Mojtabai has received research funding and consulting fees from Bristol-Myers Squibb. Dr. Comer reports no biomedical financial interests or potential conflicts of interest.

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New researchNational Trends in Child and Adolescent Psychotropic Polypharmacy in Office-Based Practice, 1996-2007

Objective

Method

Results

Conclusions

Section snippets

Sample

Overall Patterns and Clinical Correlates of Child Psychotropic Treatment

Discussion

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Child Adolesc Psychiatr Clin North Am

J Am Acad Child Adolesc Psychiatry

Jt Comm J Qual Patient Saf

Practice parameter on the use of psychotropic medication in children and adolescents

J Am Acad Child Adolesc Psychiatry

Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment

J Am Acad Child Adolesc Psychiatry

Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials

JAMA

Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) randomized controlled trial

JAMA

Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety

N Eng J Med

Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizoaffective disorder: findings from the Treatment of Early-Onset Schizophrenia Spectrum disorders (TEOSS) study

Am J Psychiatry

A multiple-center, randomized, double-blind, placebo-controlled study of oral aripiprazole for treatment of adolescents with schizophrenia

Am J Psychiatry

Effectiveness of lamotrigine in maintaining symptom control in pediatric bipolar disorder

J Child Adolesc Psychopharmacol

A double-blind, randomized, placebo-controlled trial of oxcarbazepine in the treatment of bipolar disorder in children and adolescents

Am J Psychiatry

Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents

JAMA

National trends in the outpatient treatment of children and adolescents with antipsychotic drugs

Arch Gen Psychiatry

National trends in the treatment of attention deficit hyperactivity disorder

Am J Psychiatry

Psychotropic practice patterns for youth: a 10-year perspective

Arch Pediatr Adolesc Med

Trends in the prescribing of psychotropic medications to preschoolers

JAMA

National trends in the outpatient diagnosis and treatment of bipolar disorder in youth

Arch Gen Psychiatry

Outpatient treatment of child and adolescent depression in the United States

Arch Gen Psychiatry

Acute myocardial infarction in a young male on methyphenidate, bupropion, and erythromycin

J Child Adolesc Psychopharmacol

Concomitant use of atomoxetine and OROS methylphenidate in a 10-year-old child suffering from attention-deficit/hyperactivity disorder with comorbid bipolar disorder and Tourette syndrome

J Child Adolesc Psychopharmacol

Seizures induced by the combination treatment of methylphenidate and sertraline

J Child Adolesc Psychopharmacol

Adjunctive olanzapine treatment in bipolar adolescents responding insufficiently to mood stabilizersFour case reports

Eur Child Adolesc Psychiatry

Adjunctive quetiapine for treatment-resistent adolescent major depressive disorder: a case series

J Child Adolesc Psychopharmacol

Quetiapine adjunctive and monotherapy for pediatric bipolar disorder: a retrospective chart review

J Child Adolesc Psychopharmacol

New research
National Trends in Child and Adolescent Psychotropic Polypharmacy in Office-Based Practice, 1996-2007