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Antipsychotic Prescribing in Children: What We Know—What We Need to Know

(PSYCHIATRIC TIMES) -- A pair of recent research articles has cast the public spotlight on treating children and adolescents with antipsychotic medications.1,2 In the first report, a large and broadly representative group of child and adolescent patients, all naive to antipsychotic medications, was followed for approximately 10 weeks after initiating treatment with olanzapine, risperidone, quetiapine, or aripiprazole. The average weight increase ranged from 18.7 pounds (olanzapine) to 9.7 pounds (aripiprazole).3 In the second report, Medicaid-insured youth were found to be approximately 4 times as likely as privately insured youth to fill prescriptions for antipsychotic medications. Only a minority of the privately-insured (32.6%) and Medicaid-insured (26.9%) youth had been diagnosed with schizophrenia, bipolar disorder, or a pervasive developmental disorder.4

The prospect of large numbers of youth receiving potentially weight-inducing antipsychotic medications for clinical diagnoses that have only scant empirical support of clinical efficacy understandably raises critical concern. How often do the known cardiometabolic risks outweigh uncertain clinical benefits? This question becomes especially pointed when it involves low income and minority children—vulnerable groups already at high risk for obesity and its metabolic complications. The new findings are likely to fuel fresh concerns over drug safety and raise new worries over indiscriminate antipsychotic medication use in young people. If taken out of context, the findings could tarnish the image of child psychiatric services and further restrict appropriate mental health seeking behavior by concerned parents for their children. Before jumping to conclusions, however, it is important to consider what we know and what we do not know about antipsychotic prescribing to young people.

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