Antipsychotic use in children and adolescents from 1996 to 2001: epidemiology, prescribing practices, and relationships with service utilization

The purpose of this study was to examine prevalence rates of antipsychotic use in children and adolescents from 1996 to 2001 in three state Medicaid programs and one private managed care organization; prescriber types and diagnoses associated with antipsychotic prescribing; and, trends in service utilization of youths receiving antipsychotic treatment. Prescription claims were used to evaluate total, age-specific, and genderspecific prevalence of antipsychotic use. Prescription claims from the Texas Medicaid system were used to examine prescriber types, and data from the Texas Department of Mental Health and Mental Retardation from 1998 to 2001 were used to examine diagnoses and service utilization of children and adolescents receiving antipsychotic treatment. From 1996 to 2001, the prevalence of total antipsychotic use increased in each insurance program (Ohio Medicaid: 4.7 to 14.3 per 1,000; Texas Medicaid: 6.3 to 15.5; California Medi-Cal: 4.5 to 6.9; and, Managed Care Organization: 1.5 to 3.4). The prevalence of atypical antipsychotic use dramatically increased (Ohio Medicaid: 1.4 to 13.1 per 1,000; Texas Medicaid: 2.5 to 14.9; California Medi-Cal: 0.3 to 6.2; and, Managed Care Organization: 0.4 to 2.7). Across all systems, the use of antipsychotics increased in children and adolescents above the age of five years, and in both males and females. In the Texas Medicaid system, psychiatrists accounted for the highest number of antipsychotic prescriptions for children and adolescents. Disruptive behavioral disorders were most commonly associated with antipsychotic prescribing. The mean number of inpatient psychiatric hospitalizations per child or adolescent receiving antipsychotic treatment and mental health care services from TDMHMR increased, as the mean number of hospital days per hospitalized youth decreased. Utilization of assessment services, counseling and psychotherapy, medication-related services, service coordination, and skills training increased. The mean duration of enrollment in assessment services, medication-related services, and skills training decreased, while the mean duration of enrollment in crisis intervention and service coordination increased. Given the limited efficacy and safety data with antipsychotics in children and adolescents, additional studies of atypical antipsychotics and other treatment modalities are needed on what, how, and when the best treatments can be provided to children and adolescents across health care settings.