More children now on antipsychotics drugs

10 Aug

Duff Wilson chronicles one family’s harrowing ordeal as they sought first, an accurate diagnosis and then appropriate treatment for their child. In the New York Times article, Child’s Ordeal Shows the Risk of Psychosis Drugs For The Young Wilson reports about the Warren family. Judy Lightfoot has a very informative article at Crosscut, We’re Doing Experiments On Poor Children whose are prescribed antipsychotic drugs more often. Pamela Paul has a fascinating article in the New York Times about preschoolers and depression. In the article, Can Preschoolers Be Depressed? Paul reports:

Kiran didn’t seem like the type of kid parents should worry about. “He was the easy one,” his father, Raghu, a physician, says. “He always wanted to please.” Unlike other children in his suburban St. Louis preschool, Kiran (a nickname his parents asked me to use to protect his identity) rarely disobeyed or acted out. If he dawdled or didn’t listen, Raghu (also a nickname) had only to count to five before Kiran hastened to tie his shoes or put the toys away. He was kind to other children; if a classmate cried, Kiran immediately approached. “Our little empath!” his parents proudly called him.

But there were worrisome signs. For one thing, unlike your typical joyful and carefree 4-year-old, Kiran didn’t have a lot of fun. “He wasn’t running around, bouncing about, battling to get to the top of the slide like other kids,” Raghu notes. Kiran’s mother, Elizabeth (her middle name), an engineer, recalls constant refrains of “Nothing is fun; I’m bored.” When Raghu and Elizabeth reminded a downbeat Kiran of their coming trip to Disney World, Kiran responded: “Mickey lies. Dreams don’t come true….”

Paul does a great job of describing what depression looks like in small children and reporting about nascent research efforts by various universities.

How Common Is Depression In Children?      

According to Mary H. Sarafolean, PhD in the article, Depression in School Age Children and Adolescents

In general, depression affects a person’s physical,  cognitive, emotional/affective, and motivational well-being, no matter  their age. For example, a child with depression between the ages of 6 and 12 may exhibit fatigue, difficulty with schoolwork, apathy and/or a lack of motivation. An adolescent or teen may be oversleeping, socially isolated, acting out in
self-destructive ways and/or have a sense of hopelessness. (See table 1.)

Prevalence and Risk Factors

While only 2 percent of pre-teen school-age children and 3-5 percent of teenagers have clinical depression, it is the most common diagnosis of children in a clinical setting (40-50 percent of diagnoses). The lifetime risk  of depression in females is 10-25 percent and in males, 5-12 percent. Children and teens who are considered at high risk for depression disorders include:

* children referred to a mental health provider for school problems
* children with medical problems
* gay and lesbian adolescents
* rural vs. urban adolescents
* incarcerated adolescents
* pregnant adolescents
* children with a family history of depression

If you or your child has one or more of the risk factors and your child is exhibiting symptoms of prolonged sadness, it might be wise to have your child evaluated for depression.

How to Recognize Depression In Your Child?      

MedNet has an excellent article about Depression in Children and how to recognize signs of depression in your child.

 The symptoms of depression in children vary. It is often undiagnosed  and untreated because they are passed off as normal emotional and  psychological changes that occur during growth. Early medical studies  focused on “masked” depression, where a child’s depressed mood was  evidenced by acting out or angry behavior. While this does occur,  particularly in younger children, many children display sadness or low  mood similar to adults who are depressed. The primary symptoms of  depression revolve around sadness, a feeling of
hopelessness, and mood  changes.

Signs and symptoms of depression in children include:

* Irritability or anger
* Continuous feelings of sadness, hopelessness
* Social withdrawal
* Increased sensitivity to rejection
* Changes in appetite — either increased or decreased
* Changes in sleep — sleeplessness or excessive sleep
* Vocal outbursts or crying
* Difficulty concentrating
* Fatigue and low energy
* Physical complaints (such as stomachaches, headaches) that do not respond to
treatment
* Reduced  ability to function during events and activities at home or with friends, in school, extracurricular activities, and in other hobbies or  interests

* Feelings of worthlessness or guilt
* Impaired thinking or concentration
* Thoughts of death or suicide

Not all children have all of these symptoms. In fact, most will  display different symptoms at different times and in different settings.  Although some children may continue to function reasonably well in  structured environments, most kids with significant depression will  suffer a noticeable change in social activities, loss of interest in  school and poor academic performance, or a change in appearance.  Children may also begin using drugs or alcohol,
especially if they are  over the age of 12.

The best defense for parents is a good awareness of what is going on with their child. As a parent you need to know what is going on in your child’s world. Catherine Pearson has a truly scary article at Huffington Post.

In Antipsychotics Prescribed To Treat ADHD In More Children And Teens, New Study Finds, Pearson reports:

The number of children and teens taking antipsychotic medications has skyrocketed in recent years, with psychiatrists prescribing the drugs in nearly one-in-three visits with youth, a new study found.

The drugs are not only being prescribed for schizophrenia and bipolar disorder, but also for the commonly diagnosed attention deficit hyperactivity disorder (ADHD). Many mental health experts say that the powerful medications come with serious potential side effects and that their effectiveness has not been proven in treating the disorders for which they’re increasingly prescribed.

“The growth in antipsychotic treatment of children — roughly eight-fold in 17 years — is especially impressive,” said study author Dr. Mark Olfson, a professor of clinical psychiatry at the College of Physicians and Surgeons of Columbia University.

“Practice has overstepped research,” he said. “These rapidly rising rates of antipsychotic treatment in young people should give physicians pause.”               http://www.huffingtonpost.com/2012/08/09/antipsychotics-adhd-study_n_1760602.html?utm_hp_ref=email_share

Here is the citation to the study:

National Trends in the Office-Based Treatment of Children, Adolescents, and Adults With Antipsychotics FREE ONLINE FIRST

Mark Olfson, MD, MPH; Carlos Blanco, MD, PhD; Shang-Min Liu, MS; Shuai Wang, PhD; Christoph U. Correll, MD

[+] Author Affiliations

Arch Gen Psychiatry. Published online August 06, 2012. doi:10.1001/archgenpsychiatry.2012.647

Text Size: AAA

Published online August 2012

Article

Tables

References

Comments

ABSTRACT

ABSTRACT | METHODS | RESULTS | COMMENT | AUTHOR INFORMATION | REFERENCES

Context  Although antipsychotic treatment has recently increased, little is known about how this development has differentially affected the office-based care of adults and young people in the United States.

Objective  To compare national trends and patterns in antipsychotic treatment of adults and youths in office-based medical practice.

Design  Trends between 1993 and 2009 in visits with antipsychotics for children (0-13 years), adolescents (14-20 years), and adults (≥21 years) are described on a per population basis and as a proportion of total medical office visits. Background and clinical characteristics of recent (2005-2009) antipsychotic visits are also compared by patient age.

Setting  Outpatient visits to physicians in office-based practice.

Participants  Visits from the 1993-2009 National Ambulatory Medical Care Surveys (N = 484 889).

Main Outcome Measures  Visits with a prescription of antipsychotic medications.

Results  Between 1993-1998 and 2005-2009, visits with a prescription of antipsychotic medications per 100 persons increased from 0.24 to 1.83 for children, 0.78 to 3.76 for adolescents, and 3.25 to 6.18 for adults. The proportion of total visits that included a prescription of antipsychotics increased during this period from 0.16% to 1.07% for youths and from 0.88% to 1.73% for adults. From 2005 to 2009, disruptive behavior disorders were the most common diagnoses in child and adolescent antipsychotic visits, accounting for 63.0% and 33.7%, respectively, while depression (21.2%) and bipolar disorder (20.2%) were the 2 most common diagnoses in adult antipsychotic visits. Psychiatrists provided a larger proportion of the antipsychotic visits for children (67.7%) and adolescents (71.6%) than to adults (50.3%) (P < .001). From 2005 to 2009, antipsychotics were included in 28.8% of adult visits and 31.1% of youth visits to psychiatrists.

Conclusions  On a population basis, adults make considerably more medical visits with a prescription of antipsychotics than do adolescents or children. Yet antipsychotic treatment has increased especially rapidly among young people, and recently antipsychotics have been prescribed in approximately the same proportion of youth and adult visits to psychiatrists.

Over the past several years, an increasing number of adults and children in the United States have been treated with antipsychotic medications.1 – 2 Antipsychotics are now among the most commonly prescribed and costly classes of medications.3 In adults, antipsychotic medications have demonstrated efficacy and have been approved by the Food and Drug Administration (FDA) as a primary treatment for schizophrenia4 – 5 and bipolar disorder6 – 7 and as an adjunctive treatment for major depressive disorder.8 In children and adolescents, antipsychotics are indicated for irritability associated with autistic disorder (5-16 years), tics and vocal utterances of Tourette syndrome and bipolar mania (10-17 years), and schizophrenia (13-17 years).9

With increasing use of antipsychotic drugs, the range of mental disorders treated with these medications in practice has broadened.10 – 15 As a result, the proportion of second-generation antipsychotic medications prescribed to treat schizophrenia has decreased from 51% (1995-1996) to 24% (2007-2008),2 while antipsychotic treatment of anxiety disorders in adults and youths has roughly doubled.12 In young people, attention-deficit/hyperactivity disorder and other disruptive disorders account for a substantial proportion (37.8%) of antipsychotic use.11

The metabolic safety concerns of antipsychotic medications16 – 17 focus our attention on antipsychotic prescribing practices in the community, especially on the extent to which antipsychotics are used to treat disorders for which there is limited empirical evidence of efficacy.15 ,18 Young people may be especially sensitive to the adverse metabolic effects of second-generation antipsychotics. As compared with adults, children may be more vulnerable to antipsychotic-induced weight gain19 and perhaps even to antipsychotic-associated diabetes.20 – 21

Young people and adults vary in several important clinical respects22 that might influence trends in antipsychotic use. Disruptive behavioral disorders, which are more commonly diagnosed in boys than in girls23 and in nonwhite youths than in white youths,24 – 25 occur in a substantial proportion of young people receiving outpatient mental health care.26 Increasing clinical acceptance of antipsychotics for problematic aggression in disruptive behavior disorders27 may have increased the number of children and adolescents (especially male youths and ethnic/racial minorities) being prescribed antipsychotics. The increase in the number of clinical diagnoses of bipolar disorder28 and autistic spectrum disorders29 among children and adolescents may have further increased antipsychotic use by youths, particularly by boys. With respect to adults, acceptance of antipsychotics as adjuvant treatment of major depressive disorder, even in the absence of psychotic features,30 might have increased antipsychotic use. Because depressive disorders are significantly more common in women than in men,31 such a trend might preferentially increase antipsychotic use among adult women. Increasing use of antipsychotics in adult anxiety disorders may have a similar effect.12

A comparison is presented of nationally representative survey data from adult and youth visits to office-based physicians. The analyses focus on trends and patterns of antipsychotic treatment. Prior to conducting these analyses, we predicted that the increase in the proportion of physician visits with a prescription of antipsychotic medications would be more pronounced for youths than for adults.    http://archpsyc.jamanetwork.com/article.aspx?articleid=1263977

Parents must be advocates for their children. If the first medical opinion does not seem right, get a second or even a third opinion. The New York Times article about the ordeal of the Wilson family is truly frightening.

Related:

Schools have to deal with depressed and troubled children                                       https://drwilda.wordpress.com/2011/11/15/schools-have-to-deal-with-depressed-and-troubled-children/

School psychologists are needed to treat troubled children                                             https://drwilda.wordpress.com/2012/02/27/school-psychologists-are-needed-to-treat-troubled-children/

Battling teen addiction: ‘Recovery high schools’                                                          https://drwilda.wordpress.com/2012/07/08/battling-teen-addiction-recovery-high-schools/

Resources:

1. About.Com’s Depression In Young Children

2. Psych Central’s Depression In Young Children

3. Psychiatric News’ Study Helps Pinpoint Children With Depression

4. Family Doctor’s What Is Depression?

5. WebMD’s Depression In Children

6. Healthline’s Is Your Child Depressed?

7. Medicine.Net’s Depression In Children

Dr. Wilda may be contacted at drwildasays@yahoo.com

Dr. Wilda says this about that ©

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One Response to “More children now on antipsychotics drugs”

Trackbacks/Pingbacks

  1. American Academy of Neurology study: Doctors cautioned against using drugs to treat children | drwilda - March 19, 2013

    […] Duff Wilson chronicles one family’s harrowing ordeal as they sought first, an accurate diagnosis and then appropriate treatment for their child. In the New York Times article, Child’s Ordeal Shows the Risk of Psychosis Drugs For The Young Wilson reports about the Warren family. Judy Lightfoot has a very informative article at Crosscut, We’re Doing Experiments On Poor Children whose are prescribed antipsychotic drugs more often. Pamela Paul has a fascinating article in the New York Times about preschoolers and depression. In the article, Can Preschoolers Be Depressed? Paul does a great job of describing what depression looks like in small children and reporting about nascent research efforts by various universities.                                                                                   https://drwilda.com/2012/08/10/more-children-now-on-antipsychotics-drugs/ […]

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