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. 2020 Dec;29(12):1717-1727.
doi: 10.1007/s00787-020-01488-6. Epub 2020 Feb 12.

Prescribing antipsychotics in child and adolescent psychiatry: guideline adherence

Mariken Dinnissen  1 , Andrea Dietrich  2 , Judith H van der Molen  2 , Anne M Verhallen  2   3 , Ynske Buiteveld  2 , Suzanne Jongejan  2 , Pieter W Troost  4 , Jan K Buitelaar  5   6 , Pieter J Hoekstra  2 , Barbara J van den Hoofdakker  2   7
Affiliations

Prescribing antipsychotics in child and adolescent psychiatry: guideline adherence

Mariken Dinnissen et al. Eur Child Adolesc Psychiatry. 2020 Dec.

Abstract

Antipsychotics are often prescribed to children and adolescents, mostly off-label. We aimed to assess adherence to recommendations of guidelines for antipsychotic prescription. We reviewed 436 medical records from 155 clinicians from 26 clinics within three Dutch child and adolescent psychiatry organizations (n = 398 outpatient, n = 38 inpatient care). We assessed target symptoms, diagnostic process, prior and concomitant treatment, and consideration of contra-indications. Multiple logistic regression assessed the role of age, sex, and psychiatric diagnosis on adherence to three main recommendations: to (1) prescribe antipsychotics only after other treatments proved insufficient, (2) always combine antipsychotics with psychosocial interventions, and (3) not prescribe multiple antipsychotics simultaneously. Most patients received off-label antipsychotics. Main target symptoms were inattention/hyperactivity (25%), aggression (24%), and other disruptive behaviors (41%). Most patients underwent diagnostic evaluation before the first prescription; however, screening of contra-indications was low (0.2-19%). About 84% had previously received psychosocial treatment and 48% other psychoactive medication, but 9% had not received any treatment. Notably, only 37% continuously received concomitant psychosocial treatment. Simultaneous use of multiple antipsychotics occurred in 3.2%. Younger children were at higher risk of non-adherence to guideline recommendations regarding prior and concomitant treatment, children with autism spectrum disorder or attention-deficit/hyperactivity disorder more likely not to receive concomitant psychosocial treatment. Sex did not significantly affect adherence. Our findings implicate insufficient adherence to important recommendations regarding antipsychotic use in children and adolescents. Especially younger children are at higher risk of receiving suboptimal care. There is an urgency to consistently offer psychosocial interventions during antipsychotic treatment.

Keywords: Adolescents; Antipsychotics; Children; Guidelines; Prescription.

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Conflict of interest statement

Jan K. Buitelaar has been in the past 3 years a consultant to/member of advisory board of/and/or speaker for Janssen Cilag BV, Eli Lilly, Lundbeck, Shire, Roche, Novartis, and Servier. He is not an employee of any of these companies and not a stock shareholder of any of these companies. He has no other financial or material support, including expert testimony, patents, and royalties. The other authors have no conflicts of interest relevant to this article to disclose.

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