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. 2020 Apr 20:29:e117.
doi: 10.1017/S2045796020000293.

'Use of antipsychotics in children and adolescents: a picture from the ARITMO population-based European cohort study'

Florentia Kaguelidou  1   2   3 , Jakob Holstiege  4 , Tania Schink  5 , Irene Bezemer  6 , Elisabetta Poluzzi  7 , Giampiero Mazzaglia  8 , Lars Pedersen  9 , Miriam Sturkenboom  10 , Gianluca Trifirò  11   12
Affiliations

'Use of antipsychotics in children and adolescents: a picture from the ARITMO population-based European cohort study'

Florentia Kaguelidou et al. Epidemiol Psychiatr Sci. .

Abstract

Aims: Prevalence of the use of antipsychotics (APs) in the paediatric population is globally increasing. The aim of this study was to describe multinational trends and patterns in AP use in children and adolescents in Europe.

Methods: This was a dynamic retrospective cohort study comprising all children and adolescents (⩽18 years of age). Data were extracted from five population-based electronic healthcare databases in Europe (Denmark, Germany, Italy, the Netherlands and United Kingdom) from 2000 to 2010. Yearly prevalence and incidence of AP use was expressed per 1000 person-years (PYs).

Results: Prevalence increased from 1.44 to 3.41/1000 PYs (2008) in Denmark and from 2.07 to 4.35/1000 PYs in the NL (2009), moderately increased from 2.8 to 3.24/1000 in UK (2009) and from 1.53 to 1.74/1000 PYs in Germany (2008) and remained low from 0.61 to 0.34/1000 PYs in Italy (2010). Similarly, incidence rates increased from 0.69 to 1.52/1000 PYs in Denmark and from 0.86 to 1.49/1000 PYs in the NL, stabilised from 2.29 to 2.37/1000 PYs in the UK and from 0.79 to 0.80/1000 PYs in Germany and remained low from 0.32 to 0.2/1000 PYs in Italy. AP use was highest in 15-18 year olds and in boys compared to girls. Yet, the use observed in the 5-9 year olds was found to be comparatively high in the NL. Prescriptions of second generation APs, especially risperidone, were privileged but the first generation APs were still prescribed in the youngest.

Conclusions: A steady increase in AP use in children and adolescents was observed essentially in the NL and Denmark. The use in Germany and Italy was lowest among countries. The use of APs under 9 years of age underlines their off-label use and should be carefully monitored as the risk/benefit ratio of these medications remains unclear in young children. AP use was altogether lower in Europe as compared to that reported in North America.

Keywords: Antipsychotics; child psychiatry; epidemiology; primary care.

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Conflict of interest statement

The authors declare that they have no conflicts of interest relevant to the content of this study.

Figures

Fig. 1.
Fig. 1.
Prevalence of AP use by country and calendar year. PHARMO-NL: PHARMO Database Network, the Netherlands. THIN-UK: The Health Improvement Network, United Kingdom. Aarhus-DN: Aarhus University Hospital Database, Denmark. GEP-GE: German Pharmacoepidemiological Research Database (GePaRD), Germany. ERD-IT: Emilia Romagna Regional database, Italy.
Fig. 2.
Fig. 2.
Incidence of AP use by country and calendar year. PHARMO-NL: PHARMO Database Network, the Netherlands. THIN-UK: The Health Improvement Network, United Kingdom. Aarhus-DN: Aarhus University Hospital Database, Denmark. GEP-GE: German Pharmacoepidemiological Research Database (GePaRD), Germany. ERD-IT: Emilia Romagna Regional database, Italy.
Fig. 3.
Fig. 3.
Prevalence and incidence rates per sex, age group and country. NL: the Netherlands; UK: United Kingdom; DN: Denmark; GE: Germany; IT: Italy; F: female users; M: male users.
Fig. 4.
Fig. 4.
Frequency of dispensing of AP drugs by type of AP, age group and country for year 2008. FGA: first generation antipsychotics, SGA: second generation antipsychotics. NL: the Netherlands; UK: United Kingdom; DN: Denmark; GE: Germany; IT: Italy
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