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Antipsychotic prescriptions for children have doubled

There has been a ‘worrying’ rise in antipsychotic prescriptions for children and young people, due to changes in prescribing practice by clinicians.

There has been a ‘worrying’ rise in antipsychotic prescriptions for children and young people, despite substantial side-effects, according to new research from The University of Manchester’s Centre for Women’s Mental Health.

The study, published in the Lancet Psychiatry, found that the proportion of children and adolescents prescribed antipsychotics in English general practice doubled from 0.06% to 0.11% between 2000 and 2019.

The increase in prevalence results from an increase in new prescriptions (2·2% per year) and from more children and adolescents receiving longer term treatment.

Researchers examined primary care records of 7.2 million children and adolescents, aged 3 to 18, registered at selected English General Practices over the period 2000 to 2019.

They found that boys and older children – aged 15 to 18 – were more likely to be prescribed antipsychotics than girls and younger children; however, the increasing trends were evident in all groups. The most common indications for antipsychotics were autism, anxiety, and depression and the authors suggested that the increasing prevalence of these conditions could lead to higher prescribing rates.

In 2006, the USA approved risperidone for children and adolescents with autism, bipolar mania, and schizophrenia, and the joinpoint model showed that this coincided with the steepest prescribing increase in England. In 2011, NICE approved aripiprazole for adolescents; and in 2013, risperidone for conduct disorders. The authors say that both the US and European approvals are likely to influence antipsychotic prescribing in England.

There was also a rise in antipsychotic prescriptions for children diagnosed with Attention deficit hyperactivity disorder (ADHD). Yet NICE guidance for ADHD does not include antipsychotics and advises against co-prescribing atypical antipsychotics with stimulants for ADHD with co-existing aggression and irritability without tertiary services.

Dr Matthias Pierce, senior research fellow at the University of Manchester’s Centre for Women’s Mental Health said: “This study demonstrates a concerning trend in antipsychotic prescribing in children and adolescents. We do not think the changes in prescribing necessarily relate to changes in clinical need; rather, it may be more likely to reflect changes in prescribing practice by clinicians.

“However, this study will help clinicians to evaluate the prescribing of antipsychotics to children more fully and will encourage them to consider better access to alternatives.”

Additional guidance on antipsychotic prescribing needed

Antipsychotic use is only approved by NICE for children with psychosis or with severely aggressive behaviour from conduct disorder.

Studies in adults have found that antipsychotics can cause serious side effects, so long-term safety is a particular concern, especially in children who are still rapidly developing.

There are two types of antipsychotics – typical, which have been used since the 1950s and atypical that have been used since the 1990s. According to Rethink Mental Illness, the main difference between these types is in their side effects. Typical antipsychotics may have more of an effect on your body movement than newer antipsychotics. Both can cause side effects such as sexual dysfunction, infertility, and weight gain leading to diabetes.

The researchers noted that the older drugs were more commonly prescribed to children in more deprived areas.

They added that although existing clinical trials of antipsychotics in children and adolescents are small and of short duration, meta-analyses consistently report adverse cardiometabolic events.

The authors found that adherence to antipsychotic prescribing guidelines for children and adolescents in Europe was found to have notable gaps and recommended that a national audit of how UK clinicians implement NICE recommendations is undertaken.

Senior author, Professor Kathryn Abel from The University of Manchester added: “Antipsychotic medications continue to have a valuable role in the treatment of serious mental illness. These findings represent a descriptive account of antipsychotic prescribing to children and adolescents in the UK today and provide a window onto current practice.

“It is notable, and relevant to the current discourse, that we report inequities in prescribing as a result of deprivation levels; and that the indications for which approvals are available are no longer the commonest reason these medications are being prescribed. Broadening use of antipsychotics in developing young people begs questions about their safety over time and demands more research on this topic.”

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