National trends in child and adolescent psychotropic polypharmacy in office-based practice, 1996-2007

Jonathan S. Comer, Mark Olfson, Ramin Mojtabai

Research output: Contribution to journalArticle

Abstract

Objective To examine patterns and recent trends in multiclass psychotropic treatment among youth visits to office-based physicians in the United States. Method Annual data from the 1996-2007 National Ambulatory Medical Care Surveys were analyzed to examine patterns and trends in multiclass psychotropic treatment within a nationally representative sample of 3,466 child and adolescent visits to office-based physicians in which a psychotropic medication was prescribed. Results There was an increase in the percentage of child visits in which psychotropic medications were prescribed that included at least two psychotropic classes. Across the 12 year period, multiclass psychotropic treatment rose from 14.3% of child psychotropic visits (1996-1999) to 20.2% (2004-2007) (adjusted odds ratio [AOR] = 1.89, 95% confidence interval [CI] = 1.22-2.94, p <.01). Among medical visits in which a current mental disorder was diagnosed, the percentage with multiclass psychotropic treatment increased from 22.2% (1996-1999) to 32.2% (2004-2007) (AOR = 2.23, 95% CI = 1.42-3.52, p <.001). Over time, there were significant increases in multiclass psychotropic visits in which ADHD medications, antidepressants, or antipsychotics were prescribed, and a decrease in those visits in which mood stabilizers were prescribed. There were also specific increases in co-prescription of ADHD medications and antipsychotic medications (AOR = 6.22, 95% CI = 2.82-13.70, p <.001) and co-prescription of antidepressant and antipsychotic medications (AOR = 5.77, 95% CI = 2.88-11.60, p <.001). Conclusions Although little is known about the safety and efficacy of regimens that involve concomitant use of two or more psychotropic agents for children and adolescents, multiclass psychotropic pharmacy is becoming increasingly common in outpatient practice.

Original languageEnglish (US)
Pages (from-to)1001-1010
Number of pages10
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume49
Issue number10
DOIs
StatePublished - Oct 2010

Fingerprint

Polypharmacy
Odds Ratio
Confidence Intervals
Antipsychotic Agents
Office Visits
Physicians' Offices
Antidepressive Agents
Prescriptions
Health Care Surveys
Therapeutics
Mental Disorders
Outpatients
Safety

Keywords

  • national trends
  • pediatric psychopharmacology
  • polypharmacy

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Developmental and Educational Psychology

Cite this

National trends in child and adolescent psychotropic polypharmacy in office-based practice, 1996-2007. / Comer, Jonathan S.; Olfson, Mark; Mojtabai, Ramin.

In: Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 49, No. 10, 10.2010, p. 1001-1010.

Research output: Contribution to journalArticle

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abstract = "Objective To examine patterns and recent trends in multiclass psychotropic treatment among youth visits to office-based physicians in the United States. Method Annual data from the 1996-2007 National Ambulatory Medical Care Surveys were analyzed to examine patterns and trends in multiclass psychotropic treatment within a nationally representative sample of 3,466 child and adolescent visits to office-based physicians in which a psychotropic medication was prescribed. Results There was an increase in the percentage of child visits in which psychotropic medications were prescribed that included at least two psychotropic classes. Across the 12 year period, multiclass psychotropic treatment rose from 14.3{\%} of child psychotropic visits (1996-1999) to 20.2{\%} (2004-2007) (adjusted odds ratio [AOR] = 1.89, 95{\%} confidence interval [CI] = 1.22-2.94, p <.01). Among medical visits in which a current mental disorder was diagnosed, the percentage with multiclass psychotropic treatment increased from 22.2{\%} (1996-1999) to 32.2{\%} (2004-2007) (AOR = 2.23, 95{\%} CI = 1.42-3.52, p <.001). Over time, there were significant increases in multiclass psychotropic visits in which ADHD medications, antidepressants, or antipsychotics were prescribed, and a decrease in those visits in which mood stabilizers were prescribed. There were also specific increases in co-prescription of ADHD medications and antipsychotic medications (AOR = 6.22, 95{\%} CI = 2.82-13.70, p <.001) and co-prescription of antidepressant and antipsychotic medications (AOR = 5.77, 95{\%} CI = 2.88-11.60, p <.001). Conclusions Although little is known about the safety and efficacy of regimens that involve concomitant use of two or more psychotropic agents for children and adolescents, multiclass psychotropic pharmacy is becoming increasingly common in outpatient practice.",
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