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Objective: In recent years the use of antipsychotics (APs) for neurodevelopmental, behavioral and psychiatric disorders in children and adolescents has significantly increased while the age of prescription has decreased. To the best of our knowledge, there is very limited data about the use of APs in the clinical practice in Turkish children and adolescents with different psychiatric disorders. The aim of this retrospective study was to analyze the relationship between the use of different APs and clinical factors in a child and adolescent outpatient clinic in Turkey.
Methods: Medical records of 4623 patients referred to the Children and Adolescent Psychiatry outpatient clinic between May 2013 and September 2014 were reviewed retrospectively.
Results: The analyses included 304 (6.6%) patients who were prescribed APs medications. The sample was predominantly male (61.5%) and mean age was 11.4±4.3 years. The most commonly prescribed APs were risperidone, aripiprazole, haloperidol and olanzapine, respectively. Diagnoses upon admission to clinic in descending order of frequency are disruptive behavior disorders (DBD), mental retardation (MR), bipolar disorder (BPD), posttraumatic stress disorder, autism spectrum disorder (ASD) and psychotic disorder. Risperidone was the most preferred drug in all diagnosis groups. Approximately 30% of the patients have comorbid medical conditions. The rate of Aripiprazole was more in females than males (p=0.003), and risperidone was more used in male than in female patients (p=0.001). It was detected that risperidone was more selected with the diagnosis of mental MR/ASD and DBD, olanzapine was more chosen for the diagnosis of psychotic disorder/BPD, aripiprazole was preferred for the diagnosis of anxiety disorders and psychotic/BPD than other diagnoses (in all comparison; p<0.05).
Conclusion: Previous studies in outpatients are mainly prescription studies, which stated that APs are mainly used off-label. Specifically, risperidone was the most prescribed SGA in almost all studies on the prevalence of prescriptions in children and adolescents as well as in an adolescent inpatient setting with the exception of one study performed in Italy. Consistent with the literature, the most common diagnostic category for which APs were used in patients was DBD. Effectiveness of risperidone on autism-related aggression/irritability and conduct disorder has been shown. Consistent with the literature, we have detected that risperidone was preferred with the diagnosis of MR/ASD and DPD. Effectiveness of aripiprazole for psychosis and BPD has been shown. Consistent with the literature, we have detected that aripiprazole was more prescribed with the diagnosis of psychosis and BPD. Furthermore in our study aripiprazole was preferred for the diagnosis of anxiety disorders. However, there is insufficient evidence in child and adolescent anxiety disorders. The upward trends in the use of APs have not been matched by advances in the understanding of AP safety profiles in this group of patients. It is therefore crucial to produce up-to-date syntheses of the evidence and clinical guidelines for the use and monitoring of these treatments in pediatric populations.