Antipsychotic Prescribing Guidelines For Children Often Not Followed By Doctors: Report

It appears that doctors may only follow recommended guidelines for prescribing powerful antipsychotics like Risperdal and Abilify to children about half the time, according to a recent hearing involving practices by Vermont physicians.

Late last month, the Vermont State Legislature’s Mental Health Oversight Committee held a hearing on doctor practices in that state involving the use of antipsychotic medications among children.

During the hearing, testimony given by Dr. David C. Rettew (PDF), Director of the Pediatric Psychiatry Clinic at University of Vermont’s College of Medicine, indicated that while rates of antipsychotic prescriptions to children in that state were dropping, doctors only followed prescribing guidelines by the American Academy of Child and Adolescent Psychiatry (AACAP) about 51% of the time.

Rettew told legislators that a recent survey revealed that doctors in that state followed FDA recommendations on giving antipsychotics to children even less often; only 27% of the time. He did not say how those numbers compared with other states, but there was no indication of any particular factors which would make the prescribing of powerful psychotropic drugs to minors in Vermont different from most other states.

“The main reason best practice guidelines were not followed was much more related to a lack of labwork monitoring rather than prescribing these medications for mild problems or before other pharmacological and nonpharmacological treatments had been tried first,” Rettew testified to members of the state legislature.

That would suggest that it is not a problem of prescribing the wrong drugs to children so much as it is not following up properly on children they have told to take these medications.

However, Rettew also found that only 15% of children received “evidence-based” psychotherapy before being prescribed antipsychotic drugs. He also reported that in many cases the prescriber currently responsible for a child’s antipsychotic use was not the person who originally prescribed the drug and that there was often a lack of knowledge of child patients’ prior treatment history.

Childhood Antipsychotic Concerns

The report comes about a year after the Department of Health and Human Services’ Office of the Inspector General (DHHS-OIG) launched an investigation into the use of antipsychotic drug prescriptions and use by recipients of Medicaid under the age of 18.

Both older antipsychotics and newer atypical antipsychotics are included in the investigation. Some of those drugs have actually been approved for treatment of children with behavior disorders, such as bipolar and schizophrenia, while others are often prescribed “off-label” by doctors, for indications that have not been approved by the FDA as safe and effective.

Doctors and parents have raised concerns that the drugs are being overused to treat behavioral problems, unnecessarily exposing children to the risk of side effects from antipsychotics.

In many cases, critics indicate that the focus should be on working with the child and his or her caregivers in order to determine the cause of their behavior.

In 2012, a study published in the medical journal Archives of General Psychiatry found that children are prescribed antipsychotics at a higher rate than adults, with use of those drugs by children increasing at a more rapid rate than by adults from 2003 through 2009. The report found that one-in-three minors that go to see a psychiatrist are prescribed an antipsychotic to address their behavior.

Studies regarding the effects of such drugs for children, especially when prescribed for unapproved uses, have been found to cause weight gain and to also quadruple the risk of developing diabetes in children under the age of 18.

While all atypical antipsychotic medications have been associated with a potential increased risk of childhood diabetes, a growing number of Abilify lawsuits are being pursued by families of individuals who used this popular medication, with complaints suggesting that the average dose of the medication may increase a child’s risk of diabetes 7.72 percent above normal.

Concerns have also been raised in recent years about a potential link between Johnson & Johnson’s atypical antipsychotic Risperdal and male breast growth seen among boys and young adults who used the drug. Known as gynecomastia, use of Risperdal has been linked to the irreversible development of breasts among boys, which can cause a serious impact on the child’s quality of life and may result in the need for surgical breast removal.

Hundreds of Risperdal breast growth lawsuits are pending in courts throughout the country, which allege that the drug maker failed to adequately warn users or the medical community about the risk of boys developing breasts following use of the medication. These problem are often misdiagnosed as weight gain associated with the medication, but in some cases boys have developed breasts measuring as large as a 38D cup size after using the medication.

Additional studies have also identified other potential side effects of atypical antipsychotics, including a potential risk of urinary problems and even death.