Pediatric Antipsychotic Prescription Increases In California Linked To Foster Care Docs

A new investigative report suggests that a handful of foster care psychiatric doctors appear to be driving much of the increase in antipsychotic prescriptions among California youth. 

The Mercury News and Digital First Media published a report earlier this month, which found that about 10% of the state’s foster care doctors were behind half of the antipsychotic prescriptions to children in foster care in California. In addition, the investigation found that the same population of health care providers often used drug combinations that were considered questionable, and prescribed antipsychotics for uses not approved by the FDA.

The report is part of an ongoing series called “Drugging Our Kids,” which warns that some of those with the highest prescription rates operated in ways that made some question their judgment. Seven of the doctors appeared in a Senate report in 2010, which identified doctors who prescribed antipsychotics at an unusually high rate, but there are no records of the state taking any action against them or any doctor for prescribing high rates of antipsychotics.

Almost a quarter of California foster care children were prescribed antipsychotics as a form of behavioral control, instead of for the specific mental disorders they are designed to treat, according to the findings.

Known as “chemical restraint,” the practice of using antipsychotics for behavioral modification has been mostly highlighted due to its use in nursing homes that treat elderly dementia patients, where it is considered a form of nursing home abuse. The FDA has warned nursing homes that antipsychotics do not help most dementia patients while increasing their risk of death.

A 2012 study published in the Archives of General Psychiatry found that children are now being prescribed antipsychotics, like Seroquel, Risperdal, Zyprexa and Abilify, at higher rates than adults. The study found that 31% of youths visiting a psychiatrist were prescribed an antipsychotic, compared to 29% of adults.

Childhood Antipsychotic Risks

Studies regarding the effects of such drugs for children, especially when prescribed for unapproved uses, found increased weight gain and quadruple the risk of developing diabetes in children under the age of 18. Additional studies have also found that many other side effects may also include urinary problems and even death.

With not much evidence concerning its efficacy on youths; yet a higher prescribing rate, many youth advocates and health experts question the necessity of such prescriptions.

In 2011, an outside panel of experts voted to recommend that the FDA continue safety monitoring of antipsychotics and the risks for children. Such medications may pose a serious long-term health risk for children. The advisory panel has urged the FDA to conduct further in-depth studies on the weight gain side effects of atypical antipsychotics since 2009, some of which have been prescribed to toddlers as young as two years-old.

In February 2010, the FDA issued a warning that Zyprexa side effects can lead to increased potential for weight gain and hyperlipidemia in children ages 13 through 17. The warning also suggested that prescribing doctors may want to look at other medications first, due to Zyprexa health risks for adolescents, which can include high cholesterol and diabetes.

The warnings came after an October 2009 study published in the Journal of the American Medical Association linked use of Zyprexa to dramatic weight gain among children. The study found that among children between 4 and 19, side effects of Zyprexa resulted in an average weight gain of 18.7 pounds after only 11 weeks.

Researchers also found similar problems with other antipsychotics in the same class, with side effects of Seroquel causing children to gain an average of 13.5 pounds, Risperdal causing an average increase of 11.7 pounds and Abilify causing an average weight gain of 9.7 pounds.

Previous studies have raised concerns about the link between childhood diabetes and other psychiatric medications as well, particularly involving a newer class of the drugs, known as atypical antipsychotics, such as Abilify, Risperdal, Seroquel, Zyprexa and other popular medications.

The side effects of Risperdal have also been linked to abnormal male breast growth, known as gynecomastia. A number of Risperdal lawsuits have been filed against the manufacturer, Johnson & Johnson, resulting in several verdicts in recent years awarding plaintiffs tens of millions of dollars.