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Use of antipsychotic medications nearly doubled among low-income children in Tennessee in the late 1990s

New use of antipsychotics nearly doubled from 1996 to 2001 for children insured by Tennessee's program for the uninsured and Medicaid, TennCare, according to a recent study. Nearly 1 of every 100 adolescents in the Tenncare group became a new user of an antipsychotic drug in 2001. Much of this increase was due to prescribing of antipsychotics for nonpsychotic conditions such as attention-deficit/hyperactivity disorder (ADHD), conduct disorder, and affective disorders.

Although new atypical antipsychotic medications such as risperidone and olanzapine have fewer side effects than the older antipsychotic drugs, they nevertheless can cause serious problems ranging from weight gain and diabetes to cardiovascular disorders. In addition, use of antipsychotics in children and adolescents for indications other than psychosis or Tourette syndrome is controversial. This doubling of their use (from 22.9 to 45.4 per 10,000 children) for new behavioral problems raises concern about whether this practice is clinically justified, notes Wayne A. Ray, Ph.D., of the Center for Education and Research in Therapeutics (CERT) at Vanderbilt University.

In the study, which was supported in part by the Agency for Healthcare Research and Quality through the CERTs program (HS10384), Dr. Ray and his colleagues retrospectively studied new use of antipsychotic medications among TennCare-enrolled children and adolescents from 1996 through 2001. They examined the impact of the introduction of atypical antipsychotics (for example, risperidone in 1993 and olanzapine in 1995) on clinical practice.

During the 6-year study period, 6,803 children (mean age 11.5 years) became new users of antipsychotic medications. While the rates of use for schizophrenia, acute psychosis, and Tourette syndrome remained relatively constant, rates of use for behavioral conditions such as ADHD and affective disorders increased 1.5-fold. More studies are needed to determine whether the benefits of this expanded use outweigh the risks, concludes Dr. Ray.

See "New users of antipsychotic medications among children enrolled in TennCare," by William O. Cooper, M.D., M.P.H., Gerald B. Hickson, M.D., Catherine Fuchs, M.D., and others, in the August 2004 Archives of Pediatric and Adolescent Medicine 158, pp. 753-759.

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