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Use of atypical antipsychotic drugs to treat children continues despite questions about their safety and efficacy in the young

Atypical antipsychotics such as risperidone and clozapine are approved to treat adult schizophrenia, but they are not approved for use in children. These medications work by altering brain chemistry; specifically, they work by blocking postsynaptic serotonin and dopamine receptors.

In children and adolescents, data supporting the safety and efficacy of atypical antipsychotics are limited. Some studies suggest more prevalent and serious side effects (such as weight gain and sedation) in children and adolescents than in adults. Despite these concerns, a recent study found that nearly one-fourth of children and adolescents with prescription claims for these drugs were aged 9 years or younger.

Understanding the long-term effects on the developing brain of early and prolonged exposure to atypical antipsychotics is crucial given their use in children, according to the researchers who conducted the study. Their work was supported in part by the Agency for Healthcare Research and Quality (HS10385) through the Agency's Centers for Education and Research on Therapeutics (CERTs) initiative. The investigators used a large U.S. national database of prescription drug claims to examine the use of atypical antipsychotics by children and adults from January through December 2001.

Antipsychotic use prevalence peaked at 594.3 prescription claims per 100,000 males aged 10 to 14 years and 291 per 100,000 females aged 15 to 19 years. Yet, nearly one-fourth of patients aged 18 or younger with a claim for an atypical antipsychotic were aged 9 years or younger, and nearly 80 percent of these were boys. Given that schizophrenia is seldom diagnosed before adolescence, it is likely that atypical antipsychotics were being prescribed to treat behavior disorders such as attention deficit hyperactivity disorder. Managed care plans that provide almost complete coverage for drug therapy and only limited reimbursement for psychiatric evaluation may create strong incentives to treat behavioral problems using drug therapy, suggest the researchers.

See "Prevalence of atypical antipsychotic drug use among commercially insured youths in the United States," by Lesley H. Curtis, Ph.D., Leah E. Masselink, Truls Østbye, M.D., Ph.D., and others, in the April 2005 Archives of Pediatrics and Adolescent Medicine 159, pp. 362-366.

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