Why Are Children Given Antipsychotics?

By Neuroskeptic | May 7, 2013 12:38 pm

Prescriptions of antipsychotic (aka neuroleptic) drugs in North American children and adolescents have been rising rapidly in recent years. But why?

Gabrielle Carlson of Stony Brook Children’s Hospital offers her thoughts in a brief paper: The Dramatic Rise in Neuroleptic Use In Children: Why Do We Do It and What Does It Buy Us?

Carlson is a specialist in ‘pediatric bipolar disorder’, which is a controversial topic at best, but I think this is still a thought-provoking piece:

The 10-bed children’s psychiatric inpatient unit at Stony Brook University Hospital, which opened in late 1986, treats children between the ages of 5 and 12…

The inpatient unit has experienced the same dramatic increase in use of neuroleptic medication as seen elsewhere, from 15.2% of patients receiving conventional antipsychotics in the 1988-1993 sample, to 68.5% use of atypical antipsychotics more recently (2002-2004, 2010-2011).

So the introduction of the newer, ‘atypical’ antipsychotics probably contributed to the rise, but there were other factors:

Simultaneously, however, the mean length of inpatient stay dropped from 10 weeks to 5 weeks. The rate of rehospitalization increased from 17% to 42%. Rates of children needing isolation have increased… Fewer children now return home to a biological parent.

It’s just not like it used to be:

Residents used to have a rotation of 3 months, meaning that they got to know and treat their patients; their rotations are now 1 month. Primary nurses used to spend time with the children; now they are shackled to their computers doing electronic medical records.

When children are admitted now, the first words out of the mouths of the managed care gatekeepers seems to be, “what drug are you going to start?” regardless of the six drugs the child was taking at admission…

She concludes that doctors turn to these drugs thanks to insufficient provision for other treatments:

Atypical antipsychotics clearly have important adverse effects. The question is whether society (and insurance companies) want to support the alternatives.

ResearchBlogging.orgCarlson GA (2013). The dramatic rise in neuroleptic use in children: why do we do it and what does it buy us? Theories from inpatient data 1988-2010. Journal of child and adolescent psychopharmacology, 23 (3), 144-7 PMID: 23607407

  • ohwilleke

    Don’t the “usual” psychotic conditions (bipolar, schizophrenia) manifest first in puberty or later? Is there any indication regarding what diagnosis provides a basis for these prescriptions?

  • http://www.psycritic.com/ psycritic

    As the saying goes, If all you have is a hammer, everything looks like a nail. It’s incredibly sad that most of the time antipsychotics in children and teens are being used to control things like aggression and irritability, rather than for the treatment of a psychotic disorder.

    • http://blogs.discovermagazine.com/neuroskeptic/ Neuroskeptic

      Yes, this is all at Stony Brook.

      Carlson says that the main reason for prescription was ‘explosive outbursts’, most often in kids with a diagnosis of ADHD combined with ODD.

      • Don Bartlett

        The doctor said when I asked about side effects (ADHD my son) He said the side effects of not getting an education are also horrible.
        I gave him the medicine, his hand writing went from looking like a chicken stepped in ink and walked over the paper to very nice writing.
        He went from d’s to a’s and went off the medicine in HS.
        He is now in a great college

  • http://twitter.com/sarithayat sarit hayat

    I remember seeing a documentary on bipolarity diagnoses in children (as young as 6, on the basis of frequent mood changes!) a few years back, it was quite shocking, and it saddens me to see things have prob. deteriorated..

  • JonFrum

    So it’s resident rotation length that’s causing the increase is antipsychotic drug treatment of children? Somehow I doubt it.

    • http://blogs.discovermagazine.com/neuroskeptic/ Neuroskeptic

      I can believe that it’s part of the explanation. Maybe newbies default to antipsychotics while, over time, they would have time to learn alternative approaches?

  • Buddy199

    Medical malpractice, pure and simple.

  • Megan

    According to Carlson (2013) children with bipolar disorder
    are “68.5% being treated with a typical antipsychotics are a group of drugs
    that block dopamine receptor that are thought to cause psychotic symptoms
    instead of blocking all dopamine receptors.
    The nenospitalezation rate is higher in children and apparently symptoms
    have worsened, so there is an increase use of isolation. In a book I read called Discovering
    psychology by hockenbury discusses the difference between antipsychotics and a typical
    antipsychotic with having less side effects, but the book I read says that bipolar
    in the adult population and medications for adult maybe a typical
    antipsychotics drugs don’t have the same efficiently on an immature brain in
    other words a child’s brain. How many studies
    have been done using typical antipsychotics with a pediatric population?

  • http://www.facebook.com/haszard Danny Haszard

    Risperdal reproached.

    Johnson and Johnson are the ‘baby care people’ and their marketing of Risperdal and other products must be above reproach.
    All the manufacturer’s of the SGA (Second generation Antipsychotics) engaged in deceptive promotions and off label marketing.I personally was victimized by Eli Lilly’s *viva zyprexa* campaign.
    Fours years of off label prescriptions of Zyprexa for my PTSD gave me life-long diabetes.
    Eli Lilly made $70 billion on Zyprexa!
    –Daniel Haszard

  • Pingback: What happens when you give antipsychotic drugs to a baby? | canada.com

  • Kidsno

    Carlson Gabrielle MD: Threats, Coercion and Chemical Restraints for
    Distressed Children. Procedure A rage outburst was defined as sufficient
    agitation and loss of control such that the child was unable to “time
    out” (i.e. sit in a chair for 10 minutes on being told to do so) If
    there was a second episode, the child was told “ Take this medicine or
    we may have to give you a shot”. If agreeable, the child was given 0.015
    mg/kg of liquid risperidone.

    “IF AGREEABLE” after threats of a painful scary needle against there will to coerce the now frightened children into taking the drug for this experiment.

    COERCING CHILDREN INTO MEDICAL EXPERIMENTS Read more: Bipolar Disord. 2010 March; 12(2): 205–212. doi:
    10.1111/j.1399-5618.2010.00793.x

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990969/

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About Neuroskeptic

Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.

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