JAMA Pediatrics: Pediatric Drug Dosing Topic Collection

Medication Use in US Youth With Mental Disorders Medication Use in US Youth With Mental Disorders

Merikangas KR, He J, Rapoport J, et al. — Fri, 01 Feb 2013 00:00:00 GMT

Objective

To evaluate the prevalence, demographic and clinical correlates, and specificity of classes of psychotropic medications indicated for mental disorders.

Design

Cross-sectional survey.

Setting

Direct household interviews of combined household and school samples representative of the general population of adolescents in the United States.

Participants

Ten thousand one hundred twenty-three adolescents aged 13 to 18 years who participated in the National Comorbidity Survey Adolescent Supplement.

Main Exposures

Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) mental disorders and neurodevelopmental disorders.

Outcome Measure

Psychotropic medication use in the past 12 months.

Results

Among youth with any DSM-IV mental disorder, 14.2% reported that they had been treated with a psychotropic medication in the past 12 months. Strong associations emerged between specific disorders and classes of medications with evidence for efficacy. Antidepressants were most frequently used among those with primary mood disorders (14.1%); stimulant use was most common among those with attention-deficit/hyperactivity disorder (20.4%); and antipsychotic use was infrequent and mostly seen among those with serious developmental disorders. Less than 2.5% of adolescents without a 12-month mental disorder had been prescribed psychotropic medications, and most had evidence of psychological distress or impairment reflected in a previous mental disorder, subthreshold condition, or developmental disorder. Appropriate medication use was significantly more frequent among those in treatment in the mental health specialty sector than general medicine or other settings.

Conclusions

These findings challenge recent concerns over widespread overmedication and misuse of psychotropic medications in US youth. In fact, these data highlight the need for greater recognition and appropriate treatment of youth with mental health disorders.

Conflicting Data on Psychotropic Use by Children Two Pieces to the Same Puzzle Conflicting Data on Psychotropic Use by Children

Rubin D. — Fri, 01 Feb 2013 00:00:00 GMT

Are children underusing or overusing psychotropic medications in this country? This is the question raised by an article in this month's issue. Contrary to a number of population-based analyses that have described high rates of use, Merikangas et al conclude that many American children with unrecognized psychiatric needs never obtain services and that fewer receive medications even when their concerns are recognized.

The Partnership Access Line Evaluating a Child Psychiatry Consult Program in Washington State Partnership Access Line

Hilt RJ, Romaire MA, McDonell MG, et al. — Fri, 01 Feb 2013 00:00:00 GMT

Objective

To evaluate a telephone-based child mental health consult service for primary care providers (PCPs).

Design

Record review, provider surveys, and Medicaid database analysis.

Setting

Washington State Partnership Access Line (PAL) program.

Participants

A total of 2285 PAL consultations by 592 PCPs between April 1, 2008, and April 30, 2011.

Interventions

Primary care provider–initiated consultations with PAL service.

Main Outcome Measures

The PAL call characteristics, PCP feedback surveys, and Medicaid claims between April 2007 and December 2009 for fee-for-service Medicaid children before and after a PAL call.

Results

Sixty-nine percent of calls were about children with serious emotional disturbances, and 66% of calls were about children taking psychiatric medications. Primary care providers nearly always received new psychosocial treatment advice (87% of calls) and were more likely to receive advice to start rather than stop a medication (46% vs 24% of calls). Primary care provider feedback surveys reported uniformly positive satisfaction with the program. Among Medicaid children, there was significant increases in attention-deficit/hyperactivity disorder and antidepressant medication use after the PAL call but no significant change in reimbursements for mental health medications (P < .05). Children with a history of foster care experienced a 132% increase in outpatient mental health visits after the PAL call (P < .05).

Conclusions

Primary care providers used PAL for psychosocial and medication treatment assistance for particularly high-needs children and were satisfied with the service. Furthermore, PAL was associated with increased use of outpatient mental health care for some children.