title: Regional variation and clinical indicators of antipsychotic use in residential treatment: a four-state comparison.
abstract: The last decade saw an increase in psychotropic use with pediatric populations. Antipsychotic prescriptions are used frequently in residential treatment settings, with many youth receiving antipsychotics for off-label indications. Residential treatment data from 4 states were examined to determine if regional variation exists in off-label prescription and what clinicalfactors predict use. The study used clinical and pharmacological data collected via retrospective chart reviews (N = 732). The Child and Adolescent Needs and Strengths Assessment-Mental Health Version was used to measure symptom and risk severity. Of youth receiving antipsychotics, 42.9% had no history of or current psychosis. Statistical analyses resulted in significant regional variation in use across states and yielded attention deficit/impulsivity, physical aggression, elopement, sexually abusive behavior, and criminal behavior as factors associated with antipsychotic prescription in nonpsychotic youth. Antipsychotic prescription is inconsistent across states. Off-label prescription is frequent and likelihood of use increases with behavior problems.
authors.affiliation: Institute for Health Services Research and Policy Studies, Northwestern University Feinberg Medical School, 339 E Chicago Ave, Suite 717, Chicago, IL 60614, USA. p-rawal@northwestern.edu
authors.forename: Purva H
authors.initials: PH
authors.lastname: Rawal
authors.forename: John S
authors.initials: JS
authors.lastname: Lyons
authors.forename: James C
authors.initials: JC
authors.lastname: MacIntyre
authors.forename: John C
authors.initials: JC
authors.lastname: Hunter
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D019955:Conduct Disorder / Q000188:drug therapy*; D004348:Drug Labeling; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005843:Geography; D006801:Humans; D008484:Medicaid; D008499:Medical Records; D001523:Mental Disorders / Q000145:classification / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012114:Residential Treatment; D012307:Risk Factors; D014481:United States
chemical_list: D014150:Antipsychotic Agents