Survey of atypical antipsychotic prescribing by Canadian child psychiatrists and developmental pediatricians for patients aged under 18 years.
OBJECTIVE
To describe self-reported patterns of prescribing atypical antipsychotics (ATAs) and monitoring practices of child psychiatrists and developmental pediatricians in Canada.


METHODS
We surveyed members of the Canadian Academy of Child and Adolescent Psychiatry and members of the Developmental Paediatrics Section of the Canadian Paediatric Society regarding the types and frequencies of ATAs they prescribed, the ages and diagnoses of patients for whom they prescribed these medications, and the types and frequencies of monitoring used.


RESULTS
Ninety-four percent of the child psychiatrists (95% CI, 90% to 97%) and 89% of the developmental pediatricians (95% CI, 75% to 96%) prescribed ATAs, most commonly risperidone (69%). Diagnoses included psychotic, mood, anxiety, externalizing, and pervasive developmental disorders. Prescribing for symptoms such as aggression, low frustration tolerance, and affect dysregulation was also common. Twelve percent of all prescriptions were for children under age 9 years. Most clinicians monitored patients, but there were wide variations in the type and frequency of tests performed.


CONCLUSIONS
Despite the lack of formal indications, ATAs were prescribed by this group of clinicians for many off-label indications in youth under age 18 years, including very young children. Neither evidence-based guidelines nor a consensus on monitoring exist for this age group.
Doey
Tamison
T
Department of Psychiatry, Schulich School of Medicine and Dentistry, The University of Western Ontario, London. drtamison@yahoo.com
Handelman
Kenneth
K
Seabrook
Jamie A
JA
Steele
Margaret
M
D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D002648:Child; D002665:Child Psychiatry / Q000379:methods*; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004358:Drug Therapy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D011795:Surveys and Questionnaires
D014150:Antipsychotic Agents