Psychotropic medication in children and adolescents in Germany: prevalence, indications, and psychopathological patterns.
OBJECTIVE
The aim of this study was to identify the "real-life" prevalence of psychotropic medications in children and adolescents in Germany and related behavioral and emotional problems. Data from the nationwide representative National German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were analyzed.


METHODS
A total of 17,450 subjects aged 0-17 years from 167 communities were examined as part of the KiGGS in Germany between 2003 and 2006 to determine their use of antidepressants, antipsychotics, anxiolytics, and sedatives within the 7 days prior to being interviewed. Medication use was assessed by a medical doctor who conducted a computer-assisted personal interview (CAPI) with the parents, and related emotional and behavioral problems were assessed using the Strength and Difficulties Questionnaire (SDQ).


RESULTS
The overall prevalence for these medications was moderate (4.81/1000; 95% confidence interval [CI], 3.70-6.26), but prevalence varied across the different classes of drugs (sedatives > antipsychotics > antidepressants > anxiolytics). Rates of off-label use were high for antipsychotics and antidepressants. About 30% of the medication, especially sedatives, was used without prescription. Subjects using psychotropic medication obtained higher scores in the screening for emotional or behavioral problems than the total sample, but 40% of the children did not show abnormal scores.


CONCLUSIONS
The indication for antipsychotics was mostly behavioral symptomatology, while antidepressants were used for a wide variety of symptoms. The high proportion of children and adolescents using psychotropic medication with normal scores in the emotional and behavioral screening was remarkable. It cannot be determined whether in these cases low scores were related to improvement in symptoms or whether medication was being misused.
Koelch
M
M
Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Ulm, Germany. michael.koelch@uniklinik-ulm.de
Prestel
A
A
Singer
H
H
Keller
F
F
Fegert
J M
JM
Schlack
R
R
Hoelling
H
H
Knopf
H
H
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy; D056687:Off-Label Use / Q000706:statistics & numerical data; D011159:Population Surveillance / Q000379:methods; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D011599:Psychopathology / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012651:Self Medication; D012737:Sex Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome
D011619:Psychotropic Drugs