title: Prevalence and correlates of antipsychotic polypharmacy in children and adolescents receiving antipsychotic treatment.
abstract: Antipsychotic polypharmacy (APP), which is common in adults with psychotic disorders, is of unproven efficacy and raises safety concerns. Although youth are increasingly prescribed antipsychotics, little is known about APP in this population. We performed a systematic PubMed search (last update 26 January 2013) of studies reporting the prevalence of APP in antipsychotic-treated youth. Summary statistics and statistical tests were calculated at the study level and not weighted by sample size. Fifteen studies (n = 58 041, range 68-23 183) reported on APP in youth [mean age = 13.4 ± 1.7 yr, 67.1 ± 10.2% male, 77.9 ± 27.4% treated with second-generation antipsychotics (SGAs)]. Data collected in these studies covered 1993-2008. The most common diagnoses were attention-deficit hyperactivity disorder (ADHD; 39.9 ± 23.5%) and conduct disorder/oppositional defiant disorder (CD/ODD; 33.6 ± 24.8). In studies including predominantly children (mean age = <13 yr, N = 5), the most common diagnosis were ADHD (50.6 ± 25.4%) and CD/ODD (39.5 ± 27.5%); while in studies with predominantly adolescents (mean age = ⩾13 yr, N = 7) the most common diagnoses were schizophrenia-spectrum disorders (28.6 ± 23.8%), anxiety disorders (26.9 ± 14.9%) and bipolar-spectrum disorders (26.6 ± 7.0%), followed closely by CD/ODD (25.8 ± 17.7). The prevalence of APP among antipsychotic-treated youth was 9.6 ± 7.2% (5.9 ± 4.5% in child studies, 12.0 ± 7.9% in adolescent studies, p = 0.15). Higher prevalence of APP was correlated with a bipolar disorder or schizophrenia diagnosis (p = 0.019) and APP involving SGA+SGA combinations (p = 0.0027). No correlation was found with APP definition [⩾1 d (N = 10) vs. >30-⩾90 d (N = 5), p = 0.88]. Despite lacking safety and efficacy data, APP in youth is not uncommon, even in samples predominantly consisting of non-psychotic patients. The duration, clinical motivations and effectiveness of this practice require further study.
authors.affiliation: The Zucker Hillside Hospital, Psychiatry Research,North Shore - Long Island Jewish Health System,Glen Oaks, NY,USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Toteja
authors.affiliation: The Zucker Hillside Hospital, Psychiatry Research,North Shore - Long Island Jewish Health System,Glen Oaks, NY,USA.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Gallego
authors.affiliation: The Zucker Hillside Hospital, Psychiatry Research,North Shore - Long Island Jewish Health System,Glen Oaks, NY,USA.
authors.forename: Ema
authors.initials: E
authors.lastname: Saito
authors.affiliation: Department of Pharmacy Practice and Administration,Ernest Mario School of Pharmacy, Rutgers University,Piscataway, NJ,USA.
authors.forename: Tobias
authors.initials: T
authors.lastname: Gerhard
authors.affiliation: Department of Pharmaceutical Outcomes and Policy and Department of Epidemiology,University of Florida,Gainesville, FL,USA.
authors.forename: Almut
authors.initials: A
authors.lastname: Winterstein
authors.affiliation: New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University,New York, New York,USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
authors.affiliation: The Zucker Hillside Hospital, Psychiatry Research,North Shore - Long Island Jewish Health System,Glen Oaks, NY,USA.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'; D015995:Prevalence
chemical_list: D014150:Antipsychotic Agents