title: Child and adolescent psychiatrists' attitudes and practices prescribing second generation antipsychotics.
abstract: OBJECTIVE
  The purpose of this study was to examine psychiatrists' attitudes and practices in prescribing second-generation antipsychotics (SGA) to children and adolescents (referred to here as "children") and identify factors associated with off-label SGA use.
  
  
  METHODS
  A survey was mailed to a national, randomly selected sample of 1600 child and adolescent psychiatrists identified by the American Medical Association. Multivariable logistic regression was used to identify factors, including psychiatrists' characteristics, practice characteristics, and psychiatrists' attitudes, that are associated with off-label SGA use (i.e., SGAs used in children with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, or nonbipolar mood disorders).
  
  
  RESULTS
  The final sample included 340 psychiatrists. Overall, respondents reported higher use and appropriateness of SGAs for United States Food and Drug Administration (FDA)-approved disorders, symptoms of aggression, and older child age. More than one third (36%) of respondents reported some off-label SGA use. Significant predictors of off-label use were: Practicing at inpatient/residential facilities (odds ratio [OR]=4.2, p=0.001); white/non-Hispanic race/ethnicity (OR=0.3, p<0.0001), agreeing that SGAs should be used for ADHD with aggression (OR=7.1, p<0.0001); and agreeing that SGAs should be used for severe delinquent behaviors (OR=1.9, p=0.03).
  
  
  CONCLUSIONS
  Psychiatrists' attitudes about prescribing SGAs to children exhibiting aggressive symptoms were associated with off-label SGA use. Research is needed to understand the construct of aggression, potential interaction effects of aggression with diagnostic criteria, and their impact on SGA use.
authors.affiliation: 1 The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center , Boston, Massachusetts.
authors.forename: Angie Mae
authors.initials: AM
authors.lastname: Rodday
authors.forename: Susan K
authors.initials: SK
authors.lastname: Parsons
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
authors.forename: Adelaide S
authors.initials: AS
authors.lastname: Robb
authors.forename: Bonnie T
authors.initials: BT
authors.lastname: Zima
authors.forename: Tully S
authors.initials: TS
authors.lastname: Saunders
authors.forename: Laurel K
authors.initials: LK
authors.lastname: Leslie
mesh_terms: D000293:Adolescent; D000296:Adolescent Psychiatry / Q000706:statistics & numerical data*; D000374:Aggression / Q000187:drug effects; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000188:drug therapy; D001291:Attitude of Health Personnel; D002648:Child; D002665:Child Psychiatry / Q000706:statistics & numerical data*; D019955:Conduct Disorder / Q000188:drug therapy; D003625:Data Collection; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D019964:Mood Disorders / Q000188:drug therapy; D056687:Off-Label Use / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011570:Psychiatry / Q000706:statistics & numerical data
chemical_list: D014150:Antipsychotic Agents