title: Antipsychotic polypharmacy in children and adolescents at discharge from psychiatric hospitalization.
abstract: OBJECTIVE
  Antipsychotic polypharmacy-the use of more than one antipsychotic concomitantly-has increased in children and adolescents and may be associated with increased adverse effects, nonadherence, and greater costs. Thus, we sought to examine the demographic and clinical characteristics of psychiatrically hospitalized children and adolescents who were prescribed antipsychotic polypharmacy and to identify predictors of this prescribing pattern.
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  The inpatient psychiatric unit of a large, acute care, urban children's hospital.
  
  
  METHODS
  One thousand four hundred twenty-seven children and adolescents who were consecutively admitted and discharged between September 2010 and May 2011.
  
  
  RESULTS
  At discharge, 840 (58.9%) of the 1427 patients were prescribed one or more antipsychotics, and 99.3% of these received second-generation antipsychotics. Of these 840 patients, 724 (86.2%) were treated with antipsychotic monotherapy, and 116 (13.8%) were treated with antipsychotic polypharmacy. Positive correlations with antipsychotic polypharmacy were observed for placement or custody outside the biological family; a greater number of previous psychiatric admissions; longer hospitalizations; admission for violence/aggression or psychosis; and intellectual disability, psychotic, disruptive behavior, or developmental disorder diagnoses. Negative correlations with antipsychotic polypharmacy included admission for suicidal ideation/attempt or depression, and mood disorder diagnoses. Significant predictors of antipsychotic polypharmacy included admission for violence or aggression (odds ratio [OR] 2.76 [95% confidence interval (CI) 1.36-5.61]), greater number of previous admissions (OR 1.21 [95% CI 1.10-1.33]), and longer hospitalizations (OR 1.08 [95% CI 1.04-1.12]). In addition, diagnoses of intellectual disability (OR 2.62 [95% CI 1.52-4.52]), psychotic disorders (OR 5.60 [95% CI 2.29-13.68]), and developmental disorders (OR 3.18 [95% CI 1.78-5.65]) were predictors of antipsychotic polypharmacy.
  
  
  CONCLUSIONS
  Certain youth may have a higher likelihood of being prescribed antipsychotic polypharmacy, which should prompt careful consideration of medication treatment options during inpatient hospitalization. Future examinations of the rationale for combining antipsychotics, along with the long-term safety, tolerability, and cost effectiveness of these therapies, in youth are urgently needed.
authors.affiliation: Department of Pharmacy, Intermountain Primary Children's Hospital, Salt Lake City, Utah; Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Saldaña
authors.forename: Brooks R
authors.initials: BR
authors.lastname: Keeshin
authors.forename: Anna M
authors.initials: AM
authors.lastname: Wehry
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Blom
authors.forename: Michael T
authors.initials: MT
authors.lastname: Sorter
authors.forename: Melissa P
authors.initials: MP
authors.lastname: DelBello
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Strawn
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D010351:Patient Discharge; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D014150:Antipsychotic Agents
keywords: antipsychotic; child and adolescent psychiatry; polypharmacy; psychiatric hospitalization