title: Use of Psychotropic Medications and Visits to Psychiatrists and Psychologists among Individuals with Nonsyndromic Oral Clefts: A Population-Based Cohort Study.
abstract: BACKGROUND
  Oral clefts (OCs) are among the most common congenital malformations and can have a large impact on the life of the affected individual. Research findings regarding the psychological and psychosocial consequences of OC are inconclusive.
  
  
  METHODS
  Using Danish nationwide registers, we investigated redeemed prescriptions of psychotropic medication during 1996 to 2012 and visits to psychiatrists and psychologists during 1996 to 2011 among individuals born with nonsyndromic OC in Denmark between 1936 and 2009 and a comparison cohort of individuals without OC. This includes 8244 individuals with OC and 82,665 individuals without OC.
  
  
  RESULTS
  The Cox regression analysis revealed 12% (95% confidence interval [CI], 7 to 16%) increased risk of using any psychotropic medication for individuals with OC. When examining by cleft type, higher risks for medication use were observed in individuals with cleft lip and palate (CLP) or cleft palate (CP) only. The largest increased relative risk was found for use of antipsychotics and stimulants for individuals with CP followed by use of antipsychotics for individuals with CLP. We found increased risk of visits to psychiatrists for individuals with CP and no increased risk for visits to psychologists for either group.
  
  
  CONCLUSIONS
  This study indicates that a small group of individuals with nonsyndromic OC, in particular those with palatal involvement, have greater risk of using psychotropic medications. However, elevated use was also observed among younger individuals with cleft lip (CL) only. There seems to be only a modest increase in visits to health professionals for psychological reasons. Undiagnosed syndromes (e.g., 22q11 deletion syndrome), may, however, contribute to an overestimation of the associations. Birth Defects Research 109:824-835, 2017. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense C, Denmark.
authors.forename: Dorthe Almind
authors.initials: DA
authors.lastname: Pedersen
authors.affiliation: Psychiatric Department in Copenhagen, University of Copenhagen, Copenhagen University Hospital, Denmark.
authors.forename: Ida
authors.initials: I
authors.lastname: Hageman
authors.affiliation: Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa.
authors.forename: George L
authors.initials: GL
authors.lastname: Wehby
authors.affiliation: Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense C, Denmark.|Department of Clinical Genetics, Department of Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark.
authors.forename: Kaare
authors.initials: K
authors.lastname: Christensen
mesh_terms: D000015:Abnormalities, Multiple / Q000523:psychology / Q000628:therapy; D000328:Adult; D000368:Aged; D002971:Cleft Lip / Q000523:psychology* / Q000628:therapy*; D002972:Cleft Palate / Q000523:psychology* / Q000628:therapy*; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011570:Psychiatry; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012307:Risk Factors
chemical_list: D011619:Psychotropic Drugs
keywords: cleft lip; cleft lip and palate; cleft palate; congenital disorders; mental health; oral cleft; psychotropic medication