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J Clin Psychiatry. 2017 Mar;78(3):347-357. doi: 10.4088/JCP.15r10435.

Extent, Time Course, and Moderators of Antipsychotic Treatment in Youth With Mood Disorders: Results of a Meta-Analysis and Meta-Regression Analyses.

Author information

1
Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy.
2
Department of Pediatrics, University of Padua, Italy.
3
The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, New York, USA.
4
The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA.
5
University of Pavia, Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, Pavia, Italy.
6
IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
7
Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA.
8
Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.
9
New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, USA.
10
The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, 75-59 263rd St, Glen Oaks, New York 11004. ccorrell@northwell.edu.
11
Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, New York, USA.
12
The Feinstein Institute for Medical Research, Psychiatric Neuroscience Center of Excellence, Manhasset, New York, USA.
13
Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, New York, USA.

Abstract

OBJECTIVE:

To meta-analytically examine the trends and correlates of antipsychotic use in youth with mood disorders.

METHODS:

Systematic literature search without language restriction in PubMed/MEDLINE/PsycINFO from database inception through March 2015 using the following search terms: (antipsychotic* OR neuroleptic* OR "dopamine blocker*" OR antidopaminergic) AND (child* OR adolescen* OR pediatric OR youth) AND (prescription* OR prescrib* OR use OR utilization OR database OR pharmacoepidemiolog* OR frequency OR rate OR rates). Random effects meta-analysis and meta-regression analyses were conducted.

STUDY SELECTION:

Included were studies reporting on the frequency of (1) mood disorders in antipsychotic-treated youth (≤ 19 years) and (2) antipsychotic use in youth with mood disorders.

DATA ABSTRACTION:

Two independent investigators abstracted data on study, patient, and treatment characteristics.

RESULTS:

Forty-one studies were meta-analyzed (N = 518,919, mean ± SD age = 12.8 ± 1.8 years, males = 65.7%). Altogether, 24.2% of antipsychotic-treated youth had a mood disorder diagnosis (studies = 34, depression spectrum disorder = 10.9%, bipolar spectrum disorder = 13.6%). In longitudinal studies, the overall proportion increased significantly from 17.3% in 2000 (range, 1996-2009) to 24.5% in 2006 (range, 2004-2011) (odds ratio [OR] = 1.50; 95% confidence interval [CI], 1.26-1.79; P < .0001). This increase was driven entirely by bipolar spectrum diagnoses (2001 = 11.1%, 2006 = 16.3%, P < .0001), rather than depression spectrum diagnoses (2001 = 9.1%, 2007 = 9.2%, P = .77). Among youth with mood disorders (8 studies), 24.0% received antipsychotics (depression spectrum disorder = 4.6%; bipolar spectrum disorder = 44.0%).

CONCLUSIONS:

The proportion of youth with mood disorder diagnoses increased significantly among antipsychotic-treated youth, driven entirely by an increase in youth with bipolar spectrum disorders. Progress in understanding the reasons for these trends and for an evaluation of the appropriateness of the observed antipsychotic prescribing requires more detailed information than is available in traditional pharmacoepidemiologic databases.

PMID:
28068462
DOI:
10.4088/JCP.15r10435
[Indexed for MEDLINE]

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