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Trends in Prescribing Psychotropic Medications to Preschoolers (Zito et al, 2000)

Trends in Prescribing Psychotropic Medications to Preschoolers (Zito et al, 2000). Between 1991 and 1995, prescriptions to children aged 2 to 4 years has increased for: Stimulants Antidepressants Clonidine The rate of neuroleptic prescriptions remained the same during this period.

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Trends in Prescribing Psychotropic Medications to Preschoolers (Zito et al, 2000)

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  1. Trends in Prescribing Psychotropic Medications to Preschoolers(Zito et al, 2000) • Between 1991 and 1995, prescriptions to children aged 2 to 4 years has increased for: • Stimulants • Antidepressants • Clonidine • The rate of neuroleptic prescriptions remained the same during this period. • Less well-established agents increased at the greatest rate.

  2. Trends in Prescribing Psychotropic Medications to Preschoolers (Zito et al, 2000) 1995 Midwest Medicaid Population Children Aged 2 to 4 Years Rank OrderPercent of Population 1. Methylphenidate 1.23% 2. Antidepressants 0.32% 3. Neuroleptics 0.09% 4. Clonidine 0.23%

  3. Young Children May Have More Serious Side Effects Lithium: Dysarthria, EKG changes (Campbell et al, 1972); more side effects with decreasing age (Campbell et al, 1991). Chlomipramine: Behavioral Toxicity in 4 of 8 subjects; Urinary Retention (Sanchez et al, 1996).

  4. Behavioral Toxicity is Greater in Young Children Haloperidol: Increased irritability and other behavioral symptoms (Anderson et al, 1984).

  5. Placebo-Control is Necessary to Evaluate Side Effects In well-controlled, double-blind, placebo-controlled studies, it has been shown that young children have side effects on placebo.

  6. Assessment of Young Children for Psychotropic Medications • Baseline assessments are required – preferably 2 separate rating periods. • Assessments for efficacy are available. • Assessments for safety are available.

  7. Efficacy of Psychotropic Medications in Young Children • Apart from dextroamphetamine and haloperidol, psychotropics are labeled “not recommended for use” in young children. • Careful, well-designed studies with controls (preferably placebo-control) and adequate sample sizes are required. • Studies should be conducted by investigators who are experienced with the population.

  8. Prevalence of Psychiatric Disorders (DSM IV)Disorders First Diagnosed in Children Disorder Prevalence Mental Retardation 1% Pervasive Developmental Disorders 0.02% – 0.05% Attention-Deficit Hyperactivity Disorder 3% – 5% Oppositional Defiant, Conduct Disorder 2% – 16% Tourrette’s Disorder 0.04% – 0.05% Enuresis (age 5 needed for diagnosis) 7% (males), 3% (females) Separation Anxiety Disorder 4% Selective Mutism < 1% Stereotypic Movement Disorder 2% – 3%

  9. Prevalence of Psychiatric Disorders That Usually Have Adult Onset (DSM IV)(Average age of onset in the 20’s) Disorder Adult Prevalence Schizophrenia 0.2% – 2% Major Depression 10-25% (Females); 5-12% (Males) Mania (Bipolar I) 0.4% – 1.6%

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