Antipsychotic Treatment of Young Chinese Individuals From 2004 to 2015: A Population-Based Study in Hong Kong

To the Editor: The increasing use of antipsychotic medications in young people has raised concerns in the United States regarding safety and indication (1). Such data on antipsychotic medication use in young people are lacking in Asian countries, as are data on the proportions prescribed by psychiatrists, considering prescription practices also differ from Western countries (2). We studied population-based antipsychotic prescribing trends in young people in Hong Kong.

Antipsychotic medication data (2004–2015) were retrieved from the database of the Hong Kong Hospital Authority of all public hospitals and institutions, covering more than seven million people (3). One or more filled antipsychotic prescriptions in a year qualified as antipsychotic use. A retrospective descriptive analysis of antipsychotics prescribed by psychiatrists to young patients (0–24 years) was performed (Table 1). Proportions of young people who were prescribed antipsychotics during each study year were calculated by age group (5–9, 10–14, 15–19, and 20–24 years), except the 0–4 age group, which had only a few prescriptions each year (range=1–6). Population denominators were estimated using 2004–2015 data from the Hong Kong Census and Statistics Department (4).

Our results showed that antipsychotic use in children increased from 2004 (ages 0–4, 0%; ages 5–9, 0.03%; ages 10–14, 0.09%) to 2015 (ages 0–4, 0%; ages 5–9, 0.11%; ages 10–14, 0.31%), and in adolescents and young adults from 2004 (ages 15–19, 0.25%; ages 20–24, 0.65%) to 2015 (ages 15–19, 0.47%; ages 20–24, 0.85%) (Figure 1). The percentage of antipsychotics prescribed by psychiatrists to young patients increased from 2004 (ages 5–9, 71.7%; ages 10–14, 77.7%; ages 15–19, 84.6%) to 2015 (ages 5–9, 92.5%; ages 10–14, 92.3%; ages 15–19, 88.1%). However, the percentage of prescribed antipsychotics declined in the 20–24 age group from 2004 (89.1%) to 2015 (86.9%).

In summary, we found that the percentage of young people in Hong Kong treated with antipsychotics increased from 2004 to 2015; in the United States, the figure dropped for younger children from 2006 (0.14%) to 2010 (0.11%), and for older children from 2006 (0.85%) to 2010 (0.80%). The overall antipsychotic use rates in children and adolescents appeared to be lower in Hong Kong than in the United States. In Hong Kong, most young people on antipsychotic medication are under psychiatric care. The increased use of antipsychotics may be related to the rapid development in the past decade of early intervention services for psychosis, resulting in more young people receiving diagnosis and treatment. However, we cannot exclude the possibility that increased usage has also occurred in other clinical conditions. We propose that practice guidelines be developed for psychiatrists and clinicians in other disciplines who prescribe antipsychotics for young children.