Antipsychotic Medications for Low-Income Preschoolers: Long Duration and Psychotropic Medication Polypharmacy
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Sample
Definitions and Covariates
Statistical Analysis
Results
Descriptive Characteristics
Total exposure to antipsychotic medication (years) | |||||||||
---|---|---|---|---|---|---|---|---|---|
Overall (N=316) | 0–2 (N=126) | 2–4 (N=104) | 4–6 (N=86) | ||||||
Variable | N | % | N | % | N | % | N | % | pb |
Age in 2017 (M±SD years) | 9.6±.6 | 9.6±.7 | 9.7±.6 | 9.5±.7 | .027 | ||||
Exposure to antipsychotic (M±SD years) | 2.6±1.7 | .8±.6 | 3.1±.6 | 4.6±.4 | <.001 | ||||
Foster care | 63 | 20 | 23 | 18 | 17 | 16 | 23 | 27 | .169 |
Nonmetro area | 202 | 64 | 87 | 69 | 67 | 64 | 48 | 56 | .142 |
Median comorbid psychiatric diagnosesc | 2.5 | 2.0 | 3.0 | 3.0 | <.001 | ||||
Diagnosis | |||||||||
Schizophrenia and other psychotic processes | 30 | 10 | 5 | 4 | 13 | 13 | 12 | 14 | .023 |
Autism spectrum disorders | 137 | 43 | 31 | 25 | 51 | 49 | 55 | 64 | <.001 |
Other neurodevelopmental disordersd | 208 | 66 | 68 | 54 | 70 | 67 | 70 | 81 | .000 |
Disruptive behavior disorders (total) | 293 | 93 | 116 | 92 | 101 | 97 | 76 | 88 | .065 |
Attention-deficit hyperactivity disorder | 288 | 91 | 112 | 89 | 100 | 96 | 76 | 88 | .089 |
Oppositional defiant disorder | 165 | 52 | 63 | 50 | 54 | 52 | 48 | 56 | .706 |
Conduct disorder | 173 | 55 | 67 | 53 | 56 | 54 | 50 | 58 | .756 |
Mood disorders (total) | 203 | 64 | 69 | 55 | 74 | 71 | 60 | 70 | .016 |
Depressive disorders | 174 | 55 | 54 | 43 | 69 | 66 | 51 | 59 | .001 |
Bipolar disorder | 88 | 28 | 26 | 21 | 35 | 34 | 27 | 31 | .063 |
Mood disorder not otherwise specified | 162 | 51 | 48 | 38 | 63 | 61 | 51 | 59 | .001 |
Disruptive mood dysregulation disorder | 90 | 29 | 21 | 17 | 42 | 40 | 27 | 31 | <.001 |
Anxiety and trauma-related disorders (total) | 202 | 64 | 78 | 62 | 66 | 63 | 58 | 67 | .707 |
PTSD | 70 | 22 | 23 | 18 | 26 | 25 | 21 | 24 | .395 |
Tic disorders | 24 | 8 | 10 | 8 | 6 | 6 | 8 | 9 | .647 |
Epilepsy and seizure disorders | 70 | 22 | 23 | 18 | 26 | 25 | 21 | 24 | .395 |
Polypharmacye | |||||||||
2 medication classes | 79 | 25 | 50 | 40 | 22 | 21 | 7 | 8 | .004 |
3 medication classes | 107 | 34 | 34 | 27 | 42 | 40 | 31 | 36 | <.001 |
≥4 medication classes | 97 | 31 | 11 | 9 | 39 | 38 | 47 | 55 | <.001 |
Prescribed by a psychiatrist | 266 | 84 | 99 | 79 | 91 | 88 | 76 | 88 | .083 |
Prescribed by a primary care provider | 300 | 95 | 118 | 94 | 97 | 93 | 85 | 99 | .153 |
Visit with a primary care provider | 297 | 94 | 118 | 94 | 97 | 93 | 82 | 95 | .818 |
Emergency department visit | 277 | 88 | 109 | 87 | 88 | 85 | 80 | 93 | .189 |
Inpatient hospitalizationf | 107 | 34 | 27 | 21 | 44 | 42 | 36 | 42 | .001 |
Metabolic screeningg | 131 | 42 | 32 | 25 | 52 | 50 | 47 | 55 | <.001 |
Lipid screening | 150 | 48 | 42 | 33 | 57 | 55 | 51 | 59 | <.001 |
Blood glucose screening | 236 | 75 | 81 | 64 | 83 | 80 | 72 | 84 | .002 |
Metabolic dysfunctionh | 28 | 9 | 5 | 4 | 11 | 11 | 12 | 14 | .032 |
Diagnoses
Safety and Monitoring
Types of Medications
Medication | N | % |
---|---|---|
Antipsychotics | 316 | 100 |
First generation | 17 | 5 |
Second generation | 315 | >99 |
Risperidone | 294 | 93 |
Aripiprazole | 100 | 32 |
Quetiapine | 85 | 27 |
Stimulants | 275 | 87 |
Amphetamine based | 229 | 72 |
Methylphenidate | 194 | 61 |
Dexmethylphenidate | 95 | 30 |
Alpha-agonists | 286 | 91 |
Clonidine | 230 | 73 |
Guanfacine | 212 | 67 |
Antidepressants | 200 | 63 |
Trazodone | 95 | 30 |
Sertraline | 67 | 21 |
Mirtazapine | 53 | 17 |
Fluoxetine | 50 | 16 |
Anticonvulsants and mood stabilizers | 157 | 50 |
Valproic acid | 76 | 24 |
Oxcarbazepine | 59 | 19 |
Lamotrigine | 55 | 17 |
Lithium | 13 | 4 |
Benzodiazepines, anxiolytics, and hypnotics | 115 | 36 |
Hydroxyzine | 83 | 26 |
Predictors of Duration of Antipsychotic Medication
Variable | IRRa | 95% CI | p |
---|---|---|---|
Male (reference: female) | 1.25 | 1.04–1.49 | .017* |
Nonmetro residence (reference: metro residence) | .95 | .82–1.11 | .536 |
Prescribed by a psychiatrist | .91 | .78–1.06 | .230 |
Child in foster care in 2012 | 1.25 | 1.00–1.56 | .046* |
Schizophrenia and other psychotic processes | 1.04 | .68–1.59 | .855 |
Autism spectrum disorders | 1.26 | 1.03–1.54 | .022* |
Other neurodevelopmental disordersb | 1.14 | .90–1.45 | .272 |
Disruptive behavior disorders | |||
Attention-deficit hyperactivity disorder | .98 | .80–1.20 | .440 |
Oppositional defiant disorder | 1.08 | .89–1.32 | .096 |
Conduct disorder | .83 | .67–1.03 | .827 |
Mood disorders | |||
Depressive disorders | 2.12 | .90–4.97 | .084 |
Bipolar disorder | 1.24 | .94–1.64 | .126 |
Mood disorder not otherwise specified | .50 | .21–1.16 | .108 |
Disruptive mood dysregulation disorder | .38 | .15–.98 | .044* |
Anxiety and trauma-related disorders | |||
PTSD | 1.18 | .86–1.63 | .302 |
Tic disorders | .84 | .40–1.77 | .644 |
Epilepsy and seizure disorders | 1.01 | .77–1.31 | .956 |
At least one inpatient code in 2012 | 1.16 | .89–1.50 | .265 |
At least one emergency department visit in 2012 | 1.01 | .87–1.17 | .904 |
N of mental disorders in 2012 | 1.00 | .90–1.10 | .967 |
Discussion
Conclusions
Footnote
Supplementary Material
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