The majority of children, adolescents and young adults prescribed antipsychotic medications have not been diagnosed with a mental disorder, according to a recent study published in JAMA Psychiatry. The study, led by Mark Olfson from Columbia University, examined trends in the treatment of young people with antipsychotics in the United States between 2006 and 2010 and raised concerns about the safety and efficacy of prescription practices.

“Most of the younger children (60.0%), older children (56.7%), adolescents (62.0%), and young adults (67.1%) treated with antipsychotics had no outpatient or inpatient claim that included a mental disorder diagnosis,” the study said.

Among those who did receive a diagnosis for a mental disorder, the study raised the additional concern that antipsychotics had not been FDA approved for treatment. Although the FDA has approved the use of antipsychotics for diagnoses such as schizophrenia and bipolar disorder, many children, teens and young adults are prescribed these medications off-label. In children and adolescents treated with antipsychotics the most common accompanying diagnoses are ADHD and depression.

The authors advise that the frequency with which antipsychotic medications are being prescribed by non-psychiatrists may point to potential gaps in treatment for children presenting for mental health care. This finding was especially concerning for preschool aged children who were found to be in the age group least likely to receive antipsychotic prescriptions from a psychiatrist.

Clinical guidelines suggest extreme caution in the use of antipsychotic medications with young children. Due to the possibility of serious side-effects, antipsychotics are suggested only in the most severe cases and should be paired with psychosocial interventions. Of those prescribed antipsychotic medications, however, only 13.5 % of younger children, 20.4% of older children, 24.8% of adolescents and 18.8% of young adults were found to have a claim for psychotherapy.

The study’s lead author, Dr. Olson, commented:

“Relatively few of these young people are receiving psychotherapy. We may need to put greater effort into increasing access to psychosocial interventions that can treat symptoms and behaviors that are currently being addressed with antipsychotic medications.” (Source)

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Olfson M, King M, Schoenbaum M. Treatment of young people with antipsychotic medication in the US. JAMA Psychiatry.(Full Text)