January 10, 2023

expert reaction to study on prescriptions of antipsychotics to children and adolescents from 2000-2019

A study published in Lancet Psychiatry looks at trends in antipsychotic prescribing to children and adolescents in England from 2000-2019.

Prof Emily Simonoff, Professor of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology & Neuroscience, King’s College London (IoPPN), said:

“This study uses the well-known Clinical Practice Research Database to follow rates of prescriptions of antipsychotic medication for children and young people over two decades.  To clinicians, it  will not be surprising that the authors demonstrate an increase in rates of prescriptions over that time period, as there has been a steadily emerging evidence base for the benefits of this group of medication for a range of different indications, which has been further supported by  new licensing indications and recommendations from NICE.  Indeed, the term ‘antipsychotics’ is not helpful either for clinicians or the wider public.  It describes the way in which this class of medication was first used, rather than their mode of action.  This could inadvertently lead people to consider any use that is not for a psychotic disorder to be unwarranted.  This is not the case, and there is good evidence for their benefits for other conditions such as irritability in autism spectrum disorder. However, it should also be noted that NICE recommendations for their use in many conditions is as part of a multi-modal treatment plan, for example including psychological or behavioural interventions.  This study was not able to determine whether such recommendations were being followed or medication was being used on its own.  It is reassuring that prescribing rates remain very low in the youngest children and that their use is not subject to a post-code lottery (in either direction). The authors point to longer duration of prescribing and rightly highlight the need for high-quality, longer-term  studies on  efficacy and, most importantly adverse effects.  This should be a research priority.”

‘Trends in antipsychotic prescribing to children and adolescents in England: cohort study using 2000–19 primary care data’ by Maja R Radojčić et al. was published in Lancet Psychiatry at 23:30 UK time on Tuesday 10^th January.

DOI: https://doi.org/10.1016/S2215-0366(22)00404-7

Declared interests

Prof Emily Simonoff: Emily Simonoff is Professor of Child and Adolescent Psychiatry at King’s College London and Interim Director of the King’s Maudsley Partnership for Children and Young People.  She was a member of the NICE Guideline Development Group for the management of autism (NICE Clinical Guideline 170) and has published on  the efficacy of antipsychotic medication for irritability in autism. e/g/. Salazar de Pablo, G., Jorda, C. P., Vaquerizo-Serrano, J., Moreno, C., Cabras, A., Arango, C., Hernandez, P., Veenstra-VanderWeele, J., Simonoff, E., Fusar-Poli, P., Santosh, P., Cortese, S., & Parellada, M. (2022). Systematic Review and Meta-analysis: Efficacy of Pharmacological Interventions for Irritability and Emotional Dysregulation in Autism Spectrum Disorder and Predictors of Response. J Am Acad Child Adolesc Psychiatry. https://doi.org/10.1016/j.jaac.2022.03.033