Antipsychotic prescribing trends among children and adolescents in Denmark: A historical cohort study based on register data
Authors
Strandgaard, Signe Helena Sehested ; Ahmed, Yasmin Abdirisak
Term
4. term
Publication year
2024
Abstract
The aim of this historical cohort study was to describe trends in antipsychotic prescribing and use among Danish children and adolescents (aged 0–17) with psychiatric diagnoses between 1995 and 2013. Using nationwide registers (the National Patient Register, the National Prescription Register, and the Civil Registration System), the study linked diagnoses, prescriptions, age, sex, and region, and derived the most likely treatment indication from diagnoses recorded within six months around a prescription. Treatment discontinuation was defined as a 280-day gap without a new prescription. Trends were summarized as annual period prevalence and cumulative incidence, stratified by first- and second-generation antipsychotics (FGA/SGA), sex, age group, and region; joinpoint analysis identified significant changes over time, and logistic regression examined factors associated with receiving SGA vs FGA, treatment vs no treatment, and longer vs shorter treatment duration. The annual prevalence of antipsychotic use doubled, while cumulative incidence decreased, suggesting longer treatment periods, especially among those aged 13–17. Among recipients, more were male than female. SGA use increased over time, whereas FGA use declined. The most common approved indications were psychosis, affective disorders, and autism spectrum disorders, while adjustment disorder, ADHD, and conduct disorder were the most frequent unapproved indications. Risperidone and chlorprothixene were the most commonly redeemed drugs. The findings indicate substantial off-label use across indications and age groups and highlight the need for careful evaluation of safety and evidence in this population.
Formålet med dette historiske kohortestudie var at beskrive udviklingen i ordination og brug af antipsykotika blandt danske børn og unge (0–17 år) med psykiatriske diagnoser i perioden 1995–2013. Ved hjælp af landsdækkende registre (Landspatientregistret, Lægemiddelstatistikregisteret og Det Centrale Personregister) blev diagnoser, recepter, alder, køn og region koblet, og den sandsynlige behandlingsindikation blev afledt af diagnoser givet inden for seks måneder omkring en recept. Behandlingsophør blev defineret som 280 dage uden ny recept. Tendenser blev beskrevet med årlig periodeprævalens og kumulativ incidens, stratificeret efter første- og andengenerations antipsykotika (FGA/SGA), køn, alder og region; statistiske skift i tendenser blev vurderet med joinpoint-analyse, og logistisk regression blev anvendt til at undersøge faktorer for valg af SGA vs. FGA, behandling vs. ingen behandling og længere vs. kortere behandlingsvarighed. Den årlige prævalens af antipsykotikabrug blandt børn og unge fordobledes, mens den kumulative incidens faldt, hvilket tyder på længere behandlingsforløb, særligt i aldersgruppen 13–17 år. Blandt dem, der modtog antipsykotika, var flere drenge end piger. SGAs viste stigende tendenser, mens FGAs faldt. Hyppigste godkendte indikationer var psykose, affektive lidelser og autismespektrumforstyrrelser, og hyppigste ikke-godkendte indikationer var tilpasningsreaktion, ADHD og adfærdsforstyrrelser. Risperidon og chlorprothixen var de mest indløste præparater. Resultaterne peger på udbredt off-label brug i både indikationer og aldersgrupper og understreger behovet for opmærksomhed på sikkerhed og dokumentation hos denne population.
[This apstract has been generated with the help of AI directly from the project full text]