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Annotation: The use of psychotropic medications in children: a British view
1Telford & Wrekin Primary Care Trust, Harlescott, Shrewsbury, UK. brambo@waitrose.com
Insights
Psychotropic medication use in children is increasing in Britain, with child psychiatrists and general practitioners prescribing a variety of drugs. However, research highlights methodological weaknesses and a need for improved training and objective evaluation of prescribing practices.
Area of Science:
- Child and Adolescent Psychiatry
- Pediatric Pharmacology
- Evidence-Based Medicine
Background:
- Prescribing practices for psychotropic medications in mentally disordered children have evolved significantly in Britain.
- There is a growing body of empirical data on prescribing patterns among child psychiatrists, pediatricians, and general practitioners.
Purpose of the Study:
- To review existing empirical data on psychotropic medication prescribing practices for children in Britain.
- To examine postgraduate training guidelines and identify areas for improvement.
Main Methods:
- A review of empirical data from postal questionnaire studies, British drug studies, and government-sponsored evaluations.
- Analysis of postgraduate training guidelines for child psychiatrists, pediatricians, and general practitioners.
Main Results:
- Methodological weaknesses, such as reliance on retrospective clinician reports, were noted in reviewed studies.
- Child psychiatrists and general practitioners exhibit variations in prescribing practices for various conditions.
- A significant increase in methylphenidate use for Attention Deficit Hyperactivity Disorder (ADHD) and growing use of newer antipsychotics and SSRI antidepressants in child psychiatric practice were observed.
- Many clinicians feel inadequately trained and request further education in psychotropic medication prescribing.
Conclusions:
- Despite training shortcomings, the use of psychotropic medication in British child psychiatry is becoming more informed and widespread.
- Future research should focus on objective evaluation of prescribing practices to enhance training and service development.
Background:
Prescribing practices relating to the use of psychotropic medication with mentally disordered children have changed significantly in Britain over recent years.
Methods:
I conducted a review of the modest body of empirical data available relating to the prescribing practices of child psychiatrists, paediatricians and general practitioners (primary care physicians). The data were obtained primarily from postal questionnaire studies but also from British drug studies and a government-sponsored evaluation of the efficacy of stimulant medication. Postgraduate training guidelines for the three principal clinical disciplines are also discussed.
Results:
Systematic evaluation of prescribing practices has a relatively short history. All the studies reviewed demonstrated consistent methodological weaknesses, the most important of which was reliance upon retrospective reports of prescribing practices from clinicians with no analysis of actual prescription data. No studies relating to the general use of psychotropic medication by paediatricians were found. Child psychiatrists and general practitioners appear to be using a range of drugs for a range of conditions; however, there was evidence of intra- and interdisciplinary variations in practice. It was also evident from the general practitioner data that drug treatments were frequently used for conditions best managed with behavioural methods (e.g., common sleep problems and enuresis). Government prescription data relating to methylphenidate use in ADHD reveal a dramatic rise over the past ten years. Currently, most child psychiatrists use this treatment compared to approximately half the profession only seven years ago. The use of newer antipsychotic agents as well as the SSRI antidepressants appears to be growing in child psychiatric practice. A majority of clinicians surveyed believed that medication was an important treatment modality but also felt that they were relatively unskilled in the field and requested further training.
Conclusions:
Overall, a picture of both a growing and better informed use of psychotropic medication is emerging in Britain despite shortcomings in postgraduate training. Future research needs to evaluate prescribing practice in a more objective manner in order to improve training and also service developments in the field.