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Concomitant Psychotropic Medications Overprescribed in Foster-Care Youth: Presented at AACAP

By Maria Bishop

BOSTON, MA -- October 31, 2007 -- Nearly 20% of youths in foster care receiving psychotropic medications received two or more such drugs in the same drug class, in a study presented here at the 54th Annual Meeting of the American Academy of Child & Adolescent Psychiatry (AACAP).

Professionally developed monitoring guidelines would help to validate any necessary prescriptions for multiple psychotropic medications, noted lead author Julie M. Zito, PhD, MS, Associate Professor in Pharmacy and Psychiatry, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland, United States.

Dr. Zito and colleagues selected a random sample (n = 472) from a total of 32,135 Medicaid foster-care enrolees in Texas in 2004. All subjects were 19 years of age or younger (64% over the age of 10; 5% were age 4 years and under) and all received at least one psychotropic drug in the study year (2004).

The psychotropic drugs were classified under 8 drug descriptions: anticonvulsants; alpha agonists; antianxiolytics; antidepressants (selective serotonin reuptake inhibitors, tricyclic antidepressants, other); antipsychotics (atypical and conventional); ADHD drugs (amphetamines, methylphenidate, atomoxetine); lithium; and miscellaneous.

Results demonstrated that nearly 73% of subjects were prescribed two or more psychotropic agents (in separate classes) concomitantly, while more than 41% received three or more; more than 15% received four or more drugs, and more than 2% received five or more.

Psychiatrists wrote 93% of the prescriptions for the children in this study.

Clinician-reported diagnoses indicated the following: attention-deficit hyperactivity disorder (38.8%), depression (35.5%), adjustment/anxiety (33.7%), bipolar (17.2%), and oppositional defiant disorder/conduct disorder (20.6%).

Concomitant drug use in this study was assessed manually using patient-level computerised claims data from the month of July, 2004.

Previous studies on the prevalence of multiple psychotropic medications in foster-care children have included medication claims for periods of 7 days (underestimating coprescribing) and for periods of 3, 6 and 12 months (overestimating coprescribing), Dr. Zito noted. Further more realistic data are needed to validate the use of psychotropic drugs and to ensure their effective and safe use in this at-risk population, he added.

Prescriptions for psychotropic medication for youths in foster care in the United States in general far exceed prescriptions made to similar Medicaid-insured youth who qualify because of low family income, according to the researchers.


[Presentation title: Psychotropic Medication Patterns Among Foster-Care Youth: Abstract A16]

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