This Month in Psychopharmacology

Antipsychotic Medications and Mortality in Children and Young Adults

Children and young adults are commonly prescribed antipsychotics, particularly for attention-deficit/hyperactivity disorder, disruptive behavior disorder, and depression. A recent retrospective cohort study investigated the association between oral second-generation antipsychotic medication use and all-cause mortality in a large national population of children and young adults. The cohort included 2,067,507 Medicaid patients aged 5 to 24 years, initiating treatment between 2004 and 2013. Individuals with schizophrenia or related psychoses or severe somatic disease in the past year were excluded. The risk of mortality was compared across groups prescribed antipsychotics and control psychotropic medications. A total of 8,228,850 antipsychotic prescriptions were filled during follow-up. Prescriptions were most common for risperidone (45.4%), aripiprazole (25.0%), quetiapine (20.3%), ziprasidone (3.9%), and olanzapine (2.9%). A total of 13,520,975 control prescriptions were filled during follow-up. The most commonly prescribed control medications were clonidine (19.7%), atomoxetine (10.7%), guanfacine (10.5%), and sertraline (9.9%). The following factors were associated with increased likelihood of being prescribed an antipsychotic: male sex, Medicaid enrollment related to disability or foster care, and residing in a metropolitan area with a population of 1 million or greater. Antipsychotic use and larger doses were associated with psychiatric comorbidities of bipolar disorder, stress, conduct disturbances, autism, and recent institutionalization. Lower doses of antipsychotic medications (=100 mg chlorpromazine equivalents) were not associated with increased mortality, but higher doses were linked to a significant rise in the risk of death, particularly due to drug overdoses and non-overdose unintentional injuries. The association with mortality was observed in young adults (18–24 years) but not children (5–17 years). The findings suggest that higher doses of antipsychotic treatment in young adults without severe somatic disease or diagnosed psychosis may be associated with an increased risk of mortality, warranting further investigation and caution in prescribing practices.


Ray WA et al. JAMA Psychiatry; Epub ahead of print. Abstract

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