Discontinuing Antipsychotics in Children

Summary and Comment |
September 26, 2017

Discontinuing Antipsychotics in Children

  1. Barbara Geller, MD

Children hospitalized for severe aggression at a state psychiatric facility were able to taper antipsychotic medication without worsening of symptoms while receiving structured behavioral therapy.

  1. Barbara Geller, MD

Antipsychotic medications are FDA-approved in children and adolescents for treatment of schizophrenia, bipolar disorder, autism (for irritability), and Tourette syndrome. However, the vast majority of prescriptions are for off-label diagnoses (NEJM JW Psychiatry Jul 2006 and Arch Gen Psychiatry 2006; 63:679). To examine the effect of antipsychotic tapering in hospitalized youth, investigators reviewed the charts of 74 consecutively admitted patients (age range, 6–16 years; age <12, 43%; 75% male) hospitalized for severe aggression unresponsive to outpatient interventions.

Most patients (76%) had histories of trauma and averaged three diagnoses, including disruptive disorder (52%), anxiety (23%), and mood disorder (7%). None of the patients had FDA-approved diagnoses for antipsychotics in youth.

At admission, patients were prescribed 232 unique psychotropic drugs, including antipsychotics (91%), stimulants (43%), mood stabilizers (42%), and antidepressants (33%). Of the 66 patients on antipsychotics at admission, 56 discontinued and 10 continued. Both groups had intensive behavioral interventions (mean treatment duration, about 200 days) and showed significant improvements in global functioning and aggressive behaviors. Patients who discontinued antipsychotics had decreased depression scores, weight, and body-mass index. In contrast, those who continued antipsychotics had increased depression scores. Fire setting, delinquency, and bullying did not change in either group.

Comment

These findings strongly support tapering antipsychotics in hospitalized children receiving them for severe aggressive behaviors. Translating tapering regimens to the outpatient setting will be challenging because intensive, multimodal interventions comparable to those provided at the state hospital are lacking. Regrettably, even in a highly contained environment, antisocial behaviors (e.g., firesetting) continued.

Editor Disclosures at Time of Publication

  • Disclosures for Barbara Geller, MD at time of publication Nothing to disclose

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