Evidence map›Paper›PMID 32052173›Full record

ArticleEuropean child & adolescent psychiatry2020

Prescribing antipsychotics in child and adolescent psychiatry: guideline adherence.

Mariken Dinnissen, Andrea Dietrich, Judith H van der Molen, Anne M Verhallen, Ynske Buiteveld, Suzanne Jongejan, Pieter W Troost, Jan K Buitelaar, Pieter J Hoekstra, Barbara J van den Hoofdakker

Abstract read
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In one paragraph

Article in European child & adolescent psychiatry, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

21 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
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  15. Updated European guidelines for Tourette syndrome: and now use them!European child & adolescent psychiatry · 2022
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  20. What happened to the concept of adolescence crisis?European child & adolescent psychiatry · 2020
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Mariken DinnissenDepartment of Child- and Adolescent Psychiatry, University Medical Center Groningen, University Center of Child and Adolescent Psychiatry, University of Groningen, P.O. Box 660, 9700 AR, Groningen, The Netherlands. m.dinnissen@umcg.nl.ORCID http://orcid.org/0000-0003-3856-5536
Andrea DietrichDepartment of Child- and Adolescent Psychiatry, University Medical Center Groningen, University Center of Child and Adolescent Psychiatry, University of Groningen, P.O. Box 660, 9700 AR, Groningen, The Netherlands.
Judith H van der MolenDepartment of Child- and Adolescent Psychiatry, University Medical Center Groningen, University Center of Child and Adolescent Psychiatry, University of Groningen, P.O. Box 660, 9700 AR, Groningen, The Netherlands.
Anne M VerhallenDepartment of Child- and Adolescent Psychiatry, University Medical Center Groningen, University Center of Child and Adolescent Psychiatry, University of Groningen, P.O. Box 660, 9700 AR, Groningen, The Netherlands.
Ynske BuiteveldDepartment of Child- and Adolescent Psychiatry, University Medical Center Groningen, University Center of Child and Adolescent Psychiatry, University of Groningen, P.O. Box 660, 9700 AR, Groningen, The Netherlands.
Suzanne JongejanDepartment of Child- and Adolescent Psychiatry, University Medical Center Groningen, University Center of Child and Adolescent Psychiatry, University of Groningen, P.O. Box 660, 9700 AR, Groningen, The Netherlands.
Pieter W TroostDe Bascule Child- and Adolescent Psychiatry Center Amsterdam, Amsterdam, The Netherlands.
Jan K BuitelaarDepartment of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Pieter J HoekstraDepartment of Child- and Adolescent Psychiatry, University Medical Center Groningen, University Center of Child and Adolescent Psychiatry, University of Groningen, P.O. Box 660, 9700 AR, Groningen, The Netherlands.
Barbara J van den HoofdakkerDepartment of Child- and Adolescent Psychiatry, University Medical Center Groningen, University Center of Child and Adolescent Psychiatry, University of Groningen, P.O. Box 660, 9700 AR, Groningen, The Netherlands.

Funding

ZonMw (NL) 836021020
6 · The paper itself

Abstract

Antipsychotics are often prescribed to children and adolescents, mostly off-label. We aimed to assess adherence to recommendations of guidelines for antipsychotic prescription. We reviewed 436 medical records from 155 clinicians from 26 clinics within three Dutch child and adolescent psychiatry organizations (n = 398 outpatient, n = 38 inpatient care). We assessed target symptoms, diagnostic process, prior and concomitant treatment, and consideration of contra-indications. Multiple logistic regression assessed the role of age, sex, and psychiatric diagnosis on adherence to three main recommendations: to (1) prescribe antipsychotics only after other treatments proved insufficient, (2) always combine antipsychotics with psychosocial interventions, and (3) not prescribe multiple antipsychotics simultaneously. Most patients received off-label antipsychotics. Main target symptoms were inattention/hyperactivity (25%), aggression (24%), and other disruptive behaviors (41%). Most patients underwent diagnostic evaluation before the first prescription; however, screening of contra-indications was low (0.2-19%). About 84% had previously received psychosocial treatment and 48% other psychoactive medication, but 9% had not received any treatment. Notably, only 37% continuously received concomitant psychosocial treatment. Simultaneous use of multiple antipsychotics occurred in 3.2%. Younger children were at higher risk of non-adherence to guideline recommendations regarding prior and concomitant treatment, children with autism spectrum disorder or attention-deficit/hyperactivity disorder more likely not to receive concomitant psychosocial treatment. Sex did not significantly affect adherence. Our findings implicate insufficient adherence to important recommendations regarding antipsychotic use in children and adolescents. Especially younger children are at higher risk of receiving suboptimal care. There is an urgency to consistently offer psychosocial interventions during antipsychotic treatment.

Indexed as

AdolescentAdolescent PsychiatryAntipsychotic AgentsChildChild, PreschoolFemaleGuideline AdherenceHumansMalePsychotic DisordersAntipsychotic AgentsAdolescentsAntipsychoticsChildrenGuidelinesPrescription

Identifiers

PMID32052173
PMCPMC7641940

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.