Off-label antipsychotic treatment in children and adolescents
Off-label antipsychotic treatment in children and adolescents
Antipsychotic medicines are often prescribed to youth for conditions for which they have not been officially approved, treating behavioural problems, for example. This is accompanied by crucial knowledge gaps. The thesis by Mariken Dinnissen therefore examined how these medicines are used in clinical practice, whether long-term treatment with the antipsychotic risperidone remains effective and safe, what happens when risperidone is discontinued, and why recruiting young people for clinical studies can be difficult.
A review of medical records showed that recommendations for the use and monitoring of antipsychotics were not always followed. This was particularly the case in younger children and in children with autism or ADHD. On the other side, other treatments had usually been tried before starting an antipsychotic, and clinicians generally monitored whether the medication was effective. Clinical practice would benefit from one comprehensive guideline, and clinicians should be facilitated to work according to guideline recommendations.
A placebo-controlled discontinuation study in children who had used risperidone for at least a year showed that the medicine was still effective in reducing behavioural problems. Some participants were able to discontinue successfully, but more than half deteriorated behaviourally and dropped out of the study. At the same time, discontinuation had important health benefits though, making it important to consider discontinuation regularly.
This thesis also shows that clinical studies in this field need to be easier for children and parents to participate in and better integrated into routine mental healthcare.