Prescribing practices characterized in many of these studies are considered outside of regulatory-approved indications or so-called off-label prescribing. Post-marketing pharmacoepidemiology studies characterize the “real-world” utilization, safety, and effectiveness trends of these agents. In Canada, only aripiprazole is approved for use in people under the age of 18 years ( Bristol-Myers Squibb Canada, 2011). Others are FDA approved for schizophrenia, bipolar mania, and irritability/aggression related to autistic disorder ( Correll, Kratochvil, & March, 2011). For example, in children and adolescents, risperidone received approval from the FDA in 2006 for irritability-related behaviors associated with autism ( US Food and Drug Administration (US FDA), 2006) and in 2007 for schizophrenia (aged 13–17 years) and short-term treatment of mixed or manic episodes of bipolar I in children and adolescents (aged 10–17 years) ( US FDA, 2007). In the United States, several second-generation antipsychotics have specific Food and Drug Administration (FDA)-approved pediatric indications, whereas in Canada this is limited to one agent. Regulatory-approved indications for antipsychotics differ among various age groups and regions globally, including between the United States and Canada.
Important gaps exist within the health system that are creating opportunities for the initiation and continued use of these agents.Īntipsychotics are a mainstay of treatment for mental illnesses such as schizophrenia and bipolar disorder. Our results provide knowledge regarding the prescribers’ experience of antipsychotics for children and adolescents.
Physicians prescribed antipsychotics to youth for a range of indications and had significant concerns regarding adverse effects. Struggles with health system gaps were significant leading to the use of antipsychotics as substitutes for other treatments. We identified themes related to context, role and identity, and decision-making and filtering. In all, 11 physicians including psychiatrists and general practitioners participated in our study. We used a staged approach for data analysis of transcriptions. Prescribers participated in individual interviews and a focus group.
We conducted a qualitative study using an interpretive phenomenological analysis of physicians’ experiences of antipsychotic prescribing to children and adolescents. There is a lack of qualitative data in this area, and the experience of prescribing antipsychotics to children and adolescents has not been adequately researched. Many pharmacoepidemiology trend studies have been published, and interpretations of these data are helpful in explaining what is happening in prescribing practices, but not why these patterns exist. There are significant controversies regarding rising antipsychotic prescription trends in children and adolescents.
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