(B-232) Antipsychotic use in youth and children: a cohort study from Catalonia (Spain) of treatment patterns

Background: Antipsychotics are prescribed to children and adolescents mostly off-label due to age and lack of indication. There is scarce information on their use and treatment patterns in these populations.

Objectives: To describe the use of antipsychotic and factors related to their use in children and adolescents in Catalonia, Spain.

Methods: Population based cohort study of children and adolescents with an antipsychotic treatment (over a month of duration) from 2008-2017. Data source: SIDIAP database (5.8 million health electronic records with information on sociodemographic, comorbidities, clinical parameters and medications). Inclusion criteria: patients < 18 years of age and with one antipsychotic prescription (WHO ATC classification group N05A). Descriptive estimates of patients' characteristics were calculated, and the association with concomitant or switching patterns was assessed using univariate analysis by means of Student’s t-test and Chi-square test.

Results: A cohort of 22,339 patients had an antipsychotic invoice. There were mainly males (N= 14,702, 65.8%) and almost half had 11 or less years old (N= 9,685, 43.4%) with 71.9% (N= 16,069) being referred to a psychiatrist.
Males from 6-11 years old had the highest consumption, (N=6,221, 42,3%). Risperidone was the most used antipsychotic (N=12,667, 56.7%) followed by aripiprazole (N=2,398, 10.7%). The average duration of the treatment was 9.2 months. A total of 3,272 (14.7%) children did not have a diagnosis associated with the antipsychotic treatment, being behavioral disorders (N=8,318, 37,2%), attention-deficit/hyperactivity disorder (N=7,228, 32,4%), anxiety (N=6,154, 27,5%) and autism (N=3,673, 16,4%) the most frequent ones, with different frequencies across groups of age.
A total of 9,466 (42.4%) children and adolescents had a completed follow-up episode (more than 1 prescription and 6 months of follow up after the last prescription). For this subcohort, there were 58.8% (N=5,568) that had another psychotropic drug concomitantly prescribed and 30.1% (N=2,853) that were added a psychotropic medication once started the antipsychotic, with 20.6% (N=1,947) switching from the antipsychotic to a different psychotropic medication. Being referred to the specialist or having an anxiety diagnosis were correlated with switching to a different group of psychotropic (OR 1.3, 95% CI 1.1=1.5 and OR 1.2, 95% CI 1.1-1.4, respectively) while for concomitantly use also the following diagnosis were a risk factor for this pattern (ADHD OR 2.3, 95% CI 2.0-2.6 , epilepsy OR 2.1, 95% CI 1.5-3.1, depression OR 2.5, 95% CI 2.0-3.2 and OR 2.1, 95% CI 1.6-3.0 eating disorders).

Conclusions: Antipsychotics are mainly use by preadolescents for different indications and concomitantly with other psychotropic drugs.