Trends in antipsychotic prescribing for children in UK primary care

Date of Approval: 
2018-04-18 00:00:00
Lay Summary: 
Increasing numbers of children across Europe and the US are prescribed mental health medications. Preliminary studies suggest this is also the case for antipsychotic drugs. These are drugs designed to treat psychotic disorders such as schizophrenia; however, there is evidence suggesting they are increasingly prescribed for other uses in children such as challenging behaviour. These medications have numerous side effects including weight gain and drowsiness, of which children are at greater risk. We have little understanding about which children are prescribed these medications and for what purpose. There is also limited evidence about their safety in children leading to controversy about whether this increase in prescriptions is appropriate. This study will analyse the Clinical Practice Research Database (CPRD) which contains data from patients registered with General Practices, representing 6.9% of the UK population. We aim to examine rates of antipsychotic prescribing in children between 2000 and 2017 and the factors associated with this, such as age, gender and social deprivation level. This will provide vital information to help understand the reasons for any changes in the rates in antipsychotic prescribing and which children are affected by this. This information could help develop guidelines to protect their safety.
Technical Summary: 
Evidence suggests that the rate of prescribing of psychotropic medication has increased among children and adolescents across Europe and the US since the 1990s; and that this pattern has also been seen with antipsychotics. However, we have limited data about trends in UK antipsychotic prescribing in children within the last five years; and we also have a limited understanding of the factors associated with these prescriptions. This exploratory cohort study will use CPRD-Gold data to examine changes in antipsychotic prescription rates in 3 to 17 year olds from 2000 to 2017. It will examine the overall prevalence of antipsychotic prescribing amongst children and the rate of first antipsychotic prescriptions each year. Read codes for psychosis and other indications for antipsychotics will be identified and temporally linked to first antipsychotic prescriptions. We shall then examine changes in the rates of first generation antipsychotics (FGAs) vs. second generation antipsychotics (SGAs) and in individual SGAs. We shall also investigate changes in indications for these prescriptions over time and changes in rates of prescriptions in different ages, genders and socio-economic status.
Health Outcomes to be Measured: 
Changes in rates of antipsychotic prescriptions in children over time, measured by yearly incidence of prescriptions from 2000-2017 Overall prevalence of antipsychotic prescriptions in children between 2000 and 2017 Changes in the incidence of indications for antipsychotic prescriptions in children from 2000-2017 How prescription rates of first generation vs. second generation antipsychotics and the indications associated with them change in children from 2000-2017 How prescription rates of individual second generation antipsychotics and their indications change in children from 2000-2017 How yearly incidence of antipsychotic prescriptions and their indications in children from 2000-2017 varies according to gender, age and practice-level IMD
Application Number: 

Kathryn Abel - Chief Investigator - University of Manchester
Holly Hope - Corresponding Applicant - University of Manchester
Darren Ashcroft - Collaborator - University of Manchester
Eleanor Swift - Collaborator - University of Manchester
Matthias Pierce - Collaborator - University of Manchester
Nejla Cemre Su Osam - Collaborator - University of Manchester
Rosa Parisi - Collaborator - University of Manchester

Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation