Prevalence and patterns of psychotropic and anticonvulsant medication use in children and adolescents referred to residential treatment

The prevalence and patterns of use of psychiatric and anticonvulsant medications were studied in 83 seriously emotionally disturbed children and adolescents at the time of their admission to a residential treatment facility. Youths (aged 5-19, mean = 13.6 years), consecutively admitted over 17 months, were assessed for the prevalence and patterns of use of psychotropic and anticonvulsant treatments. At admission, 76% of the youths were receiving psychiatric pharmacotherapy, 40% with more than one psychiatric agent, and 15% with a combination of psychotropic and anticonvulsant medications. Frequently prescribed medications were neuroleptics (35% of the medicated youths), sedative-hypnotics (26%), and anticonvulsants (15%). Psychostimulants (16%) and antidepressants (22%) were under-prescribed relative to their diagnostic indications. Over 50 different medication combinations were used. The neuroleptic + lithium combination was most common (25% of the polypharmacological treatments). Neuroleptics were the most commonly prescribed medication and mostly used for nonpsychotic, nontic, and nonbipolar indications (55% of neuroleptic trials). Neuroleptics were used primarily for aggression regardless of diagnosis. Neuroleptics were used more in symptomatic treatments than in treatments for indicated diagnoses. The high prevalence of psychiatric and antiepileptic medication use in children and adolescents admitted to a residential treatment facility, and especially the pattern of their use, raises questions about prescribing practices for youths entering residential treatment and about pediatric psychopharmacotherapy in general.