Northampton Electronic Collection of Theses and Research

Off-label psychotropic prescribing for young persons in medium security

Haw, C. and Stubbs, J. (2010) Off-label psychotropic prescribing for young persons in medium security. Journal of Psychopharmacology. 24(10), pp. 1491-1498. 0269-8811.

Item Type: Article
Abstract: Psychotropic drug prescribing for children and adolescents is frequently off-label and has increased over time and can be controversial. Psychotropic prescribing in two large UK medium secure units for young people has been studied. A total of 89 patients were included, 64% being aged less than 18 years. A total of 137 of 202 (67.8%) of prescriptions were off-label. The most common reasons for a prescription being off-label were the indication (N = 103) and the patient's age (N = 41). The main classes of drugs involved were antipsychotics (N = 59), antiepileptics as mood stabilisers (N = 22), anticholinergics and hyoscine (N = 15) and antidepressants (N = 11). Aggression (N = 48) and post-traumatic stress disorder (N = 30) were the most common off-label indications. Some antidepressant prescriptions were contrary to advice of the Committee on Safety of Medicines (CSM). Meta-analyses or randomised controlled trials supported 27% of off-label prescriptions, with lesser quality studies supporting a further 29.2% and expert opinion 38.7%, whereas for 5.1% no evidence could be found. Prescribers tended to over-estimate the level of evidence from clinical trials or extrapolated from findings in adults. They often quoted their own experience rather than expert sources to justify their prescribing practice. It is important that prescribers are fully aware of the quality of experimental data and the risk-benefit ratio when prescribing off-label for young persons. If the evidence base is limited, it is particularly important to provide information about the risks and benefits of the treatment to the patient/relatives. A second opinion may be helpful. Both target symptoms and side effects should be monitored and regularly reviewed.
Uncontrolled Keywords: adolescent psychiatry, evidence-based practice, mental retardation, off-label, paediatric psychopharmacology, prescribing practices, psychiatric practice, risks and benefits, unlicensed indications
Subjects: R Medicine > RJ Pediatrics > RJ499 Mental disorders. Child psychiatry > RJ503 Adolescent psychiatry
R Medicine > RM Therapeutics. Pharmacology > RM138 Drug prescribing
R Medicine > RM Therapeutics. Pharmacology > RM300 Drugs and their actions > RM315 Psychopharmacology
Creators: Haw, Camilla and Stubbs, Jean
Publisher: SAGE Publications
Northamptonshire and East Midlands: Health
Faculties, Divisions and Institutes: University Faculties, Divisions and Research Centres - OLD > Faculty of Health & Society > Mental Health and Learning Disability
Faculties > Faculty of Health & Society > Nursing
Date: 24 October 2010
Date Type: Publication
Page Range: pp. 1491-1498
Journal or Publication Title: Journal of Psychopharmacology
Volume: 24
Number: 10
Language: English
ISSN: 0269-8811
Status: Published / Disseminated

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