Psychotropic prescription practices in child psychiatric inpatients 9 years old and younger

OBJECTIVE: We set out to examine psychotropic prescribing patterns among inner city children on public assistance admitted to a university-based inpatient service. METHODS: A chart review of children 9 years old and younger admitted between 1998 and 2001 recorded demographic variables, diagnoses, and admission and discharge medications. RESULTS: The sample (N = 301) was 78% male, 66% African American, and averaged 7.2 years of age. Of this sample, 85% had a behavior disorder on admission and discharge; 51.8% of the patients were medicated on admission, 78.7% on discharge. Approximately 25% received polypharmacy on either admission or discharge. Stimulants were the most widely used psychotropic (38.2% on admission, 60.5% on discharge). Other medications prescribed at admission versus discharge were alpha-2 agonists (9.3% vs. 9%), atypical antipsychotics (9% vs. 12%), antidepressants (8.3% vs. 15.9%), and mood stabilizers (5.6% vs. 2.3%). CONCLUSIONS: Among inner city children, pharmacotherapy is more prevalent in an inpatient unit compared with the community standard. Community physicians prescribed more mood stabilizers; the academic faculty used more stimulants, atypical antipsychotics, and antidepressants. Predictors of pharmacotherapy in the community such as age, sex, race, and a behavior disorder shifted at discharge to include only length of stay and a behavior disorder diagnosis. Further research is needed to clarify whether nonadherence, treatment failure, and social factors account for lower medication utilization in the community.