New Rx Guidelines May Keep Kids Out of ER

Antipsychotic medications in children and adolescents tied to increase in emergency room visits

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) The guidelines for prescribing antipsychotics to kids are changing — and those changes may keep kids safer.

The rate of emergency room visits among children and teens taking antipsychotic medications skyrocketed from the mid-1900s to the mid-2000s, a new study found. Side effects from these medications were often the culprits behind these ER visits.

Doctors may have prescribed these medications more often than needed, suggested lead study author Lee M. Hampton, MD, of the Centers for Disease Control and Prevention in Atlanta, and colleagues.

The latest version of the Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM-5) — the go-to resource for mental health professionals — was released in May 2013. It included revisions meant to set clearer guidelines for which pediatric disorders should be treated with antipsychotics.

It's a little early to tell, but it is hoped that setting new guidelines will bring those ER visit numbers down, Dr. Hampton and team said.

Between 1999 and 2002, kids were prescribed antipsychotics for many disorders. These included behavior disorders, schizophrenia, bipolar disorder, mood disorders and obsessive–compulsive disorder. About a third of the antipsychotics were prescribed for mood disorders like major depression.

Clozapine (brand name Clozaril), risperidone (brand name Risperdal) and olanzapine (brand name Zyprexa) are antipsychotics sometimes given to kids and young adults, according to a past study published in Advances in Psychiatric Treatment.

Those prescriptions to kids may have come at a cost, according to Dr. Hampton and colleagues.

The number of visits to the ER due to antipsychotics increased by 660 percent among children younger than 10 from the mid-1990s to the mid-2000s, these researchers found. In adolescents between the ages of 11 and 18, that figure increased by 380 percent.

Movement problems were the most common side effects of these medications seen in the ER. The patients had spastic muscles and abnormal, slow or uncontrolled movements.

"The higher rates of antipsychotic [side effect-related ER] visits should remind clinicians of antipsychotics' risks and of the importance of heeding the American Psychiatric Association's warning that antipsychotics should be used cautiously," Dr. Hampton and team wrote.

This study was published online Jan. 14 in JAMA Psychiatry.

Dr. Hampton and colleagues disclosed no relevant funding sources or conflicts of interest.

Review Date: 
January 13, 2015
Last Updated:
January 15, 2015