To what extent do medication experts agree on diagnoses derived from psychotropic medication prescribed for children and adolescents in a state Medicare database?

2021 ◽  
pp. 251610322110190
Author(s):  
Conor O’Brien ◽  
John T. Rapp

This study evaluated the extent to which psychotropic medication experts agreed on psychiatric/behavior diagnoses derived from 30 individuals’ psychotropic medication regimens. Three medication experts reviewed the medication regimens and inferred one or more diagnoses based on the medication listed. Thereafter, we used kappa statistical analyses and category-by-category analyses to evaluate agreement of diagnoses (a) across all three reviewers for two time points (separated by 8 to 14 months) covered by each data set, (b) across each pairing of reviewers at the two time points, and (c) within each reviewer across both time points. Between-reviewer kappa statistical analyses of first- and last-regimen data yielded only five instances with excellent agreement and 13 instances of poor agreement. All remaining instances indicated various levels of disagreement. Similarly, within-expert kappa statistical analyses showed two instances with excellent agreement, four instances with poor agreement, and the remaining instances with various levels of disagreement. Overall, the highest kappa values were attached to low-count regimens, while most scores, regardless of medication count, were low and indicated potential disagreement. The category-by-category analyses yielded similar results. A secondary, conditional analysis revealed higher agreements between and within reviewers when medication regimens contained psychotropic medications typically prescribed to individuals diagnosed with Attention Deficit Hyperactivity Disorder.

1999 ◽  
Vol 153 (10) ◽  
pp. 1039 ◽  
Author(s):  
Marsha D. Rappley ◽  
Patricia B. Mullan ◽  
Francisco J. Alvarez ◽  
Ihouma U. Eneli ◽  
Jenny Wang ◽  
...  

2013 ◽  
Vol 203 (2) ◽  
pp. 107-111 ◽  
Author(s):  
Marian L. Hamshere ◽  
Evangelia Stergiakouli ◽  
Kate Langley ◽  
Joanna Martin ◽  
Peter Holmans ◽  
...  

BackgroundThere is recent evidence of some degree of shared genetic susceptibility between adult schizophrenia and childhood attention-deficit hyperactivity disorder (ADHD) for rare chromosomal variants.AimsTo determine whether there is overlap between common alleles conferring risk of schizophrenia in adults with those that do so for ADHD in children.MethodWe used recently published Psychiatric Genome-wide Association Study (GWAS) Consortium (PGC) adult schizophrenia data to define alleles over-represented in people with schizophrenia and tested whether those alleles were more common in 727 children with ADHD than in 2067 controls.ResultsSchizophrenia risk alleles discriminated ADHD cases from controls (P = 1.04 × 104, R2 = 0.45%); stronger discrimination was given by alleles that were risk alleles for both adult schizophrenia and adult bipolar disorder (also derived from a PGC data-set) (P = 9.98 ×10−6, R2 × 0.59%).ConclusionsThis increasing evidence for a small, but significant, shared genetic susceptibility between adult schizophrenia and childhood ADHD highlights the importance of research work across traditional diagnostic boundaries.


2021 ◽  
pp. 000486742110677
Author(s):  
Julie Klau ◽  
Carla De Oliveira Bernardo ◽  
David Alejandro Gonzalez-Chica ◽  
Melissa Raven ◽  
Jon Jureidini

Objective: To examine trends in prescribing psychotropic medications to children and adolescents in Australian primary care from 2011 to 2018. Method: A retrospective cohort study examined prescriptions written by general practitioners using MedicineInsight, a large Australian primary care database, covering approximately 9% of all general practitioner practices. Numbers of patients receiving prescriptions for five main classes of psychotropics (antipsychotics, antidepressants, attention deficit hyperactivity disorder medications, anxiolytics, and hypnotics/sedatives [including benzodiazepines and Z-drugs, but excluding melatonin]) were examined annually by age-group (0–4, 5–9, 10–14, 15–18 years). Melatonin was analysed separately. Results: The number of patients prescribed any psychotropic increased from 25.6 to 36.2 per 1000 individuals from 2011 to 2018 (average annual increase +4.5%, 95% confidence interval [4.1%, 4.9%]; overall +41.4%). Among the five main classes, the largest annual increase was for attention deficit hyperactivity disorder medications (+9.6%, 95% confidence interval [8.8%, 10.5%]; overall +95.8%), followed by antipsychotics (+6.2%, 95% confidence interval [5.0%, 7.3%]; overall +62.8%) and antidepressants (+4.5%, 95% confidence interval [4.0%, 5.0%]; overall +42.8%). Hypnotic/sedative prescribing decreased on average 6.5% per year (95% confidence interval [–8.0%, –5.0%]; overall −40.2%). Anxiolytic prescribing remained steady. Melatonin prescriptions showed the highest increase of all (+24.7%, 95% confidence interval [23.7%, 25.8%]; overall +606.7%). The largest annual increase in antipsychotic, antidepressant or attention deficit hyperactivity disorder medication prescribing occurred in 10- to 14-year-olds (+7.5%, +6.5% and +10.4%, respectively). The largest point prevalence occurred in 2018 among 15- to 18-year-olds, with 98.5 per 1000 prescribed antidepressants. Antidepressants were more frequently prescribed to females; antipsychotics, attention deficit hyperactivity disorder medications and melatonin more often to males. The most prescribed antipsychotics were risperidone (<15 years) and quetiapine (15- to 18-year-olds). Fluoxetine was the most prescribed antidepressant in those aged 5+ years and amitriptyline in 0- to 4-year-olds. Conclusion: General practitioner prescribing of melatonin, antipsychotics, antidepressants and attention deficit hyperactivity disorder medications to under-19-year-olds increased markedly from 2011 to 2018. Although benzodiazepine and Z-drug prescriptions declined, this was offset by a substantial increase in melatonin prescribing.


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