June 16, 2011

Are Antipsychotics Overprescribed To Kids?

does this make me look like I'm keeping an eye on waste?

10 year study of inpatient kids: 44% got antipsychotics.  Is that a lot?  Yes.  It's a lot.

And most of the time, not even for psychosis.  44% of the PTSD and ADHD kids got antipsychotics.

You can wrack your brain trying to figure this out or blame the usual suspects, but the answer is right there in the article:

Variables associated with antipsychotic use [included] male gender, age 12 years and under, being nonwhite, and a length of stay 13 days or longer.

You'll observe that none of those words is "diagnosis" or "severity."

The cause of these high levels of medications is so simple you'll recoil from the truth of it, but pour yourself a drink and take it like a man: the kids showed up.  That's it.  The kid is in front of you and you have to do something, now, that results in an acute change. Not better grades 4 years out, or less sadness over the teen years; change the sleep tonight, make the kid less hyper now, and when it "stops working" you can up the dose or change the med.

It doesn't matter what the diagnosis is or what the symptoms are, really, whether he ate his dog or got a C on a test he's going to be getting something at qd and hs because that's what you get when you put psychiatry as the cornerstone of a Multidisciplinary Treatment Team.

When a kid is presented to a psychiatrist, the psychiatrist is pressured, obligated, to do something pharmacological.  If a psychiatrist looked a single parent a joint away from a nap right in the eye and said, "nope, he's acting out because of X, Y, Z, and medications aren't going to fix this" that doctor will get his head handed to him by parent or by lawyer.  Justice will be done, you negligent elitist.

And the simple reason why the kids showed up is that the parents and the schools and the cops and the courts were told that's where you go when a kid punches another kid or becomes hispanic.  That's why outside the oakwood offices of the private docs the shingle says "Practice of Psychiatry" in Palatino Linotype, but get within fifty blocks of a black kid and the whole thing is labeled "Behavioral Health" in what I think is Erasermate.

This is why reducing antipsychotic prescription is a Chuck Grassley political diversion, if the kids don't get antipsychotics they won't get nothing.  The problem is the overprescription of prescriptions.

I get that when a 15 year old starts up with cocaine it is a bad thing.  But is it automatically true he has ADHD or BPD and needs medications?  Check the map:

map of psychiatry today.jpg

There's a very large system in place for not doing what's best for people, it is expedient and simple and the law but nevertheless ineffective and counterproductive in the long run.  The trouble is, this system screws it up for people who actually need it.  Just because a 10 minute med check is perfect for the vast majority of patients who don't have any psychiatric illness, doesn't mean it'll work on the kid with prodromal schizophrenia and the crying parents who look at you like, wtf?  Are you kidding me with this?


An Epidemic of Mental Illness