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The Journal of Behavioral Health Services & Research
Published in: The Journal of Behavioral Health Services & Research 1/2013

01-01-2013

Antipsychotic Treatment Patterns and Aggressive Behavior Among Adolescents in Residential Facilities

Authors: Leslie Miller, MD, Mark A. Riddle, MD, David Pruitt, MD, Al Zachik, MD, Susan dosReis, PhD

Published in: The Journal of Behavioral Health Services & Research | Issue 1/2013

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Abstract

This study examined the association between acute aggressive behavior patterns of 145 adolescents in residential treatment facilities with use of and changes in antipsychotic medication for the chronic management of aggression. Seclusion/restraint (S/R) frequency over 12 months was used to categorize youth into none, low, moderate, and high S/R groups. Data were analyzed using longitudinal mixed effects logistic regression models that allowed for intra-subject variability over time. The high and moderate S/R groups were significantly more likely to receive antipsychotics, get higher doses, and have changes in medication compared with the none S/R group. Increases in antipsychotic dose were associated with a lower likelihood of changes in antipsychotic medication over time. Despite persistent antipsychotic use at higher doses, youth in the high and moderate S/R groups continued to be secluded/restrained frequently. The findings question the adequacy of these medications in managing aggressive behavior.
Literature
1.
Olfson M, Blanco C, Liu L, et al. National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Archives of General Psychiatry. 2006;63:679–685.PubMedCrossRef
2.
Matone M, Localio R, Huang YS, et al. The relationship between mental health diagnosis and treatment with second-generation antipsychotics over time: A national study of U.S. medicaid-enrolled children. Health Services Research. 2012;47:1836–1860.PubMedCrossRef
3.
Olfson M, Blanco C, Liu SM, et al. National trends in the office-based treatment of children, adolescents, and adults with antipsychotics. Archives of General Psychiatry. 2012; (online) E1–E10.
4.
Correll, CU, Penzner JB, Parikh UH, et al. Recognizing and monitoring adverse events of second-generation antipsychotics in children and adolescents. Child and Adolescent Psychiatric Clinics of North America. 2005;15:177–206.CrossRef
5.
Staller JA, Wade MJ, Baker M. Current prescribing patterns in outpatient child and adolescent psychiatric practice in Central New York. Journal of Child and Adolescent Psychopharmacology. 2005;15:57–61.PubMedCrossRef
6.
Cooper WO, Hickson GB, Fuchs C, et al. New users of antipsychotic medications among children enrolled in Tenncare. Archives of Pediatric and Adolescent Medicine. 2004;158:753–759.CrossRef
7.
Crystal S, Olfson M, Huang C, et al. Broadened use of atypical antipsychotics: Safety, effectiveness, and policy changes. Health Affairs. 2009;28:w770–w781.PubMedCrossRef
8.
Domino MA and Swartz MS. Who are the new users of antipsychotic medications? Psychiatric Services.2008;59:507–514.PubMedCrossRef
9.
Connor DF, Ozbayrak KR, Harrison RJ, et al. Prevalence and patterns of psychotropic and anticonvulsant medication use in children and adolescents referred to residential treatment. Journal of Child and Adolescent Psychopharmacology. 1998;8:27–38.PubMedCrossRef
10.
Rawal PH, Lyons JS, MacIntyre II JC, et al. Regional variation and clinical indicators of antipsychotic use in residential treatment: A four-state comparison. The Journal of Behavioral Health Services and Research. 2004; 31:178–188.
11.
Folz R. The efficacy of residential treatment: An overview of the evidence. Residential Treatment for Children & Youth. 2004; 22:1–19.CrossRef
12.
Seida JC, Schouten JR, Boylan K, et al. Antipsychotics for children and young adults: A comparative effectiveness review. Pediatrics. 2012; 129: e771–e784.PubMedCrossRef
13.
Pfeifer JC, Kowatch RA, DelBello MP. Pharmacotherapy of bipolar disorder in children and adolescents. CNS Drugs. 2010; 24: 575–593.PubMedCrossRef
14.
Elbe D, Lalani Z. Review of the pharmacotherapy of irritability of autism. Journal of the Canadian Academy of Child and Adolescent Psychiatry. 2012; 21:130–146.PubMed
15.
Schur SB, Sikich L, Findling RL, et al. Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY). Part I: A review. Journal of the American Academy of Child and Adolescent Psychiatry. 2003;42: 132–44.PubMedCrossRef
16.
Findling, RL. Atypical antipsychotic treatment of disruptive behavior disorders in children and adolescents. The Journal of Clinical Psychiatry. 2008;69:9–14.PubMedCrossRef
17.
Pappadopulos E, MacIntyre II JC, Crismon ML, et al. Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY). Part II. Journal of the American Academy of Child and Adolescent Psychiatry. 2003;42:145–61.PubMedCrossRef
18.
Barnett SR, dosReis S, Riddle MA, et al. Improving the management of acute aggression in state residential and inpatient psychiatric facilities for youth. Journal of the American Academy of Child and Adolescent Psychiatry. 2002;41:897–905.PubMedCrossRef
19.
dosReis S, Barnett S, Love RC, et al., Maryland Youth Practice Improvement Committee. A guide for managing acute aggressive behavior of youths in residential and inpatient treatment facilities. Psychiatric Services. 2003;54:1357-1363.PubMedCrossRef
20.
dosReis S, Davarya S. Staff perspectives of precipitants to aggressive behavior of adolescents in residential treatment facilities. Residential Treatment for Children and Youth. 2008;25:85-101.CrossRef
21.
dosReis S, McCulloch J, Colantuoni E, et al. Early identification of seclusion and restraint patterns during adolescents’ course of residential treatment. Residential Treatment for Children and Youth. 2010; 27:160-174.CrossRef
22.
Leidy BD, Haugaard JJ, Nunno MA, et al. Review of restraint data in a residential treatment center for adolescent females. Child Youth Care Forum. 2006; 35;339–352.CrossRef
23.
Beck NC, Durret C, Stinson J, et al. Trajectories of seclusion and restraint use at a state psychiatric hospital. Psychiatric Services. 2008; 59:1027–1032.PubMedCrossRef
24.
Sadock BJ, Sadock VA. Pocket Handbook of Psychiatric Drug Treatment. Philadelphia: Lippincott Williams and Wilkins; 2001:114.
25.
Woods SW. Chlorpromazine equivalent doses for the newer atypical antipsychotics. The Journal of Clinical Psychiatry. 2003;64:663–667.PubMedCrossRef
26.
Pan W. Akaike’s information criterion in generalized estimating equations. Biometrics. 2001; 57:120–125.PubMedCrossRef
27.
Ebesutani C, Ale C, Luebbe A, et al. A practical guide for implementing evidence-based assessment in a psychiatric residential treatment facility: Translating theory into practice. Residential Treatment for Children & Youth. 2011; 28:211–231.CrossRef
28.
Rappaport N, Thomas C. Recent findings on aggressive and violent behavior in youth: Implications for clinical assessment and intervention. Journal of Adolescent Health. 2004;35:260–277.PubMed
29.
Connor DF, Anderson JJ, Steingard RJ, et al. Proactive and reactive aggression in referred children and adolescents. The American Journal of Orthopsychiatry. 2004;74:129–136.PubMedCrossRef
30.
Jensen PS, Youngstrom EA, Steiner H, et al. Consensus report on impulsive aggression as a symptom across diagnostic categories in child psychiatry: Implications for medication studies. Journal of the American Academy of Child and Adolescent Psychiatry. 2007;46:309–322.PubMedCrossRef
31.
King A, Waschbusch DA, Pelham WE, et al. Subtypes of aggression in children with attention deficit hyperactivity disorder: Medication effects and comparison with typical children. Journal of Clinical Child and Adolescent Psychology. 2009; 38: 619–629.PubMedCrossRef
32.
Blader JC, Schooler NR, Jensen PS, et al. Adjunctive divalproex versus placebo for children with ADHD and aggression refractory to stimulant monotherapy. American Journal of Psychiatry. 2009;166:1392–1401.PubMedCrossRef
33.
Connor DF, Chartier KG, Preen EC, et al. Impulsive aggression in attention-deficit/hyperactivity disorder: Symptom severity, co-morbidity, and attention-deficit/hyperactivity disorder subtype. Journal of Child and Adolescent Psychopharmacology. 2010;20:119–126.PubMedCrossRef
34.
Dangel RF, Deschner JP, Rasp CR. Anger control training for adolescents in residential treatment. Behavior Modification. 1989;13:447–458.PubMedCrossRef
35.
Larson JD, Calamari JE, West JG. Aggression management with disruptive adolescents in the residential setting: Integration of a cognitive–behavioral component. Residential Treatment for Children and Youth. 1998; 15: 1–9.CrossRef
36.
McDonell MG, Tarantino J, Dubose AP, et al. A pilot evaluation of dialectical behavioural therapy in adolescent long-term inpatient care. Child and Adolescent Mental Health. 2010; 15:193–196.CrossRef
37.
Little L, Butler L and Fowler J. Change from the ground up: Bringing informed-dialectical behavioral therapy to residential treatment. Residential Treatment for Children & Youth. 2010; 27:80–91.CrossRef
38.
Huefner JC, Griffith AK, Smith GL et al., Reducing psychotropic medications in an intensive residential treatment center. Journal of Child and Family Studies. 2012. doi:10.​1007/​s10826-012-9628-7
39.
Hair H. Outcomes for children and adolescents after residential treatment: A review of research from 1993–2003. Journal of Child and Family Studies. 2005;14:551–575.CrossRef
40.
Knorth EJ, Harder AT, Zandberg T, et al. Under one roof: A review and selective meta-analysis on the outcomes of residential child and youth care. Children and Youth Services Review. 2008; 30:123–140CrossRef
41.
42.
Metadata
Title
Antipsychotic Treatment Patterns and Aggressive Behavior Among Adolescents in Residential Facilities
Authors
Leslie Miller, MD
Mark A. Riddle, MD
David Pruitt, MD
Al Zachik, MD
Susan dosReis, PhD
Publication date
01-01-2013
Publisher
Springer US
Published in
The Journal of Behavioral Health Services & Research / Issue 1/2013
Print ISSN: 1094-3412
Electronic ISSN: 2168-6793
DOI
https://doi.org/10.1007/s11414-012-9314-y

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