Pharmacological treatments prescribed to people with asd

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1012 Psychopharmacology 2014 231 1011 1021, due to the early onset of ASDs their lifelong persistence and Mandell et al 2008 This is of importance because once. associated pervasive impairments Simonoff et al 2008 The an individual has been prescribed a psychotropic medica. annual societal cost in the UK of supporting children with tion they are a 11 times more likely to remain on it than. ASDs has been calculated as 2 7 billion and these costs for non psychotropic drugs Esbensen et al 2009 and b. amount to 25 billion per annum for adults with estimated much more likely to be exposed to potentially hazardous. lifetime costs of 1 7 million for those with intellectual dis polypharmacy e g some have reported that more than half. ability and 0 8 million for those without Knapp et al 2009 of children and youths with ASD who were prescribed. Furthermore individuals with ASD have a very high preva psychotropic medication experienced this Logan et al. lence of co morbid mental health conditions including 2012 Frazier et al 2011. attention deficit hyperactivity disorder ADHD learning dis Although there is limited evidence to guide psychotropic. abilities oppositional or conduct disorder emotional disorders medication use in the ASD population two drugs have. anxiety and other phobic disorders and chronic tic disorder shown efficacy for the alleviation of behavioural symptoms. Bradley and Bolton 2006 Green et al 2005 Simonoff et al in children and adolescents with autistic disorder risperi. 2008 Hence the development and optimisation of interven done Research Units on Pediatric Psychopharmacology. tions including behavioural treatment educational approaches Autism Network RUPPAN 2002 Shea et al 2004 and. and pharmacotherapy to alleviate symptoms impairments of aripiprazole Owen et al 2009 Marcus et al 2009 In 2006. those with ASDs so as to improve the quality of life of in risperidone was approved by the Food and Drug. dividuals and their families is imperative Administration FDA in the USA for the treatment of. Medication may be a helpful therapeutic intervention to irritability associated with autistic disorder in 5 16 year. manage disabling behavioural and or mental health symp olds this includes aggression and deliberate self. toms in the autistic population however there are currently injuriousness Aripiprazole was also approved by the FDA. no practice guidelines Frazier et al 2011 A review con in 2009 after demonstrating efficacy in the same indication. cluded that although there is no standard medication for in 6 17 year olds Owen et al 2009 Marcus et al 2009 An. treating ASD people are prescribed a variety of psychotro application for UK approval was submitted but subsequent. pic medications and there is scant reliable research evi ly withdrawn by the licence holder of risperidone Janssen. dence supporting this practice in adolescents and adults Cilag in 2006 after receiving an offer of conditional. Broadstock et al 2007 In fact some have suggested that approval but limiting its indication to the symptomatic. individuals with ASDs experience decreased efficacy and treatment of severe aggression and violence in children with. more adverse effects from psychiatric medications such as autism Morgan Taylor 2007 Safety monitoring through. behavioural toxicity with tricyclic antidepressants and so a treatment registry formed part of the conditions due to. cial withdrawal and irritability with methylphenidate concerns that risperidone could be misused as long term. Sanchez et al 1996 Aman et al 1997 Handen et al chemical control in children In the UK risperidone remains. 2000 This creates uncertainty about the appropriateness unlicensed for use in children with autism but it is approved. of using existing pharmacological treatment s for co for the treatment of persistent aggression in conduct disorder. morbid conditions such as ADHD Frazier et al 2011 in children of sub average intellectual functioning The. Aman et al 2003 and has led to recent work on drug reported side effects of antipsychotic drugs include signifi. effectiveness Simonoff et al 2012 Despite this uncertain cant weight gain and other metabolic effects such as. ty drug surveys and studies of health insurance claims hyperprolactinaemia and diabetes mellitus Almandil and. databases conducted in the USA have shown that over time Wong 2011 Almandil et al 2013 and movement disorders. more psychotropic drugs and in particular antipsychotics such as tardive dyskinesia tremor and dystonia Almandil. antidepressants and stimulants are being prescribed to chil and Wong 2011 Fleischhaker et al 2006 Robb et al 2011. dren young people and adults with ASD Aman et al 2005 life threatening side effects such as rhabdomyolysis neuro. Oswald and Sonenklar 2007 Mandell et al 2008 Esbensen leptic malignant syndrome and seizures have also been. et al 2009 Williams et al 2012 For example in North reported Star et al 2012 Rani et al 2009 2011. Carolina between 1992 1993 and 2001 psychotropic drug However little is known about the long term safety of anti. use rose significantly from 30 5 of children and adults psychotics and polypharmacy with other drug classes es. with autism to 45 2 Furthermore antidepressant use pecially in the autistic population This is a valid concern. increased 3 5 fold from 6 1 in 1992 1993 to 21 4 in because of the early diagnosis of ASDs and the lifetime. 2001 Aman et al 2005 There is also increasing evidence persistence of symptoms which are increasingly managed. that the likelihood of an ASD person being prescribed with psychotropic drugs Esbensen et al 2009. medication increases with age For instance one study Studies have identified substantial support needs for ASD. reported that rates of psychotropic drug use rose from in terms of health social care and educational services. 56 of 6 11 year olds to 73 of 18 21 year olds Knapp et al 2009 Barrett et al 2012 but to date we have. Psychopharmacology 2014 231 1011 1021 1013, very little data in the UK about the prescribing of pharma database using MULTILEX codes First DataBank. cological treatment by young people with ASDs and asso THIN Diagnoses symptoms and referrals are coded using. ciated neuropsychiatric co morbid disorders Information Read Clinical Terms a comprehensive hierarchical system. about prescribing practices and co morbidities is necessary Chisholm 1990 The database has been previously used to. for prioritising further research into the efficacy and short study trends in disease incidence and prescribing patterns in. and long term safety of psychotropic medications in this paediatric and adult populations McCarthy et al 2012a b. particular patient population Hence we conducted an ob Wijlaars et al 2012 A previous study using a similar UK. servational cohort study based on a primary care database to primary care database the former General Practice Research. investigate the pharmacological treatments used among a Database GPRD has validated diagnoses of ASDs in GP. cohort of children adolescents and young adults diagnosed records by expert review and by a computerised diagnostic. with ASD algorithm of Diagnostic and Statistical Manual of Mental. Disorders DSM IV symptoms ratings showing they are. appropriate for the identification of ASD cases Fombonne. Method et al 2004 Practices who contribute to THIN and or GPRD. use the same practice management software Vision In. Study design Practice Systems Ltd so data from both databases are. collected in a similar manner and structure in fact a large. A descriptive cohort study was conducted using The Health proportion 66 327 of 495 practices in 2001 2008 of. Improvement Network THIN database to investigate the practices contributing to THIN also contribute to GPRD. incidence and prevalence of ASD diagnoses psychotropic Cai et al 2012. medication prescribing and neuropsychiatric related co. morbidities of children adolescents and young adults in Study population. UK primary care, The study population comprised all individuals in THIN. Data source who were children adolescents and young adults aged. 25 years who had a record of diagnosis of ASD in the. THIN contains anonymised computerised information sys study period between 1 January 1992 and 31 December. tematically recorded by general practitioners GPs in the 2009 The start date of each patient was defined as the latest. UK for patient management The database provider collates of the following the date of the patient s registration at the. and organises this information in order for it to be used for general practice the date that the general practice began. research In the UK almost all patient care is managed by using the Vision software a clinical management system. GPs in primary care who act as gatekeepers of the UK and the date that the practice was deemed to meet a key. National Health Service When required GPs will refer quality indicator known as the Acceptable Mortality. patients to hospital consultants or specialists in secondary Reporting Maguire et al 2009 Patients were included if. care for diagnosis and initiation of treatment and GPs they had an observation period of least 6 months available. usually continue to monitor their patients and issue pre from their start date and were registered with the general. scriptions The diagnosis and management of ASDs and practice during the study period. the initiation of drug treatment for symptoms of ASDs or. co morbidities is usually the responsibility of specialist Prevalence of ASD. teams and general practitioners manage patients in primary. care through shared care arrangements with these teams Patient records dated within one year after a patient s start. THIN covers approximately 5 7 of the UK population date which may or may not be within the study period. with 3 6 million active patients from 464 general practices were screened to identify diagnoses of ASD Any individual. Cegedim Strategic Data Medical Research UK 2009 The with an ASD diagnosis within 1 year of the start date were. demographic distribution of THIN is broadly representative considered affected with ASD i e prevalent unless they. of that of the UK therefore analysis of the clinical and were aged 2 years at the time of the diagnosis Autistic. prescribing data will provide information on trends that is disorder can be diagnosed in children as young as 2 years of. representative of national trends This is particularly useful age whereas those with Asperger disorder and pervasive. in evaluating treatment rates rates of specific diagnoses and development disorder not otherwise specified are fre. changes in these rates quently not reliably diagnosed until 4 5 years of age. THIN is a rich source of clinical primary care data and Shattuck et al 2009 Hence patients with a record of. contains information on patient demographics prescrip ASD at ages 2 years are likely to be incident with ASD. tions diagnoses and referrals Drugs are coded in the Incident patients were defined as 1 those who have a first. 1014 Psychopharmacology 2014 231 1011 1021, diagnosis of ASD following the first year screening period Results. and 2 those with an ASD diagnosis when aged 2 years. during the screening period The index date for each patient Characteristics of the ASD cohort. was defined as the date of the first recorded diagnosis of. ASD following the patient s start date The annual preva There were 5 651 patients aged under 25 years in the THIN. lence of ASD was calculated by counting all patients inci database with at least one diagnosis record of ASD during. dent with ASD in a particular year and all prevalent patients the study period 83 0 were male n 4 688 Table 1. in active follow up of that year divided by the total number provides details on the characteristics of the study cohort. of individuals in the THIN mid year population i e those In 4 541 patients who became incident with ASD during the. who remained registered on the database on 1st July of that study period the mean age at first recorded diagnosis was. calendar year The annual incidence of ASD was calculated 9 0 years SD 4 74 years however a bimodal distribution. by counting all patients incident with ASD in a particular of age was observed with peak frequencies of first diagnoses. year divided by the total number of individuals in the THIN recorded at 4 and 8 years of age First diagnoses of ASD. mid year population Annual prevalence of ASD was calcu were recorded at a later age in female than in male. lated by age group defined as 0 5 year olds young chil. dren 6 12 year olds children 13 17 year olds Prevalence incidence of ASD diagnoses. adolescents and 18 24 year olds young adults, Overall prevalence of ASD diagnoses during the study.
Drug prescribing period was 2 23 persons per 1 000 mid year population. MYP the highest prevalence was seen in children with. Nine categories of drugs were defined by MLM ES and 3 87 children per 1000 MYP In 2008 ASD prevalence for. KG as stimulants methylphenidate dexamfetamine young children was 2 06 per 1 000 MYP 8 89 per. and atomoxetine antidepressants antipsychotics 1 000 MYP in children 6 64 per 1 000 MYP in adoles. antiepileptics mood stabilisers benzodiazepines sleep med cents 13 17 years and 2 44 per 1 000 MYP in young. ication including melatonin clonidine beta blockers and adults 18 24 years. antiparkinsonism drugs that may be co prescribed with an Figure 1 shows the prevalence of ASD in the cohort over. tipsychotics to counteract unwanted motor effects The pre the study period The prevalence of ASD in. Pharmacological treatments prescribed to people with autism in children of sub average intellectual functioning The patients to hospital consultants or

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