Article Text

  1. J. C. Blader
  1. School of Medicine, NY


Background Recent clinical research has established an evidentiary basis for the pharmacotherapy of several psychiatric disorders of childhood. However, children hospitalized for psychiatric disorders seldom experience robust response to monotherapy with the agents studied, and consequently receive polytherapy involving medication combinations that lack data to support their efficacy. Longitudinal, observational data on medication use and outcomes for this patient group may furnish information useful to the development of controlled research on the potential effects of medication combinations.

Objectives 1) To assess the utilization of specific pharmacotherapy strategies for child psychiatric inpatients from pre-admission care through 12 months after discharge. 2) To examine associations between these strategies and postdischarge outcomes.

Method Prospective follow-up of 83 5-13 year-old children admitted to acute inpatient care for aggressive behavior in the context of a disruptive behavior disorder. Treatment and symptom severity data were obtained via standardized rating scales at admission, discharge, and 3, 6 and 12 months after discharge.

Results Utilization: Number of concurrent medications increased over assessment times. Changes in children's pharmacotherapy occurred most frequently during hospitalization and 3 months after discharge, but even between postdischarge assessments over half experienced treatment changes, most often initiation of new agents. Treatment with antipsychotics and mood stabilizers increased over assessment times while SSRI treatment decreased. Outcomes: Children treated with stimulants and risperidone 3 months after discharge had significantly improved ratings, adjusted for admission scores and concurrent medications; improvements were not apparent at 6- and 12-month follow-ups. Children treated with SSRIs at 6 months postdischarge had higher problem severity ratings. Those who maintained lithium and SSRI treatment between 6 and 12 months displayed improvements. Medication interactions suggested better outcomes with combined risperidone and lithium at 12 months and less advantageous outcomes for children treated with alpha-agonists unaccompanied by stimulants.

Conclusions Complexity of pharmacotherapy for child inpatients ratchets upwards from admission through one year after discharge. Hospital-initiated treatment is commonly altered soon after discharge and throughout follow-up. Within the limitations of observational methodology, postdischarge outcomes seem related to specific pharmacotherapy regimens, some of which may improve children's functioning while others may worsen it.

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