Abstract
This issue of the journal contains investigations of a variety of topics in pediatric psychopharmacology and psychopathology that are on the cutting edge or otherwise outside of the mainstream in the field: deep brain stimulation (DBS), medication treatment for attention-deficit/hyperactivity disorder (ADHD) in preschool-aged children, metabolic monitoring in antipsychotic treatment, and international trends in prevalence and prescribing.
Hayden et al. report on a large-scale study of metabolic monitoring practices in youth prescribed atypical antipsychotics. In their analysis of health insurance company data for 2016 and 2017 (n = 1502 and 1239, respectively), the authors found that the rate of any metabolic testing in this population was just >50%. “The intent of recommended metabolic monitoring is to facilitate early detection of changes in metabolic status, thereby allowing for potential modifications to pharmacotherapy to reduce risk of harm to the patient,” the authors caution. The most disturbing thing about these low rates may be that their cause is unclear, they continue. “It remains unclear whether clinicians fail to order metabolic blood tests, patients do not complete ordered blood tests, and/or patients and clinicians are unaware of the risks associated with poor monitoring.”
Storch et al. give a welcome report on parental attitudes toward DBS as a therapeutic alternative for youth with treatment-resistant psychiatric disorders. The authors administered an online survey to >270 parents, who were presented with scenarios involving adolescents with severe treatment-resistant autism spectrum disorder, obsessive-compulsive disorder, and Tourette syndrome, among other conditions. The authors report an “overall parental willingness to consider DBS as a treatment option,” and that “familiarity with DBS was directly associated with attitudes.” This suggests that education can have a positive impact on the adoption of novel therapeutics.
Mittal et al. present a fascinating article describing their retrospective chart review of medication-prescribing trends in young children diagnosed with ADHD. The authors' basic results support widespread clinical experience and anecdote: practitioners are more likely to prescribe nonstimulant medication in young children than in older patients. Mittal et al. report that alpha agonists (AAs) such as clonidine and guanfacine are the most commonly prescribed medications for 2-, 3-, and 4-year olds in their study. “We can only hypothesize why practitioners are prescribing AAs so commonly in very young children without supportive evidence,” the authors write, and that is possibly because “families are often apprehensive about the use of stimulants due to the stigma associated with this classification of medication.”
Finally, I would like to draw your attention to the study of Barczyk et al. on mental health disorder prevalence trends in New Zealand and a concomitant rise in prescribing rates. It is fascinating and informative to take a broad view of a mental health system, its idiosyncrasies, and its similarities to others around the globe, and this article presents this opportunity. Topics of interest include demographic insights into prescribing in the native Maori population and the authors' assertion that “there is no evidence that increased prescribing has been associated with a decrease in the burden of mental illness.”