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01-05-2014 | Original Paper

Reducing Psychotropic Medications in an Intensive Residential Treatment Center

Auteurs: Jonathan C. Huefner, Annette K. Griffith, Gail L. Smith, Dennis G. Vollmer, Laurel K. Leslie

Gepubliceerd in: Journal of Child and Family Studies | Uitgave 4/2014

Abstract

Medication rates in behaviorally disordered children and youth have greatly increased to current high levels and are very controversial. This study examined changes in psychotropic medication use, levels of behavioral disturbance, and use of personal restraint and seclusion in a population of youth with serious behavioral disorders receiving medically directed cognitive-behavioral treatment in an intensive residential setting. The hypothesis was that there would be significant reductions in medication rates, without the unintended consequences of increased rates of problem behavior or offsetting increases in the use of seclusion or personal restraint. Results showed significant reductions in both the number of youth on medication and the average number of psychotropic medications during the residential stay. There were also significant reductions in behavioral disturbance, seclusions, and personal restraints. These results demonstrate that psychotropic medication can be significantly reduced without increases in problem behavior or the use of seclusions or personal restraints. We conclude that it is possible to significantly reduce psychotropic medication rates to far more conservative levels within the context of a clinically directed cognitive-behavioral treatment milieu.

vorige artikel Use of Psychotropic Medications Among Youth in Treatment Foster Care

volgende artikel A Model of Pediatric Psychopharmacology-Psychotherapy Treatment Integration in the Ambulatory Clinical Setting

Boxer, P. (2007). Aggression in very high-risk youth: Examining developmental risk in an inpatient psychiatric population. American Journal of Orthopsychiatry, 77, 636–646. doi:10.1037/0002-9432.77.4.636.PubMedCrossRef

Brown, R. T. (2005). Recent advances in pharmacotherapies for the externalizing disorders. School Psychology Quarterly, 20, 118–134. doi:10.1521/scpq.20.2.118.66515.CrossRef

Chamberlain, P., Price, J. M., Reid, J. B., Landsverk, J., Fisher, P. A., & Stoolmiller, M. (2006). Who disrupts from placement in foster and kinship care? Child Abuse and Neglect, 30, 409–424.PubMedCrossRef

Chamberlain, P., & Reid, J. B. (1987). Parent observation and report of child symptoms. Behavioral Assessment, 9, 97–109.

Chouinard, G. (2004). New nomenclature for drug-induced movement disorders including tardive dyskinesia. Journal of Clinical Psychiatry, 65, 9–15.PubMed

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.

Connor, D. F., & McLaughlin, T. J. (2005). A naturalistic study of medication reduction in a residential treatment setting. Journal of Child and Adolescent Psychopharmacology, 15, 302–310. doi:10.1089/cap.2005.15.302.PubMedCrossRef

Connor, D. F., Ozbayrak, K. R., Harrison, R. J., & Melloni, R. H. J. (1998). Prevalence and patterns of psychotropic and anticonvulsant medication use in children and adolescents referred to residential treatment. Journal of Child and Adolescent Psychopharmacology, 8, 27–38. doi:10.1016/S0031-9384(96)00373-3.PubMedCrossRef

Connor, D. F., Ozbayrak, K. R., Kusiak, K. A., Caponi, A. B., & Melloni, R. H. (1997). Combined pharmacotherapy in children and adolescents in a residential treatment center. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 248–254. doi:10.1097/00004583-199702000-00016.PubMedCrossRef

Criste, T. R. (1989). Needs analysis at Western New York Children’s Psychiatric Center (Internal report). Boys Town, NE: Father Flanagan’s Boys’ Home.

Daly, D. L., Schmidt, M. D., Spellman, D. F., Criste, T. R., Dinges, K., & Teare, J. F. (1998). The Boys Town Residential Treatment Center: Treatment implementation and preliminary outcomes. Child & Youth Care Forum, 27, 267–279.

Dean, A. J., Duke, S. G., George, M., & Scott, J. (2007). Behavioral management leads to reduction in aggression in a child and adolescent psychiatric inpatient unit. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 711–720. doi:10.1097/chi.0b013e3180465a1a.PubMedCrossRef

Dean, A. J., McDermott, B. M., & Marshall, R. T. (2006). Psychotropic medication utilization in a child and adolescent mental health service. Journal of Child and Adolescent Psychopharmacology, 16, 273–285. doi:10.1089/cap.2006.16.273.PubMedCrossRef

dosReis, S., Zito, J. M., Safer, D. J., Gardner, J. F., Puccia, K. B., & Owens, P. L. (2005). Multiple psychotropic medication use for youths: A two-state comparison. Journal of Child and Adolescent Psychopharmacology, 15, 68–77.PubMedCrossRef

Duffy, F. F., Narrow, W. E., Rae, D. S., West, J. C., Zarin, D. A., Rubio-Stipec, M., et al. (2005). Concomitant pharmacotherapy among youths treated in routine psychiatric practice. Journal of Child and Adolescent Psychopharmacology, 15, 12–25. doi:10.1089/cap.2005.15.12.PubMedCrossRef

Foltz, R. (2006). The mistreatment of mood disorders in youth. Ethical Human Psychology and Psychiatry: An International Journal of Critical Inquiry, 8, 147–155.CrossRef

Fontanella, C. A., Bridge, J. A., & Campo, J. V. (2009). Psychotropic medication changes, polypharmacy, and the risk of early readmission in suicidal adolescent inpatients. The Annals of Pharmacotherapy, 43, 1939–1947. doi:10.1345/aph.1M326.PubMedCrossRef

Foxx, R. M. (1998). A comprehensive treatment program for inpatient adolescents. Behavioral Interventions, 13, 67–77.CrossRef

Griffith, A. K., Huscroft-D’Angelo, J., Epstein, M. H., Singh, N. N., Huefner, J. C., & Pick, R. (2010). Psychotropic medication use for youth in residential treatment: A comparison between youth with monopharmacy versus polypharmacy. Journal of Child and Family Studies, 19, 795–802. doi:10.1007/s10826-010-9372-9.CrossRef

Griffith, A. K., Ingram, S. D., Barth, R. P., Trout, A. L., Duppong Hurley, K., Thompson, R. W., et al. (2009). The family characteristics of youth entering a residential care program. Residential Treatment for Children & Youth, 26, 135–150. doi:10.1080/08865710902914283.CrossRef

Gudjonsson, G. H., Rabe-Hesketh, S., & Wilson, C. (2000). Violent incidents on a medium secure unit: The target of assault and the management of incidents. Journal of Forensic Psychiatry, Francis, 11, 105–118. doi:10.1080/095851800362391;10.1080/095851800362391.CrossRef

Guevara, J., Lozano, P., Wickizer, T., Mell, L., & Gephart, H. (2002). Psychotropic medication use in a population of children who have attention-deficit/hyperactivity disorder. Pediatrics, 109, 733–739.PubMedCrossRef

Gullick, K., McDermott, B., Stone, P., & Gibbon, P. (2005). Seclusion of children and adolescents: Psychopathological and family factors. International Journal of Mental Health Nursing, 14, 37–43. doi:10.1111/j.1440-0979.2005.00353.x;10.1111/j.1440-0979.2005.00353.x.PubMedCrossRef

Haw, C., & Stubbs, J. (2007). Off-label use of antipsychotics: Are we mad? Expert Opinion on Drug Safety, 6, 533–545. doi:10.1517/14740338.6.5.533.PubMedCrossRef

Heflinger, C. A., & Humphreys, K. L. (2008). Identification and treatment of children with oppositional defiant disorder: A case study of one state’s public service system. Psychological Services, 5, 139–152. doi:10.1037/1541-1559.5.2.139.CrossRef

Hussey, D. L., & Guo, S. (2005). Forecasting length of stay in child residential treatment. Child Psychiatry and Human Development, 36, 95–111. doi:10.1007/s10578-004-3490-9.PubMedCrossRef

Kubiszyn, T. (2005). Introduction to the special issue: The Division 16 Task Force on Psychopharmacology, Learning and Behavior. School Psychology Quarterly, 20, 115–117.CrossRef

Larzelere, R. E., Chmelka, M. B., Schmidt, M. D., & Jones, M. (2002). The Treatment Progress Checklist: Psychometric development of a daily symptom checklist. In C. Newman, C. J. Liberton, K. Kutash, & R. M. Friedman (Eds.), Proceedings of the 14th Annual Florida Mental Health Institute Conference (pp. 359–362). Tampa, FL: University of South Florida.

LeFever, G. B., Arcona, A. P., & Antonuccio, D. O. (2003). ADHD among American schoolchildren evidence of overdiagnosis and overuse of medication. The Scientific Review of Mental Health Practice, 2, 49–60.

Lekhwani, M., Nair, C., Nikhinson, I., & Ambrosini, P. J. (2004). Psychotropic prescription practices in child psychiatric inpatients 9 years old and younger. Journal of Child and Adolescent Psychopharmacology, 14, 95–103.PubMedCrossRef

Leo, J. (2006). The truth about academic medicine: Children on psychotropic drugs and the illusion of science. In S. Timimi & B. Maitra (Eds.), Critical voices in child and adolescent mental health (pp. 107–127). London: Free Association Books.

Lerer, B. (2002). Pharmacogenetics of psychotropic drugs. Cambridge, UK: Cambridge University Press.CrossRef

Martin, A., Van Hoof, T., Stubbe, D., Sherwin, T., & Scahill, M. C. (2003). Multiple psychotropic pharmacotherapy among child and adolescent enrollees in Connecticut Medicaid managed care. Psychiatric Services, 54, 72–77. doi:10.1176/appi.ps.54.1.72.PubMedCrossRef

Najjar, F., Welch, C., Grapentine, W. L., Sachs, H., Siniscalchi, J., & Price, L. H. (2004). Trends in psychotropic drug use in a child psychiatric hospital from 1991–1998. Journal of Child and Adolescent Psychopharmacology, 14, 87–93. doi:10.1089/104454604773840526.PubMedCrossRef

Pappadopulos, E., MacIntyre, J. C., Crismon, M. L., Findling, R. L., Malone, R. P., Derivan, A., et al. (2003). Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY). Part II. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 145–161. doi:10.1097/00004583-200302000-00008.PubMedCrossRef

Pappadopulos, E., Woolston, S., Chait, A., Perkins, M., Connor, D. F., & Jensen, P. S. (2006). Pharmacotherapy of aggression in children and adolescents: Efficacy and effect size. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 15, 27–39.PubMedCentralPubMed

Pathak, S., Arszman, S. P., Danielyan, A., Johns, E. S., Smirnov, A., & Kowatch, R. A. (2004). Psychotropic utilization and psychiatric presentation of hospitalized very young children. Journal of Child and Adolescent Psychopharmacology, 14, 433–442. doi:10.1089/cap.2004.14.433.PubMedCrossRef

Pavkov, T. W., & Walrath, C. M. (2008). Clinical and non-clinical characteristics associated with medication use among children with serious emotional disturbance. Journal of Child and Family Studies, 17, 839–852. doi:10.1007/s10826-008-9193-2.CrossRef

Pelham, W. E., Burrows-MacLean, L., Gnagy, E. M., Fabiano, G. A., Coles, E. K., Tresco, K. E., et al. (2005). Transdermal methylphenidate, behavioral, and combined treatment for children With ADHD. Experimental and Clinical Psychopharmacology, 13, 111–126. doi:10.1037/1064-1297.13.2.111;10.1037/1064-1297.13.2.111.PubMedCrossRef

Pogge, D. L., Young, K., Insalaco, B., & Harvey, P. D. (2007). Use of atypical antipsychotic medications in adolescent psychiatric inpatients: A comparison with inpatients who did not receive antipsychotic medications during their stay. International Journal of Clinical Practice, 61, 896–902. doi:10.1111/j.1742-1241.2007.01379.x.PubMedCrossRef

Pottick, K. J., Warner, L. A., & Yoder, K. A. (2005). Youths living away from families in the US mental health system: Opportunities for targeted intervention. Journal of Behavioral Health Services & Research, 32, 264–281. doi:10.1007/BF02291827.CrossRef

Prinz, R. (2009). Dissemination of a multilevel evidence-based system of parenting interventions with broad application to child welfare populations. Child Welfare: Journal of Policy, Practice, and Program, 88, 127–132.

Rawal, P. H., Lyons, J. S., MacIntyre, J. C., I. I., & Hunter, J. C. (2004). Regional variation and clinical indicators of antipsychotic use in residential treatment: A four-state comparison. Journal of Behavioral Health Services & Research, 31, 178–188.

Safer, D. J., Zito, J. M., & dosReis, S. (2003). Concomitant psychotropic medication for youths. American Journal of Psychiatry, 160, 438–449. doi:10.1176/appi.ajp.160.3.438.PubMedCrossRef

Schachter, H. M., Pham, B., King, J., Langford, S., & Moher, D. (2001). How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis. Canadian Medical Association Journal, 165, 1475–1488.PubMedCentralPubMed

Singh, N. N., Landrum, T. J., Donatelli, L. S., & Hampton, C. (1994). Characteristics of children and adolescents with serious emotional disturbance in systems of care: I. Partial hospitalization and inpatient psychiatric services. Journal of Emotional and Behavioral Disorders, 2, 13–20.CrossRef

Spellman, D. F., Griffith, A. K., Huefner, J. C., Wise, N., III, McElderry, E., & Leslie, L. K. (2010). Psychotropic medication management in a residential group care program. Child Welfare, 89, 151–167.PubMed

Sukhodolsky, D. G., Cardona, L., & Martin, A. (2005). Characterizing aggressive and noncompliant behaviors in a children’s psychiatric inpatient setting. Child Psychiatry and Human Development, 36, 177–193. doi:10.1007/s10578-005-3494-0.PubMedCrossRef

Swanson, J., Arnold, L. E., Kraemer, H., Hechtman, L., Molina, B., Hinshaw, S., et al. (2008). Evidence, interpretation, and qualification from multiple reports of long-term outcomes in the Multimodal Treatment study of children with ADHD (MTA): Part I: Executive summary. Journal of Attention Disorders, 12, 4–14. doi:10.1177/1087054708319345.PubMedCrossRef

Timimi, S., & Maitra, B. (2006). New directions. In S. Timimi & B. Maitra (Eds.), Critical voices in child and adolescent mental health (pp. 222–228). London: Free Association Books.

Trout, A. L., Hagaman, J., Casey, K., Reid, R., & Epstein, M. H. (2008). The academic status of children and youth in out-of-home care: A review of the literature. Children and Youth Services Review, 30, 979–994.CrossRef

Van Bellinghen, M., & De Troch, C. (2001). Risperidone in the treatment of behavioral disturbances in children and adolescents with borderline intellectual functioning: A double-blind, placebo-controlled pilot trial. Journal of Child and Adolescent Psychopharmacology, 11, 5–13. doi:10.1089/104454601750143348.PubMedCrossRef

Vitiello, B. (2005). Pharmacoepidemiology and pediatric psychopharmacology research. Journal of Child and Adolescent Psychopharmacology, 15, 10–11. doi:10.1089/cap.2005.15.10.PubMedCrossRef

Vitiello, B., Rohde, P., Silva, S., Wells, K., Casat, C., Waslick, B., et al. (2006). Functioning and quality of life in the Treatment for Adolescents With Depression Study (TADS). Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1419–1426. doi:10.1097/01.chi.0000242229.52646.6e.PubMedCrossRef

Warner, L. A., Fontanella, C. A., & Pottick, K. J. (2007). Initiation and change of psychotropic medication regimens among adolescents in inpatient care. Journal of Child and Adolescent Psychopharmacology, 17, 701–712. doi:10.1089/cap.2007.0120.PubMedCrossRef

Woolston, J. L. (1999). Combined pharmacotherapy: Pitfalls of treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1455–1457. doi:10.1097/00004583-199911000-00021.PubMedCrossRef

Zakriski, A. L., Wheeler, E., Burda, J., & Shields, A. (2005). Justifiable psychopharmacology or overzealous prescription? Examining parental reports of lifetime prescription histories of psychiatrically hospitalised children. Child and Adolescent Mental Health, 10, 16–22. doi:10.1111/j.1475-3588.2005.00111.x.CrossRef

Zito, J. M., Craig, T. J., & Wanderling, J. (1994). Pharmacoepidemiology of 330 child/adolescent psychiatric patients. Journal of Pharmacoepidemiology, 3, 47–62. doi:10.1300/J055V03N01_04.CrossRef

Zito, J. M., Safer, D. J., Sai, D., Gardner, J. F., Thomas, D., Coombes, P., et al. (2008). Psychotropic medication patterns among youth in foster care. Pediatrics, 121, 157–163. doi:10.1542/peds.2007-0212.CrossRef

Zito, J. M., Safer, D. J., Zuckerman, I. H., Gardner, J. F., & Soeken, K. (2005). Effect of medicaid eligibility category on racial disparities in the use of psychotropic medications among youths. Psychiatric Services, 56, 157–163.PubMedCrossRef

Titel: Reducing Psychotropic Medications in an Intensive Residential Treatment Center
Auteurs: Jonathan C. Huefner
Annette K. Griffith
Gail L. Smith
Dennis G. Vollmer
Laurel K. Leslie
Publicatiedatum: 01-05-2014
Uitgeverij: Springer US
Gepubliceerd in: Journal of Child and Family Studies / Uitgave 4/2014
Print ISSN: 1062-1024
Elektronisch ISSN: 1573-2843
DOI: https://doi.org/10.1007/s10826-012-9628-7

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