Two of every three children prescribed with antipsychotic drugs paid for by Medicaid experience potentially life-threatening lapses in their treatment.
The Department of Health and Human Services inspector general said in a report made public Thursday that two-thirds of children in Medicaid prescribed with second-generation antipsychotics — typically used to treat psychiatric disorders like schizophrenia — often receive poor medical care, including incorrect treatment.
“These drugs can have serious side effects, and little clinical research has been conducted on the safety of treating children with these drugs,” the report’s lead investigator, Michala Walker said in a podcast released in conjunction with the report.
Investigators looked at nearly 700 Medicaid claims for antipsychotics prescribed to children. More than 350,000 children in Medicaid were prescribed antipsychotics in 2007, according to a 2012 Children’s Hospital of Philadelphia study. That number is growing rapidly.
The total number of children in Medicaid is over 43 million, according to the program’s website.
Walker described one child as an example of the poor treatment psychiatric patients may receive.
“[One] child experienced hallucinations, paranoia and suicidal thoughts while being treated with a regimen of six psychotropic drugs, including three second-generation antipsychotic drugs,” Walker said. “When all her medications were stopped, those symptoms resolved.”
Walker’s team reported that more than one-third of the kids reviewed were taking too many drugs simultaneously. Another third took medications for too long.
“This child also experienced significant side effects while being treated with her medications, including weight gain, insomnia and swelling of her hands and feet, but those side effects were not properly monitored,” Walker continued.
More than half of the children received inadequate monitoring from their provider.
“Reviewers were concerned about a lack of monitoring for many physiological and behavioral changes,” the inspector general said, a development that is alarming since more than one-third of the children were prescribed with antipsychotics with “the increased chance of suicidal thinking and behavior in children, adolescents and young adults.”
The child Walker described also lacked documentation that justified the need for antipsychotics.
“The only explanation in this child’s medical record for her regimen of multiple drugs was a vague reference to her hallucinations,” Walker said.
The report cited three additional case studies where children received similar, inadequate medical care, such as incorrect treatment and severe side effects.
Additionally, nearly one-fifth of children reviewed were too young for their prescribed medication, while another fifth were given the wrong dosage. More than 4 out of 10 children were given the wrong treatment.
“I’m not saying that antipsychotic drugs should never be used in children,” Walker said. “But they should only be used for a medically appropriate reason and, when they’re used, they must be very carefully managed to ensure safety and quality care.”
