Polypharmacy in children and adolescents initiating antipsychotic drug in 2008-2016: a nationwide register study.

OBJECTIVE: The use of antipsychotics in children and adolescents has increased rapidly. Little is known about psychotropic polypharmacy in children and adolescent initiating an antipsychotic drug. Thus, we investigated the frequency and predictors of polypharmacy during the first year of antipsychotic use in Finnish children and adolescents. METHODS: Between 2008 and 2016, 14 848 individuals aged 1-17 years initiating risperidone, quetiapine, aripiprazole, or olanzapine treatment were identified from Finnish Prescription Registry. Data on psychotropic drug prescriptions prior to and during antipsychotic treatment were collected. Associations between predictors and polypharmacy were analyzed with regression models. RESULTS: During the study period polypharmacy occurred in 44.9% of the new antipsychotic users, being more frequent in girls (55.5%) than in boys (44.5%, p < 0.001). The two most frequent concomitant psychotropic drug classes were antidepressants (66.2%) and psychostimulants/atomoxetine (30.8%). Adolescents aged 13-15 and 16-17 years, and girls showed an increased risk of polypharmacy during antipsychotic treatment (OR 2.37 [95% CI 1.91-2.92], OR 2.39 [95% CI 1.92-2.98], and OR 1.64 [95% CI 1.51-1.78], respectively). The use of psychostimulants/atomoxetine or antidepressants prior to initiation of antipsychotic treatment was strongly associated with polypharmacy during antipsychotic treatment (OR 8.39 [95% CI 7.49-9.41], OR 3.02 [95% CI 2.75-3.31]). CONCLUSIONS: Polypharmacy was common in children and adolescents initiating antipsychotic treatment. Prior use of psychostimulants/atomoxetine and antidepressants increased the risk of polypharmacy. The use of antipsychotics was mainly off-label, thus, the risks of concomitant use of antipsychotics with other psychotropic drugs should be carefully weighed.

All snoring is not adenoids in young children.

OBJECTIVE: To determine the prevalence of snoring in young children and to assess age, growth, previous surgery therapy, respiratory problems and sleep-related symptoms in relation to child's snoring, and to evaluate the relationship between child's snoring and parents' snoring and smoking. CHILDREN AND METHODS: A cross-sectional study evaluated 2100 children 1-6 years of age in Helsinki, Finland. Child's frequency of snoring on a five-point scale (never to every night) and age, height, weight and body mass index, previous adenotonsillectomies, tympanostomies, allergic rhinitis and respiratory infections were determined as was frequency of parental snoring and smoking. Sleep problems were determined based on Finnish or Swedish modified version of the sleep disturbance scale for Children. RESULTS: Of the 2100 eligible children, 1471 (71%) returned questionnaires. Children always or often snoring numbered 92 (6.3%), sometimes snoring, 183 (12.4%), and never or occasionally snoring, 1196 (81.3%). No difference in age (p=0.06) or gender (p=0.39) existed between snorers and non-snorers. History of previous adenotonsillectomies (p<0.001), allergic rhinitis (p<0.001), recurrent respiratory infections (p<0.001), and otitis media (p<0.001) were more common among snorers than among occasional or never-snorers. Nocturnal symptoms such as breathing problems, sleep hyperhydrosis, sleep-wake transition disorders, and daytime somnolence were associated with children's snoring. Frequency of children's snoring was also associated with parental snoring (p<0.001) and smoking (p<0.001). CONCLUSIONS: Snoring is common among young children and is associated with previous adenotonsillectomy, allergic rhinitis, respiratory infections, nocturnal symptoms, and parents' snoring and smoking. The high prevalence of snoring among children with adenotonsillectomy raises the question whether adenotonsillectomy alone is adequate treatment for snoring in young children.

Mental health service use among 18-year-old adolescent boys: a prospective 10-year follow-up study.

OBJECTIVE: To study prevalence and factors associated with mental health service use among 18-year-old adolescent boys. METHOD: Predictors at age 8 and factors at age 18 associated with mental health service use during the preceding 12 months were studied in a general population sample of 2,316 Finnish boys born in 1981 attending military call-up (79% of the original sample). RESULTS: Within the preceding 12 months, 2.1% of the boys had used mental health services. At age 18, internalizing, anxious-depressive, and withdrawal symptoms; health problems; not living with parents; use of illicit drugs; high level of alcohol use; and regular smoking were independently associated with service use. At age 8, a high level of emotional and behavioral symptoms, need for referral, and low school performance according to teacher evaluations predicted service use 10 years later. CONCLUSIONS: Only a minority of adolescents with severe problems had used mental health services. Because of the wide range of problems and comorbidity among service users, there is a need for integration of different services. Education services have a central role in the early detection of those who will later use mental health services.