Comparison of antipsychotic drug use among Dutch Youth before and after implementation of the Youth Act (2010-2019).

OBJECTIVE: The Dutch law on youth care (the Youth Act) was implemented from 2015 onwards. One of the government's aims by implementing this new policy was de-medicalization of youths by separating youth mental healthcare from the rest of the healthcare system. A previous study conducted by our research group showed that prevalence rates of antipsychotic drug prescriptions stabilized among Dutch youth in the period 2005-2015, just before the introduction of the Youth Act. In our study, we aimed to describe antipsychotic drug use among Dutch children aged 0-19 years old before and after implementation of the Youth Act (2010-2019). METHODS: We analyzed prescription data of 7405 youths aged 0-19 years using antipsychotic drugs between 2010 and 2019, derived from a large Dutch community pharmacy-based prescription database (IADB.nl). RESULTS: Prevalence rates of antipsychotic drug use per thousand youths decreased significantly in youths aged 7-12 years old in 2019 compared to 2015 (7.9 vs 9.0 p < 0.05). By contrast, prevalence rates increased in adolescent females in 2019 compared to 2015 (11.8 vs 9.5 p < 0.05). Incidence rates increased significantly in adolescent youths in 2019 compared to 2015 (3.9 vs 3.0 p < 0.05), specifically among adolescent girls (4.2 per thousand in 2019 compared to 3.0 per thousand in 2015). Dosages in milligram declined for the most commonly prescribed antipsychotic drugs during the study period. The mean duration of antipsychotic drug use in the study period was 5.7 (95% CI 5.2-6.2) months. CONCLUSION: Despite the aim of the Youth Act to achieve de-medicalization of youths, no clear reduction was observed in prevalence rates of antipsychotic drugs or treatment duration in all subgroups. Prevalence rates even increased in adolescent females.

[Improving the safety of antipsychotic drugs in children and adolescents by antipsychotic drug concentration measurements using a fingerprick]. / Naar veiliger antipsychoticagebruik bij jongeren: bloedspiegelbepalingen met vingerprik.

BACKGROUND: Antipsychotic drugs are associated with serious side effects in children and adolescents including weight gain. It is still unknown whether therapeutic drug monitoring (TDM) can improve patient outcomes. AIM: To test whether the dried blood spot method is a valid and feasible method to measure antipsychotic drug concentrations with a fingerprick; to assess the relationship between antipsychotic drug concentrations, side-effects and effectiveness in minors. METHOD: A dried blood spot (DBS) method was developed and tested for validity and feasibility. 89 children and adolescents with autism spectrum disorder (ASD) and behavioral problems were included in the multicenter, prospective, observational study SPACe (NTR6050). Antipsychotic drug concentrations, side-effects and effectiveness were measured during a 6-month follow-up. RESULTS: The DBS method showed a higher variability than venipuncture in measuring antipsychotic drug concentrations, but seemed feasible in minors with behavioral problems. Higher risperidon trough concentrations were associated with more weight gain and more effectiveness. A therapeutic window with optimal effectiveness and minimal side-effects was defined. CONCLUSION: The DBS method can be used to measure antipsychotic drug concentrations in children and adolescents with ASD and behavioral problems. As a relationship between antipsychotic drug concentrations and clinical outcomes was established, TDM might improve safety and effectiveness of antipsychotic drugs in this population.