Verschreibungen von Psychopharmaka für Kinder und Jugendliche in Deutschland : eine Analyse von Verordnungspraxis und -trends anhand ausgewählter Erkrankungen und Substanzgruppen

In this dissertation thesis, health insurance funds data on psychotropic prescriptions for children and adolescents in Germany are presented and analysed. The data refer to prescription patterns in different child and adolescent psychiatric disorders (depressive disorders, autism spectrum disorders, tic disorders, eating disorders, functional urinary incontinence) and also to prescription of defined pharmacological substance groups (antidepressants, antipsychotics). The psychotropic prescriptions were stratified by age groups, sex and sub-diagnosis of the respective child and adolescent psychiatric disorder. In some of the papers compiled in this thesis, the specialty of the prescribing physician was also evaluated. The use of the mentioned health insurance funds data allowed to study the data of up to 1.6m children and adolescents (population under risk). Study designs involved both cross-sectional and longitudinal analyses over time periods of up to eight years, employing various statistical methods. The two papers analysing time trends in the prescription of antidepressants and antipsychotics show a marked increase in the prescription of these substance groups over recent years. Regarding antipsychotics, a considerable increase in the prescription of atypical antipsychotics and a substantial proportion of non-guideline adherent therapies was found. The study on antidepressant prescriptions showed a distinct increase in SSRI prescriptions, with TCA still accounting for a significant percentage of prescriptions. The papers on psychotropic prescriptions in various child and adolescent psychiatric disorders (autism spectrum disorders, depressive disorders, tic disorders, eating disorders, functional urinary incontinence) constitute a foundational inventory of psychopharmacological therapy in German children and adolescents with mental health problems. They show that for some of these conditions, current guidelines are applied only in a fraction of patients. Concluding, the findings compiled in this thesis indicate a general trend towards increased psychotropic prescriptions in children and adolescents and point to the need of implementation of child and adolescent psychiatric guidelines into daily practice.