{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T20:33:10Z","timestamp":1794256390142,"version":"4.9.0"},"reference-count":75,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum W\u00fcrzburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Child Adolesc Psychiatry Ment Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background\/Objectives<\/jats:title>\n            <jats:p>Off-label psychopharmacologic medication use is widespread in child and adolescent psychiatry, but little is known about its associated factors. This study aimed to assess frequency and determinants of off-label use of antidepressants and antipsychotics in youths in daily clinical practice.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>In a prospective clinical study (\u2018TDM-VIGIL\u2019) at 18 centers in three German-speaking countries, child psychiatric patients aged 4\u201318 years undergoing routine treatment with antidepressants and antipsychotics were systematically followed. Demographic, clinical and pharmacological data were collected in an online-based patient registry; off-label use was categorized by reasons, including age, indication or duration of treatment for each treatment episode. Examined correlates of off-label use included sex, treatment setting, diagnosis and illness severity.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>About 67% of all antidepressant and antipsychotic treatment episodes in the 700 included patients (mean age\u2009=\u200914.6 years, girls\u2009=\u200967%) were off-label. For antidepressants, 55.2% were off-label (age\u2009=\u200951.1%, non-licensed indications\u2009=\u200937.4%, age\u2009+\u2009indication\u2009=\u200911.5%), for antipsychotics 81.7% were off-label (age\u2009=\u200929.4%, non-licensed indications\u2009=\u200933.2%, age\u2009+\u2009indication\u2009=\u200937.4%). Sex, age (&lt;\u200912, \u2265\u200912 years) as well as illness severity were not associated with off-label use. In antidepressant treatment, \u2018depression\u2019 and \u2018obsessive compulsive disorder\u2019 diagnoses were associated with reduced and \u2018suicidality at admission\u2019 with increased off-label prescriptions. In antipsychotics, \u2018schizophrenia diagnoses\u2019 was linked to decreased, university hospital treatment to increased off-label use.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The frequency of off-label use of antidepressants and even more of antipsychotics in youths treated at specialized child psychiatric centers is high. As the clinical efficacy and safety of off-label antidepressant and antipsychotic use in youth is under-researched, our results call for further pharmacovigilance studies and strategies to improve drug safety.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s13034-025-00957-7","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:05:18Z","timestamp":1760360718000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Off-label drug use in children and adolescents treated with antidepressants and antipsychotics: results from a prospective multicenter trial"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8704-1424","authenticated-orcid":false,"given":"Regina","family":"Taurines","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manfred","family":"Gerlach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7254-5646","authenticated-orcid":false,"given":"Christoph U.","family":"Correll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul L.","family":"Plener","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Malzahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Heuschmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4780-612X","authenticated-orcid":false,"given":"Maike","family":"Scherf-Clavel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Rock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8253-5070","authenticated-orcid":false,"given":"Wolfgang","family":"Briegel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4167-0014","authenticated-orcid":false,"given":"Christian","family":"Fleischhaker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"H\u00e4ge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Hellenschmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hartmut","family":"Imgart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0031-7764","authenticated-orcid":false,"given":"Michael","family":"Kaess","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9053-998X","authenticated-orcid":false,"given":"Andreas","family":"Karwautz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"K\u00f6lch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Reitzle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2151-9480","authenticated-orcid":false,"given":"Tobias J.","family":"Renner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su-Yin","family":"Reuter-Dang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Rexroth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerd","family":"Schulte-K\u00f6rne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Theisen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvira","family":"Tini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Wewetzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1925-6228","authenticated-orcid":false,"given":"Stefanie","family":"Fekete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7628-8299","authenticated-orcid":false,"given":"Marcel","family":"Romanos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0270-0954","authenticated-orcid":false,"given":"Karin M.","family":"Egberts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"issue":"2","key":"957_CR1","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1002\/wps.20881","volume":"20","author":"CU Correll","year":"2021","unstructured":"Correll CU, Cortese S, Croatto G, Monaco F, Krinitski D, Arrondo G, et al. Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review. World Psychiatry. 2021;20(2):244\u201375.","journal-title":"World Psychiatry"},{"issue":"1","key":"957_CR2","doi-asserted-by":"publisher","DOI":"10.1186\/s13034-023-00684-x","volume":"18","author":"M Otter","year":"2024","unstructured":"Otter M, Kothgassner OD, Lepuschutz L, Drahos S, Plener PL. The impact of the COVID-19 pandemic on rates of adolescents receiving psychopharmacological medication in Austria. Child Adolesc Psychiatry Ment Health. 2024;18(1): 10.","journal-title":"Child Adolesc Psychiatry Ment Health"},{"issue":"2","key":"957_CR3","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1001\/jamapsychiatry.2022.4165","volume":"80","author":"M Bliddal","year":"2023","unstructured":"Bliddal M, Rasmussen L, Andersen JH, Jensen PB, Pottegard A, Munk-Olsen T, et al. Psychotropic medication use and psychiatric disorders during the COVID-19 pandemic among Danish children, adolescents, and young adults. JAMA Psychiatr. 2023;80(2):176\u201380.","journal-title":"JAMA Psychiatr"},{"issue":"Suppl 1","key":"957_CR4","first-page":"S39","volume":"37","author":"D Degner","year":"2004","unstructured":"Degner D, Grohmann R, Kropp S, Ruther E, Bender S, Engel RR, et al. Severe adverse drug reactions of antidepressants: results of the German multicenter drug surveillance program AMSP. Pharmacopsychiatry. 2004;37(Suppl 1):S39\u201345.","journal-title":"Pharmacopsychiatry"},{"issue":"3","key":"957_CR5","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1177\/0883073808323523","volume":"24","author":"JM Jerrell","year":"2009","unstructured":"Jerrell JM, McIntyre RS. Cardiovascular and neurological adverse events associated with antidepressant treatment in children and adolescents. J Child Neurol. 2009;24(3):297\u2013304.","journal-title":"J Child Neurol"},{"key":"957_CR6","doi-asserted-by":"publisher","DOI":"10.1055\/a-1716-1856","author":"KM Egberts","year":"2022","unstructured":"Egberts KM, Gerlach M, Correll CU, Plener PL, Malzahn U, Heuschmann P, et al. Serious adverse drug reactions in children and adolescents treated on- and off-label with antidepressants and antipsychotics in clinical practice. Pharmacopsychiatry. 2022. https:\/\/doi.org\/10.1055\/a-1716-1856.","journal-title":"Pharmacopsychiatry"},{"issue":"2","key":"957_CR7","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1002\/wps.20031","volume":"12","author":"CU Correll","year":"2013","unstructured":"Correll CU, Gerhard T, Olfson M. Prescribing of psychotropic medications to children and adolescents: quo vadis? World Psychiatry. 2013;12(2):127\u20138.","journal-title":"World Psychiatry"},{"issue":"6","key":"957_CR8","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1007\/s00228-019-02641-0","volume":"75","author":"D Putignano","year":"2019","unstructured":"Putignano D, Clavenna A, Reale L, Bonati M. The evidence-based choice for antipsychotics in children and adolescents should be guaranteed. Eur J Clin Pharmacol. 2019;75(6):769\u201376.","journal-title":"Eur J Clin Pharmacol"},{"issue":"6","key":"957_CR9","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1089\/cap.2009.0003","volume":"19","author":"H Zoega","year":"2009","unstructured":"Zoega H, Baldursson G, Hrafnkelsson B, Almarsdottir AB, Valdimarsdottir U, Halldorsson M. Psychotropic drug use among Icelandic children: a nationwide population-based study. J Child Adolesc Psychopharmacol. 2009;19(6):757\u201364.","journal-title":"J Child Adolesc Psychopharmacol"},{"issue":"9","key":"957_CR10","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.1002\/pds.1430","volume":"16","author":"AC Volkers","year":"2007","unstructured":"Volkers AC, Heerdink ER, van Dijk L. Antidepressant use and off-label prescribing in children and adolescents in Dutch general practice (2001\u20132005). Pharmacoepidemiol Drug Saf. 2007;16(9):1054\u201362.","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"6","key":"957_CR11","doi-asserted-by":"publisher","first-page":"972","DOI":"10.4088\/JCP.v67n0615","volume":"67","author":"H Chen","year":"2006","unstructured":"Chen H, Reeves JH, Fincham JE, Kennedy WK, Dorfman JH, Martin BC. Off-label use of antidepressant, anticonvulsant, and antipsychotic medications among Georgia medicaid enrollees in 2001. J Clin Psychiatry. 2006;67(6):972\u201382.","journal-title":"J Clin Psychiatry"},{"issue":"8","key":"957_CR12","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1007\/s00787-013-0395-9","volume":"22","author":"M Dorks","year":"2013","unstructured":"Dorks M, Langner I, Dittmann U, Timmer A, Garbe E. Antidepressant drug use and off-label prescribing in children and adolescents in Germany: results from a large population-based cohort study. Eur Child Adolesc Psychiatry. 2013;22(8):511\u20138.","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"2","key":"957_CR13","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1002\/pds.2145","volume":"21","author":"E Lee","year":"2012","unstructured":"Lee E, Teschemaker AR, Johann-Liang R, Bazemore G, Yoon M, Shim KS, et al. Off-label prescribing patterns of antidepressants in children and adolescents. Pharmacoepidemiol Drug Saf. 2012;21(2):137\u201344.","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"7500","key":"957_CR14","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1136\/bmj.330.7500.1151","volume":"330","author":"ML Murray","year":"2005","unstructured":"Murray ML, Wong IC, Thompson M. Do selective serotonin reuptake inhibitors cause suicide? Antidepressant prescribing to children and adolescents by gps has fallen since csm advice. BMJ. 2005;330(7500):1151.","journal-title":"BMJ"},{"issue":"20","key":"957_CR15","first-page":"2653","volume":"127","author":"JG Bramness","year":"2007","unstructured":"Bramness JG, Engeland A, Furu K. Use of antidepressants among children and adolescents\u2013did the warnings lead to fewer prescriptions? Tidsskr Nor Laegeforen. 2007;127(20):2653\u20135.","journal-title":"Tidsskr Nor Laegeforen"},{"issue":"9","key":"957_CR16","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.1002\/pds.1396","volume":"16","author":"AJ Dean","year":"2007","unstructured":"Dean AJ, Hendy A, McGuire T. Antidepressants in children and adolescents\u2013changes in utilisation after safety warnings. Pharmacoepidemiol Drug Saf. 2007;16(9):1048\u201353.","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"9","key":"957_CR17","doi-asserted-by":"publisher","first-page":"1356","DOI":"10.1176\/appi.ajp.2007.07030454","volume":"164","author":"RD Gibbons","year":"2007","unstructured":"Gibbons RD, Brown CH, Hur K, Marcus SM, Bhaumik DK, Erkens JA, et al. Early evidence on the effects of regulators\u2019 suicidality warnings on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry. 2007;164(9):1356\u201363.","journal-title":"Am J Psychiatry"},{"issue":"4","key":"957_CR18","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1001\/archpsyc.64.4.466","volume":"64","author":"CB Nemeroff","year":"2007","unstructured":"Nemeroff CB, Kalali A, Keller MB, Charney DS, Lenderts SE, Cascade EF, et al. Impact of publicity concerning pediatric suicidality data on physician practice patterns in the united States. Arch Gen Psychiatry. 2007;64(4):466\u201372.","journal-title":"Arch Gen Psychiatry"},{"issue":"1","key":"957_CR19","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1001\/archgenpsychiatry.2007.5","volume":"65","author":"M Olfson","year":"2008","unstructured":"Olfson M, Marcus SC, Druss BG. Effects of food and drug administration warnings on antidepressant use in a national sample. Arch Gen Psychiatry. 2008;65(1):94\u2013101.","journal-title":"Arch Gen Psychiatry"},{"issue":"4","key":"957_CR20","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1111\/bcpt.12706","volume":"120","author":"ES Nielsen","year":"2017","unstructured":"Nielsen ES, Rasmussen L, Hellfritzsch M, Thomsen PH, Norgaard M, Laursen T. Trends in Off-Label prescribing of sedatives, hypnotics and antidepressants among children and Adolescents - A danish, nationwide Register-Based study. Basic Clin Pharmacol Toxicol. 2017;120(4):360\u20137.","journal-title":"Basic Clin Pharmacol Toxicol"},{"key":"957_CR21","doi-asserted-by":"publisher","first-page":"1348887","DOI":"10.3389\/fphar.2024.1348887","volume":"15","author":"S Pesiou","year":"2024","unstructured":"Pesiou S, Barcelo R, Papazisis G, Torres F, Pontes C. Prevalence of use of on-label and off-label psychotropics in the Greek pediatric population. Front Pharmacol. 2024;15:1348887.","journal-title":"Front Pharmacol"},{"issue":"4","key":"957_CR22","first-page":"237","volume":"97","author":"CE Martinez","year":"2022","unstructured":"Martinez CE, Martinez DPS, Gonzalo JJA. Antidepressant use and off-label prescribing in primary care in Spain (2013\u20132018). Pediatr (Engl Ed). 2022;97(4):237\u201346.","journal-title":"Pediatr (Engl Ed)"},{"issue":"5","key":"957_CR23","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1111\/ppe.12870","volume":"36","author":"AL Schaffer","year":"2022","unstructured":"Schaffer AL, Bruno C, Buckley NA, Cairns R, Litchfield M, Paget S, et al. Prescribed medicine use and extent of off-label use according to age in a nationwide sample of Australian children. Paediatr Perinat Epidemiol. 2022;36(5):726\u201337.","journal-title":"Paediatr Perinat Epidemiol"},{"issue":"11","key":"957_CR24","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1002\/pds.4289","volume":"26","author":"C Schroder","year":"2017","unstructured":"Schroder C, Dorks M, Kollhorst B, Blenk T, Dittmann RW, Garbe E, et al. Extent and risks of antidepressant off-label use in children and adolescents in Germany between 2004 and 2011. Pharmacoepidemiol Drug Saf. 2017;26(11):1395\u2013402.","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"2","key":"957_CR25","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1002\/pds.4138","volume":"26","author":"C Schroder","year":"2017","unstructured":"Schroder C, Dorks M, Kollhorst B, Blenk T, Dittmann RW, Garbe E, et al. Outpatient antidepressant drug use in children and adolescents in Germany between 2004 and 2011. Pharmacoepidemiol Drug Saf. 2017;26(2):170\u20139.","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"957_CR26","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1240681","volume":"14","author":"I Hach","year":"2023","unstructured":"Hach I, Bertsch T, Nonell P. The prevalence of off-label use and supratherapeutic blood levels of outpatient psychotropic medication in suicidal adolescents. Front Psychiatry. 2023;14: 1240681.","journal-title":"Front Psychiatry"},{"issue":"4","key":"957_CR27","doi-asserted-by":"publisher","first-page":"205","DOI":"10.4103\/jrpp.JRPP_18_42","volume":"7","author":"KT Korno","year":"2018","unstructured":"Korno KT, Aagaard L. Off-label prescribing of antipsychotics in a Danish child and adolescent mental health center: a register-based study. J Res Pharm Pract. 2018;7(4):205\u20139.","journal-title":"J Res Pharm Pract"},{"issue":"22\u201323","key":"957_CR28","first-page":"396","volume":"113","author":"S Abbas","year":"2016","unstructured":"Abbas S, Ihle P, Adler JB, Engel S, Gunster C, Linder R, et al. Psychopharmacological prescriptions in children and adolescents in Germany. Dtsch Arztebl Int. 2016;113(22\u201323):396\u2013403.","journal-title":"Dtsch Arztebl Int"},{"issue":"2","key":"957_CR29","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1017\/S1461145711000381","volume":"15","author":"MF Flament","year":"2012","unstructured":"Flament MF, Bissada H, Spettigue W. Evidence-based pharmacotherapy of eating disorders. Int J Neuropsychopharmacol. 2012;15(2):189\u2013207.","journal-title":"Int J Neuropsychopharmacol"},{"issue":"2","key":"957_CR30","doi-asserted-by":"publisher","first-page":"E25","DOI":"10.1542\/peds.108.2.e25","volume":"108","author":"E Schirm","year":"2001","unstructured":"Schirm E, Tobi H, Zito JM. De Jong-van Den Berg LT. Psychotropic medication in children: a study from the Netherlands. Pediatrics. 2001;108(2):E25.","journal-title":"Pediatrics"},{"issue":"4","key":"957_CR31","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1007\/s00431-006-0244-7","volume":"166","author":"A Clavenna","year":"2007","unstructured":"Clavenna A, Rossi E, Derosa M, Bonati M. Use of psychotropic medications in Italian children and adolescents. Eur J Pediatr. 2007;166(4):339\u201347.","journal-title":"Eur J Pediatr"},{"issue":"3","key":"957_CR32","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1089\/cap.2007.0091","volume":"18","author":"C Sevilla-Dedieu","year":"2008","unstructured":"Sevilla-Dedieu C, Kovess-Masfety V. Psychotropic medication use in children and adolescents: a study from France. J Child Adolesc Psychopharmacol. 2008;18(3):281\u20139.","journal-title":"J Child Adolesc Psychopharmacol"},{"issue":"2","key":"957_CR33","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1007\/s11096-014-9924-y","volume":"36","author":"L Aagaard","year":"2014","unstructured":"Aagaard L, Hansen EH. Adverse drug reactions associated with asthma medications in children: systematic review of clinical trials. Int J Clin Pharm. 2014;36(2):243\u201352.","journal-title":"Int J Clin Pharm"},{"issue":"5 Suppl","key":"957_CR34","doi-asserted-by":"publisher","first-page":"S68","DOI":"10.1016\/j.acap.2014.05.009","volume":"14","author":"E Kealey","year":"2014","unstructured":"Kealey E, Scholle SH, Byron SC, Hoagwood K, Leckman-Westin E, Kelleher K, et al. Quality concerns in antipsychotic prescribing for youth: a review of treatment guidelines. Acad Pediatr. 2014;14(5 Suppl):S68\u201375.","journal-title":"Acad Pediatr"},{"issue":"10","key":"957_CR35","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1016\/j.euroneuro.2017.07.001","volume":"27","author":"O Halfdanarson","year":"2017","unstructured":"Halfdanarson O, Zoega H, Aagaard L, Bernardo M, Brandt L, Fuste AC, et al. International trends in antipsychotic use: a study in 16 countries, 2005\u20132014. Eur Neuropsychopharmacol. 2017;27(10):1064\u201376.","journal-title":"Eur Neuropsychopharmacol"},{"key":"957_CR36","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s13034-017-0192-1","volume":"11","author":"LJ Kalverdijk","year":"2017","unstructured":"Kalverdijk LJ, Bachmann CJ, Aagaard L, Burcu M, Glaeske G, Hoffmann F, et al. A multi-national comparison of antipsychotic drug use in children and adolescents, 2005\u20132012. Child Adolesc Psychiatry Ment Health. 2017;11:55.","journal-title":"Child Adolesc Psychiatry Ment Health"},{"issue":"1","key":"957_CR37","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1186\/s13052-016-0259-2","volume":"42","author":"S Pisano","year":"2016","unstructured":"Pisano S, Catone G, Veltri S, Lanzara V, Pozzi M, Clementi E, et al. Update on the safety of second generation antipsychotics in youths: a call for collaboration among paediatricians and child psychiatrists. Ital J Pediatr. 2016;42(1):51.","journal-title":"Ital J Pediatr"},{"issue":"5","key":"957_CR38","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1111\/j.1365-2125.2011.03915.x","volume":"71","author":"L Aagaard","year":"2011","unstructured":"Aagaard L, Hansen EH. Prescribing of medicines in the Danish paediatric population outwith the licensed age group: characteristics of adverse drug reactions. Br J Clin Pharmacol. 2011;71(5):751\u20137.","journal-title":"Br J Clin Pharmacol"},{"issue":"9","key":"957_CR39","doi-asserted-by":"publisher","first-page":"3259","DOI":"10.1007\/s00431-022-04515-7","volume":"181","author":"M Meng","year":"2022","unstructured":"Meng M, Lv M, Wang L, Yang B, Jiao P, Lei W, et al. Off-label use of drugs in pediatrics: a scoping review. Eur J Pediatr. 2022;181(9):3259\u201369.","journal-title":"Eur J Pediatr"},{"issue":"11","key":"957_CR40","doi-asserted-by":"publisher","first-page":"e1660","DOI":"10.1097\/PEC.0000000000002693","volume":"38","author":"S Minghetti","year":"2022","unstructured":"Minghetti S, Vannini M, Casula L, Asprea M, Gori S, Calvani AM, et al. Epidemiological and psychopharmacological study about Off-Label treatment in child and adolescent psychiatric emergencies: A tertiary\/single center experience. Pediatr Emerg Care. 2022;38(11):e1660\u20133.","journal-title":"Pediatr Emerg Care"},{"issue":"8","key":"957_CR41","first-page":"1035","volume":"27","author":"S Chen","year":"2021","unstructured":"Chen S, Barner JC, Cho E. Trends in off-label use of antipsychotic medications among Texas Medicaid children and adolescents from 2013 to 2016. J Manag Care Spec Pharm. 2021;27(8):1035\u201345.","journal-title":"J Manag Care Spec Pharm"},{"issue":"1","key":"957_CR42","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1186\/s12888-021-03374-0","volume":"21","author":"J Wang","year":"2021","unstructured":"Wang J, Jiang F, Yang Y, Zhang Y, Liu Z, Qin X, et al. Off-label use of antipsychotic medications in psychiatric inpatients in China: a national real-world survey. BMC Psychiatry. 2021;21(1):375.","journal-title":"BMC Psychiatry"},{"issue":"8","key":"957_CR43","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1007\/s11920-013-0382-3","volume":"15","author":"ML Birnbaum","year":"2013","unstructured":"Birnbaum ML, Saito E, Gerhard T, Winterstein A, Olfson M, Kane JM, et al. Pharmacoepidemiology of antipsychotic use in youth with ADHD: trends and clinical implications. Curr Psychiatry Rep. 2013;15(8):382.","journal-title":"Curr Psychiatry Rep"},{"issue":"12","key":"957_CR44","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.1001\/archgenpsychiatry.2012.647","volume":"69","author":"M Olfson","year":"2012","unstructured":"Olfson M, Blanco C, Liu SM, Wang S, Correll CU. National trends in the office-based treatment of children, adolescents, and adults with antipsychotics. Arch Gen Psychiatry. 2012;69(12):1247\u201356.","journal-title":"Arch Gen Psychiatry"},{"issue":"1","key":"957_CR45","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1001\/jamapsychiatry.2013.3074","volume":"71","author":"M Olfson","year":"2014","unstructured":"Olfson M, Blanco C, Wang S, Laje G, Correll CU. National trends in the mental health care of children, adolescents, and adults by office-based physicians. JAMA Psychiatr. 2014;71(1):81\u201390.","journal-title":"JAMA Psychiatr"},{"issue":"6","key":"957_CR46","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1016\/j.jaac.2016.03.012","volume":"55","author":"SY Park","year":"2016","unstructured":"Park SY, Cervesi C, Galling B, Molteni S, Walyzada F, Ameis SH, et al. Antipsychotic use trends in youth with autism spectrum disorder and\/or intellectual disability: A Meta-Analysis. J Am Acad Child Adolesc Psychiatry. 2016;55(6):456\u201368. e4.","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"3","key":"957_CR47","doi-asserted-by":"publisher","first-page":"347","DOI":"10.4088\/JCP.15r10435","volume":"78","author":"C Cervesi","year":"2017","unstructured":"Cervesi C, Park SY, Galling B, Molteni S, Masi G, Gerhard T, et al. Extent, time course, and moderators of antipsychotic treatment in youth with mood disorders: results of a meta-analysis and meta-regression analyses. J Clin Psychiatry. 2017;78(3):347\u201357.","journal-title":"J Clin Psychiatry"},{"issue":"3","key":"957_CR48","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1089\/cap.2017.0077","volume":"28","author":"RS Sultan","year":"2018","unstructured":"Sultan RS, Correll CU, Schoenbaum M, King M, Walkup JT, Olfson M. National patterns of commonly prescribed psychotropic medications to young people. J Child Adolesc Psychopharmacol. 2018;28(3):158\u201365.","journal-title":"J Child Adolesc Psychopharmacol"},{"issue":"4","key":"957_CR49","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1089\/cap.1997.7.237","volume":"7","author":"JM Zito","year":"1997","unstructured":"Zito JM, Safer DJ. Sources of data for pharmacoepidemiological studies of child and adolescent psychiatric disorders. J Child Adolesc Psychopharmacol. 1997;7(4):237\u201353.","journal-title":"J Child Adolesc Psychopharmacol"},{"issue":"5","key":"957_CR50","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1097\/00004583-200205000-00008","volume":"41","author":"M Olfson","year":"2002","unstructured":"Olfson M, Marcus SC, Weissman MM, Jensen PS. National trends in the use of psychotropic medications by children. J Am Acad Child Adolesc Psychiatry. 2002;41(5):514\u201321.","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"1","key":"957_CR51","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1001\/archpedi.157.1.17","volume":"157","author":"JM Zito","year":"2003","unstructured":"Zito JM, Safer DJ, DosReis S, Gardner JF, Magder L, Soeken K, et al. Psychotropic practice patterns for youth: a 10-year perspective. Arch Pediatr Adolesc Med. 2003;157(1):17\u201325.","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"1","key":"957_CR52","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1089\/cap.2005.15.38","volume":"15","author":"A Faber","year":"2005","unstructured":"Faber A, de Jong-van den Berg LT, van den Berg PB, Tobi H. Psychotropic co-medication among stimulant-treated children in the Netherlands. J Child Adolesc Psychopharmacol. 2005;15(1):38\u201343.","journal-title":"J Child Adolesc Psychopharmacol"},{"issue":"1\u20132","key":"957_CR53","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1089\/cap.2006.16.197","volume":"16","author":"JM Fegert","year":"2006","unstructured":"Fegert JM, Kolch M, Zito JM, Glaeske G, Janhsen K. Antidepressant use in children and adolescents in Germany. J Child Adolesc Psychopharmacol. 2006;16(1\u20132):197\u2013206.","journal-title":"J Child Adolesc Psychopharmacol"},{"issue":"4","key":"957_CR54","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1176\/ajp.2006.163.4.579","volume":"163","author":"SH Zuvekas","year":"2006","unstructured":"Zuvekas SH, Vitiello B, Norquist GS. Recent trends in stimulant medication use among U.S. children. Am J Psychiatry. 2006;163(4):579\u201385.","journal-title":"Am J Psychiatry"},{"issue":"18","key":"957_CR55","first-page":"2360","volume":"127","author":"H Asheim","year":"2007","unstructured":"Asheim H, Nilsen KB, Johansen K, Furu K. Prescribing of stimulants for ADHD in Nordland county. Tidsskr Nor Laegeforen. 2007;127(18):2360\u20132.","journal-title":"Tidsskr Nor Laegeforen"},{"issue":"4","key":"957_CR56","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1177\/1087054707299597","volume":"10","author":"L Castle","year":"2007","unstructured":"Castle L, Aubert RE, Verbrugge RR, Khalid M, Epstein RS. Trends in medication treatment for ADHD. J Atten Disord. 2007;10(4):335\u201342.","journal-title":"J Atten Disord"},{"issue":"1","key":"957_CR57","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/1753-2000-2-24","volume":"2","author":"JM Zito","year":"2008","unstructured":"Zito JM, Derivan AT, Kratochvil CJ, Safer DJ, Fegert JM, Greenhill LL. Off-label psychopharmacologic prescribing for children: history supports close clinical monitoring. Child Adolesc Psychiatry Ment Health. 2008;2(1):24.","journal-title":"Child Adolesc Psychiatry Ment Health"},{"issue":"4","key":"957_CR58","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1024\/1422-4917\/a000417","volume":"44","author":"C Franke","year":"2016","unstructured":"Franke C, Fegert JM, Kruger U, Kolch M. Verordnungsh\u00e4ufigkeiten von Psychopharmaka bei Kindern und Jugendlichen mit psychischen Erkrankungen in Deutschland. Z Kinder Jugendpsychiatr Psychother. 2016;44(4):259\u201374.","journal-title":"Z Kinder Jugendpsychiatr Psychother"},{"issue":"3","key":"957_CR59","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1089\/cap.2017.0054","volume":"28","author":"N Ansermot","year":"2018","unstructured":"Ansermot N, Jordanov V, Smogur M, Holzer L, Eap CB. Psychotropic drug prescription in adolescents: a retrospective study in a Swiss psychiatric university hospital. J Child Adolesc Psychopharmacol. 2018;28(3):192\u2013204.","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"957_CR60","doi-asserted-by":"publisher","first-page":"w30124","DOI":"10.4414\/SMW.2022.w30124","volume":"152","author":"A Feka","year":"2022","unstructured":"Feka A, Di Paolo ER, Pauchard JY, Mariguesa A, Gehri M, Sadeghipour F. Off-label use of psychotropic drugs in a Swiss paediatric service: similar results from two different cohort studies. Swiss Med Wkly. 2022;152:w30124.","journal-title":"Swiss Med Wkly"},{"key":"957_CR61","unstructured":"Egberts KP, Malzahn P, Taurines U, Reuter-Dang R, Gerlach S-Y, Romanos M. M. Sicherheit von Psychopharmaka bei Kindern und Jugendlichen in der klinischen Praxis \u2013 Erkenntnisse einer prospektiven Studie. 2020. https:\/\/www.bfarm.de\/SharedDocs\/Downloads\/DE\/Arzneimittel\/Pharmakovigilanz\/Bulletin\/2020\/3-2020.pdf?__blob=publicationFile&v=4"},{"issue":"1","key":"957_CR62","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/1753-2000-3-14","volume":"3","author":"C Mehler-Wex","year":"2009","unstructured":"Mehler-Wex C, Kolch M, Kirchheiner J, Antony G, Fegert JM, Gerlach M. Drug monitoring in child and adolescent psychiatry for improved efficacy and safety of psychopharmacotherapy. Child Adolesc Psychiatry Ment Health. 2009;3(1):14.","journal-title":"Child Adolesc Psychiatry Ment Health"},{"key":"957_CR63","unstructured":"Guy W. ECDEU assessment manual for psychopharmacology. US Department of Health, Education, and Welfare, Service PH. Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch, Division of Extramural Research Programs. 1976:603."},{"issue":"12","key":"957_CR64","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1002\/pds.3649","volume":"23","author":"F Hoffmann","year":"2014","unstructured":"Hoffmann F, Glaeske G, Bachmann CJ. Trends in antidepressant prescriptions for children and adolescents in Germany from 2005 to 2012. Pharmacoepidemiol Drug Saf. 2014;23(12):1268\u201372.","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"12","key":"957_CR65","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1007\/s00787-014-0523-1","volume":"23","author":"A Pottegard","year":"2014","unstructured":"Pottegard A, Zoega H, Hallas J, Damkier P. Use of SSRIs among Danish children: a nationwide study. Eur Child Adolesc Psychiatry. 2014;23(12):1211\u20138.","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"10","key":"957_CR66","doi-asserted-by":"publisher","first-page":"1694","DOI":"10.3346\/jkms.2017.32.10.1694","volume":"32","author":"MW Chon","year":"2017","unstructured":"Chon MW, Lee J, Chung S, Kim Y, Kim HW. Prescription pattern of antidepressants for children and adolescents in Korea based on nationwide data. J Korean Med Sci. 2017;32(10):1694\u2013701.","journal-title":"J Korean Med Sci"},{"issue":"5","key":"957_CR67","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1097\/JCP.0000000000000559","volume":"36","author":"JV Brauner","year":"2016","unstructured":"Brauner JV, Johansen LM, Roesbjerg T, Pagsberg AK. Off-label prescription of psychopharmacological drugs in child and adolescent psychiatry. J Clin Psychopharmacol. 2016;36(5):500\u20137.","journal-title":"J Clin Psychopharmacol"},{"key":"957_CR68","unstructured":"Deutsche Gesellschaft f\u00fcr Kinder- und Jugendpsychiatrie PuPeVD. Autism spectrum disorders in childhood, adolescence and adulthood part 1: diagnostics. Interdisciplinary S3 guideline of the DGKJP and the DGPPN as well as the participating professional societies, professional associations and patient organisations. 2016."},{"issue":"23","key":"957_CR69","doi-asserted-by":"publisher","first-page":"3280","DOI":"10.2174\/1381612821666150619092903","volume":"21","author":"L Carton","year":"2015","unstructured":"Carton L, Cottencin O, Lapeyre-Mestre M, Geoffroy PA, Favre J, Simon N, et al. Off-label prescribing of antipsychotics in adults, children and elderly individuals: a systematic review of recent prescription trends. Curr Pharm Des. 2015;21(23):3280\u201397.","journal-title":"Curr Pharm Des"},{"issue":"9","key":"957_CR70","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.1016\/j.arcped.2009.06.012","volume":"16","author":"U Winterfeld","year":"2009","unstructured":"Winterfeld U, Le Heuzey MF, Acquaviva E, Mouren MC, Brion F, Bourdon O. Off-label use of psychotropic medications in pediatric wards: a prospective study. Arch Pediatr. 2009;16(9):1252\u201360.","journal-title":"Arch Pediatr"},{"issue":"3","key":"957_CR71","first-page":"CD006617","volume":"2008","author":"J Bhattacharjee","year":"2008","unstructured":"Bhattacharjee J, El-Sayeh HG. Aripiprazole versus typical antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev. 2008;2008(3):CD006617.","journal-title":"Cochrane Database Syst Rev"},{"issue":"16","key":"957_CR72","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1001\/jama.2009.1549","volume":"302","author":"CU Correll","year":"2009","unstructured":"Correll CU, Manu P, Olshanskiy V, Napolitano B, Kane JM, Malhotra AK. Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA. 2009;302(16):1765\u201373.","journal-title":"JAMA"},{"issue":"9","key":"957_CR73","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1016\/j.jaac.2023.03.007","volume":"62","author":"MT Koch","year":"2023","unstructured":"Koch MT, Carlson HE, Kazimi MM, Correll CU. Antipsychotic-related prolactin levels and sexual dysfunction in mentally ill youth: a 3-month cohort study. J Am Acad Child Adolesc Psychiatry. 2023;62(9):1021\u201350.","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"1 Suppl","key":"957_CR74","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1055\/s-2007-979514","volume":"30","author":"RW Dittmann","year":"1997","unstructured":"Dittmann RW, Linden M, Osterheider M, Schaaf B, Ohnmacht U, Weber HJ. Antidepressant drug use: differences between psychiatrists and general practitioners. results from a drug utilization observation study with Fluoxetine. Pharmacopsychiatry. 1997;30(1 Suppl):28\u201334.","journal-title":"Pharmacopsychiatry"},{"issue":"1","key":"957_CR75","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1186\/s40337-023-00862-4","volume":"11","author":"B Frank","year":"2023","unstructured":"Frank B, Arnold S, Jaite C, Correll CU. Antipsychotic effects on anthropometric outcomes in anorexia nervosa: a retrospective chart review of hospitalized children and adolescents. J Eat Disord. 2023;11(1):151.","journal-title":"J Eat Disord"}],"container-title":["Child and Adolescent Psychiatry and Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13034-025-00957-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13034-025-00957-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13034-025-00957-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T15:23:26Z","timestamp":1760369006000},"score":1,"resource":{"primary":{"URL":"https:\/\/capmh.biomedcentral.com\/articles\/10.1186\/s13034-025-00957-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,13]]},"references-count":75,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["957"],"URL":"https:\/\/doi.org\/10.1186\/s13034-025-00957-7","relation":{},"ISSN":["1753-2000"],"issn-type":[{"value":"1753-2000","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,13]]},"assertion":[{"value":"16 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted adhering to the principles of Good Clinical Practice and the Declaration of Helsinki. The independent ethics committees of all participating centers approved the study (University Hospital of Wuerzburg study number 301\/13_ff).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors W.B., C.F., S.F., T.H., H.I., A.K., M.K., U.M., C.R., H.R, K.R., T.R., S. R.-D., G. S.-K., E.T., F.T., C.W., report no conflicts of interest. R.T., M.G., M.R., P.L.P. and K.E. received grant research support from BfArM. M.R. received a research grant from Kids-Safe, Innovation Committee of the German Federal Joint Committee (G-BA grant number 01NVF16021). M.S.-C. received an advisor honorarium from Rovi. C.U.C. has been a consultant and\/or advisor to or has received honoraria from: AbbVie, Alkermes, Allergan, Angelini, Aristo, Autobahn, Boehringer-Ingelheim, Bristol-Meyers Squibb, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Darnitsa, Delpor, Denovo, Draig, Eli Lilly, Eumentis Therapeutics, Gedeon Richter, GH, Hikma, Holmusk, IntraCellular Therapies, Jamjoom Pharma, Janssen\/J&J, Karuna, LB Pharma, Lundbeck, MedInCell, MedLink, Merck, Mindpax, Mitsubishi Tanabe Pharma, Maplight, Mylan, Neumora Therapeutics, Neuraxpharm, Neurocrine, Neurelis, Newron, Noven, Novo Nordisk, Otsuka, PPD Biotech, Recordati, Relmada, Response Pharmaeutical, Reviva, Rovi, Saladax, Sanofi, Seqirus, Servier, Sumitomo Pharma America, Sunovion, Sun Pharma, Supernus, Tabuk, Takeda, Teva, Terran, Tolmar, Vertex, Viatris and Xenon Pharmaceuticals. He provided expert testimony for Janssen, Lundbeck and Otsuka. He served on a Data Safety Monitoring Board for Compass Pathways, IntraCellular Therapies, Relmada, Reviva, Rovi. He has received grant support from Boehringer-Ingelheim, Janssen and Takeda. He received royalties from UpToDate and is also a stock option holder of Cardio Diagnostics, Kuleon Biosciences, LB Pharma, MedLink Global, Mindpax, Quantic, Terran.P.H. reports grants from the German Ministry of Research and Education, European Union, Berlin Chamber of Physicians, German Parkinson Society, University Hospital Wuerzburg, Robert Koch Institute, German Heart Foundation, Federal Joint Committee (G-BA) within the Innovationfond, German Research Foundation, Bavarian State (ministry for science and the arts), German Cancer Aid, grants from Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin (within Mondafis; Mondafis is supported by an unrestricted research grant to the Charit\u00e9 from Bayer), University G\u00f6ttingen (within FIND-AF randomized; FIND-AF randomized is supported by an unrestricted research grant to the University G\u00f6ttingen from Boehringer-Ingelheim), University Hospital Heidelberg (within RASUNOA-prime; RASUNOA-prime is supported by an unrestricted research grant to the University Hospital Heidelberg from Bayer, BMS, Boehringer-Ingelheim, and Daiichi Sankyo).P.L.P. received grant research support from the German Federal Ministry of Education and Research (BMBF) and was involved in clinical trials from Servier and Lundbeck; he received an advisor honorarium from Boehringer-Ingelheim and speaker\u2019s honoraria from Shire, Infectopharm, Janssen, Medice and Gerot Lannach as well as royalties from Hogrefe publishers.A.H. has received compensation for serving as consultant or speaker for Shire\u2013Takeda and Medice, unrelated to this work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"110"}}