{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:11:55Z","timestamp":1783469515083,"version":"3.55.0"},"reference-count":33,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2017,11,23]],"date-time":"2017-11-23T00:00:00Z","timestamp":1511395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>The purpose of the study was three-fold: (1) to estimate the national trends in antipsychotic (AP) polypharmacy among 6- to 24-year-old patients in the U.S.; (2) to identify frequently used AP agents and mental disorder diagnoses related to AP polypharmacy; and (3) to assess the strength of association between AP polypharmacy and patient\/provider characteristics. We used publicly available ambulatory health care datasets to evaluate AP polypharmacy in office-based or hospital outpatient department settings to conduct a cross-sectional study. First, national visit rates between 2007 and 2011 were estimated using sampling weights. Second, common diagnoses and drugs used in AP polypharmacy were identified. Third, a multivariate logistic regression model was developed to assess the strength of association between AP polypharmacy and patient and provider characteristics. Between 2007 and 2011, approximately 2% of office-based or hospital outpatient department visits made by 6- to 24-year-old patients included one or more AP prescriptions. Of these visits, 5% were classified as AP polypharmacy. The most common combination of AP polypharmacy was to use two or more second-generation APs. Also, bipolar disorder and schizophrenia were the two most frequent primary mental disorder diagnoses among AP polypharmacy visits. The factors associated with AP polypharmacy were: older age (young adults), black, having one or more non-AP prescriptions, and having schizophrenia or ADHD.<\/jats:p>","DOI":"10.3390\/pharmacy5040064","type":"journal-article","created":{"date-parts":[[2017,11,23]],"date-time":"2017-11-23T11:15:47Z","timestamp":1511435747000},"page":"64","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Antipsychotic Polypharmacy among Children and Young Adults in Office-Based or Hospital Outpatient Department Settings"],"prefix":"10.3390","volume":"5","author":[{"given":"Minji","family":"Sohn","sequence":"first","affiliation":[{"name":"College of Pharmacy, Ferris State University, 220 Ferris Drive, Big Rapids, MI 49307, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Burgess","sequence":"additional","affiliation":[{"name":"College of Health Professions, Ferris State University, 200 Ferris Drive, Big Rapids, MI 49307, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Bazzi","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Ferris State University, 220 Ferris Drive, Big Rapids, MI 49307, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,11,23]]},"reference":[{"key":"ref_1","first-page":"13","article-title":"Trends in antipsychotic drug use by very young, privately insured children","volume":"49","author":"Olfson","year":"2010","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.pedhc.2011.10.009","article-title":"Antipsychotic medication prescribing trends in children and adolescents","volume":"26","author":"Harrison","year":"2012","journal-title":"J. Pediatr. Health Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1002\/pds.3897","article-title":"Antipsychotic prescribing for behavioral disorders in US youth: Physician specialty, insurance coverage, and complex regimens","volume":"25","author":"Burcu","year":"2016","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e3784","DOI":"10.1097\/MD.0000000000003784","article-title":"National trends in off-label use of atypical antipsychotics in children and adolescents in the United States","volume":"95","author":"Sohn","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"ref_5","first-page":"187","article-title":"Second generation antipsychotics for schizophrenia","volume":"6","author":"Feltus","year":"1999","journal-title":"Can. J. Clin. Pharmacol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1176\/appi.ajp.161.3.414","article-title":"Lower Risk for Tardive Dyskinesia Associated with Second-Generation Antipsychotics: A Systematic Review of 1-Year Studies","volume":"161","author":"Correll","year":"2004","journal-title":"Am. J. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1001\/archpedi.153.12.1257","article-title":"Psychotherapeutic medication patterns for youths with attention-deficit\/hyperactivity disorder","volume":"153","author":"Zito","year":"1999","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.euroneuro.2009.04.008","article-title":"Antipsychotics in children and adolescents: Increasing use, evidence for efficacy and safety concerns","volume":"19","author":"Vitiello","year":"2009","journal-title":"Eur. Neuropsychopharmacol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1001\/archgenpsychiatry.2012.647","article-title":"National trends in the office-based treatment of children, adolescents, and adults with antipsychotics","volume":"69","author":"Olfson","year":"2012","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1089\/cap.2013.0094","article-title":"Atypical Antipsychotic Use among Medicaid-Insured Children and Adolescents: Duration, Safety, and Monitoring Implications","volume":"24","author":"Burcu","year":"2014","journal-title":"J. Child Adolesc. Psychopharmacol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1001\/archpedi.158.8.753","article-title":"New Users of Antipsychotic Medications Among Children Enrolled in TennCare","volume":"158","author":"Cooper","year":"2004","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"483","DOI":"10.2165\/00002512-200926060-00005","article-title":"Use of antipsychotics among elderly nursing home residents with dementia in the US: An analysis of National Survey Data","volume":"26","author":"Kamble","year":"2009","journal-title":"Drugs Aging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1002\/pds.2082","article-title":"Increasing off-label use of antipsychotic medications in the United States, 1995\u20132008","volume":"20","author":"Alexander","year":"2011","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s00787-016-0905-7","article-title":"Outpatient antipsychotic drug use in children and adolescents in Germany between 2004 and 2011","volume":"26","author":"Kollhorst","year":"2017","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.ambp.2005.11.002","article-title":"Trends in Prescribing of Antipsychotic Medications for US Children","volume":"6","author":"Cooper","year":"2006","journal-title":"Ambul. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1176\/ps.2010.61.2.123","article-title":"Evidence-based use of second-generation antipsychotics in a state Medicaid pediatric population, 2001\u20132005","volume":"61","author":"Pathak","year":"2010","journal-title":"Psychiatr. Serv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e771","DOI":"10.1542\/peds.2011-2158","article-title":"Antipsychotics for children and young adults: A comparative effectiveness review","volume":"129","author":"Seida","year":"2012","journal-title":"Pediatrics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1038\/sj.npp.1300023","article-title":"Effect of divalproex combined with olanzapine or risperidone in patients with an acute exacerbation of schizophrenia","volume":"28","author":"Casey","year":"2003","journal-title":"Neuropsychopharmacology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1001\/archpsyc.60.11.1079","article-title":"Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression","volume":"60","author":"Tohen","year":"2003","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1017\/S1461145704004146","article-title":"Focus on antipsychotic polypharmacy: Evidence-based prescribing or prescribing-based evidence?","volume":"7","author":"Stahl","year":"2004","journal-title":"Int. J. Neuropsychopharmacol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"383","DOI":"10.2165\/11587810-000000000-00000","article-title":"Antipsychotic Polypharmacy in Schizophrenia","volume":"25","author":"Barnes","year":"2011","journal-title":"CNS Drugs"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1001\/jamapsychiatry.2013.2053","article-title":"Antipsychotics and the risk of type 2 diabetes mellitus in children and youth","volume":"70","author":"Bobo","year":"2013","journal-title":"JAMA Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1002\/pds.3768","article-title":"Atypical antipsychotic initiation and the risk of type II diabetes in children and adolescents","volume":"24","author":"Sohn","year":"2015","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.sapharm.2008.08.005","article-title":"Concomitant antipsychotic prescribing in US outpatient settings","volume":"5","author":"Aparasu","year":"2009","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"17","DOI":"10.18553\/jmcp.2005.11.1.17","article-title":"Prescribing of Antipsychotic Medication in a Medicaid Population: Use of Polytherapy and Off-Label Dosages","volume":"11","author":"Kogut","year":"2005","journal-title":"J. Manag. Care Pharmacy"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1176\/ps.2007.58.7.1007","article-title":"Antipsychotic polypharmacy trends among Medicaid beneficiaries with schizophrenia in San Diego County, 1999\u20132004","volume":"58","author":"Gilmer","year":"2007","journal-title":"Psychiatr. Serv."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1176\/ps.2007.58.4.489","article-title":"Long-term antipsychotic polypharmacy in the VA health system: Patient characteristics and treatment patterns","volume":"58","author":"Kreyenbuhl","year":"2007","journal-title":"Psychiatr. Serv."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1017\/S2045796011000242","article-title":"Antipsychotic utilisation and polypharmacy in Italian residential facilities: A survey","volume":"20","author":"Ghio","year":"2011","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Millier, A., Sarlon, E., Azorin, J.-M., Boyer, L., Aballea, S., Auquier, P., and Toumi, M. (2011). Relapse according to antipsychotic treatment in schizophrenic patients: A propensity-adjusted analysis. BMC Psychiatry, 11.","DOI":"10.1186\/1471-244X-11-24"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"566","DOI":"10.4088\/JCP.08m04912gre","article-title":"Persistent antipsychotic polypharmacy and excessive dosing in the community psychiatric treatment setting: A review of medication profiles in 435 Canadian outpatients","volume":"71","author":"Procyshyn","year":"2010","journal-title":"J. Clin. Psychiatry"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.schres.2006.08.017","article-title":"Does antipsychotic polypharmacy increase the risk for metabolic syndrome?","volume":"89","author":"Correll","year":"2007","journal-title":"Schizophr. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/WNF.0b013e3181672213","article-title":"Combined treatment with amisulpride in patients with schizophrenia discharged from a short-term hospitalization unit: A 1-year retrospective study","volume":"32","author":"Molina","year":"2009","journal-title":"Clin. Neuropharmacol."},{"key":"ref_33","unstructured":"Center for Disease Control and Prevention (2017, May 08). Ambulatory Health Care Data, Available online: http:\/\/www.cdc.gov\/nchs\/ahcd.htm."}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/5\/4\/64\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:51:01Z","timestamp":1760208661000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/5\/4\/64"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,23]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2017,12]]}},"alternative-id":["pharmacy5040064"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy5040064","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,23]]}}}