The Science and Ethics of Antipsychotic Use in Children

1st Edition - April 24, 2015
Editors: Nina Di Pietro, Judy Illes
Language: English
Hardback ISBN:
9 7 8 - 0 - 1 2 - 8 0 0 0 1 6 - 8
eBook ISBN:
9 7 8 - 0 - 1 2 - 8 0 0 4 8 1 - 4

The Science and Ethics of Antipsychotic Use in Children reviews the latest findings for the safety and efficacy of the rapidly rising incidence of antipsychotic use in children… Read more

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The Science and Ethics of Antipsychotic Use in Children reviews the latest findings for the safety and efficacy of the rapidly rising incidence of antipsychotic use in children and examines tensions that are created by off-label use, both in clinical psychiatric practice and research.
In the past ten years, the number of antipsychotics prescribed to children with psychiatric disorders has skyrocketed. Despite this rapid growth, most medications have been inadequately studied in children for safety or efficacy and many have serious adverse health. Measures are needed to ensure that the health and safety of children are being protected, and debates have emerged over whether or not clinical trials in this population should be conducted.

Foreword
Acknowledgments
Introduction: A Call for Partnership
Chapter 1: A Brief History of the Science and Ethics of Antipsychotics and Off-Label Prescribing
- Abstract
- A New Era in Psychopharmacology Research Begins
- A Second Generation Emerges
- The Expansion of Antipsychotics: Off-Label Use in Children
- Benefits in the Face of Risks
- A Call for Partnership
Chapter 2: Pharmacoepidemiology of Antipsychotic Use in Canadian Children and Adolescents
- Abstract
- Introduction
- Differences in SGA Regulation Between Canada and Other Countries
- Canadian Second-Generation Antipsychotic Medications Prescription Trends for Children and Adolescents
- National Prescribing Trends
- Provincial Prescribing Trends
- Comparing Canadian SGA Prescription Trends to those in Other Countries
- Conclusions
Chapter 3: Do We Know If They Work and If They Are Safe: Second-Generation Antipsychotics for Treatment of Autism Spectrum Disorders and Disruptive Behavior Disorders in Children and Adolescents
- Abstract
- Introduction
- Methods
- Discussion
- Conclusion
Chapter 4: Ensuring the Safety of Children Treated with Second-Generation Antipsychotics
- Abstract
- Introduction
- Side Effects Associated with SGA Use in Children and Youth
- Monitoring the Health of Children and Youth on SGAs
- Guidelines for Metabolic Monitoring
- Recommendations for Monitoring Metabolic Changes
- Management of Metabolic Complications
- Why Standardized Metabolic Monitoring Matters
- Overcoming Barriers to Completion of Monitoring
- Conclusion
Chapter 5: Pediatric Clinical Trial Activity for Antipsychotics and the Sharing of Results: A Complex Ethical Landscape
- Abstract
- Introduction
- Mapping the Landscape: Clinical Trials for Antipsychotics in Children and Youth
- Reflections on the Current State of Pediatric Clinical Trials for Antipsychotics
- Recommendations
Chapter 6: Pathways to Overmedication and Polypharmacy: Case Examples from Adolescents with Fetal Alcohol Spectrum Disorders
- Abstract
- Introduction
- Medication History in 17 Children with an FASD and Sleep Problems
- Case Vignette Demonstrating Interactions between Sleep Problems, WED, and ADRs
- Discussion
- Conclusion and Outlook
Chapter 7: Implementing Change in Prescribing Practices
- Abstract
- Introduction
- Pharmacotherapeutic Decision Making
- The Youth and Family Experience of Psychotropic Decision Making
- The Prescriber Experience of Psychotropics and Decision Making
- An Approach to Designing Strategies for Changing Prescribing Behaviors
- Selection of Behavior Change Techniques
- Examples of Intervention Functions and Behavior Change Techniques for Improving Use of Antipsychotics
- Implementation of Interventions to Change Behaviors
- Future Considerations
Chapter 8: Canadian Initiatives and Recommendations: Safeguarding the Health of Children and Youth Receiving Off-Label Treatment with Antipsychotics
- Abstract
- Introduction
- Post-Approval Monitoring of Off-Label Antipsychotic Prescriptions
- Informed Consent for Patients and Caregivers
- Incentivizing Clinical Trials and Expanding the Knowledge Base
- Canadian Pharmaceutical Marketing Regulatory Policies
- Summary of Guidelines for Prescribing Antipsychotics
- Conclusion
Appendix A: List of Online Resources
- Chapter 1: Introduction
- Chapter 2: Pharmacoepidemiology of Antipsychotic Use in Canadian Children and Adolescents
- Chapter 3: Do We Know if they Work and if they are Safe: Second-generation Antipsychotics for Treatment of Autism Spectrum Disorders and Disruptive Behavior Disorders in Children and Adolescents
- Chapter 4: Ensuring the Safety of Children Treated with Second-generation Antipsychotics
- Chapter 5: Pediatric Clinical Trial Activity for Antipsychotics and the Sharing of Results: A Complex Ethical Landscape
- Chapter 6: Pathways to Overmedication and Polypharmacy: Case Examples from Adolescents with Fetal Alcohol Spectrum Disorders
- Chapter 7: Implementing Change in Prescribing Practices
- Chapter 8: Canadian Initiatives and Recommendations: Safeguarding the Health of Children and Youth Receiving Off-label Treatment with Antipsychotics
Index

Nina Di Pietro

Senior Research Fellow at the University of British Columbia’s “National Core for Neuroethics, Dr. Di Pietro also serves as the Neuroethics Program Lead for NeuroDevNet (Canadian org focused on children’s neurodevelopmental disorders) and is described by one reviewer as “a rising force in the field of neuroethics and developmental neuroscience.”

Affiliations and expertise

University of British Columbia, Vancouver, BC, Canada

Judy Illes

Dr. Illes, trailblazing neuroethicist, is Professor of Neurology at the University of British Columbia (UBC), Distinguished University Scholar, UBC Distinguished Scholar in Neuroethics, and Director of Neuroethics Canada. She holds appointments in UBC’s School of Population and Public Health, and in Journalism, and in the Department of Computer Science and Engineering at the University of Washington, in Seattle. She is a pioneer of the field of neuroethics through which she has made groundbreaking contributions to cross-cultural ethical, legal, social and policy challenges at the intersection of the brain sciences and biomedical ethics.

Dr. Illes received her PhD in Hearing and Speech Sciences and in Neuropsychology from Stanford University in 1987, and turned to ethics in 2000, 25 years ago. She was among the first to use high density EEG recordings and pattern recognition to understand language processing in neurodegenerative disease, and was part of the revolution that functional MRI introduced. Together with others whose vision for ethics for neuroscience led from within the neurosciences, Dr. Illes has not only placed neuroethics on the world map of , but has tirelessly trained the generation that leads it today, and already those who will lead it tomorrow.

Dr. Illes has published 11 edited volumes, including three handbooks in neuroethics and as Editor in Chief of the series of volumes for Developments in Neuroethics and Bioethics. She has led major research projects and hundreds of publications on invasive and noninvasive technologies, fixed and portable imaging systems such as MRI, biologics, pharmaceuticals, and devices, open science and intellectual property protections. In 2023, she released an award-winning film on neurotechnology ethics and decision-making for children with drug resistant epilepsy. Dr. Illes has also contributed significantly to the Canadian landscape in understanding crosscultural perspectives on brain and mind, including those of Indigenous People. She has received countless awards and recognitions for her empirical work and her mentoring alike.

Dr. Illes places a particular emphasis on issues of ethics in neuroscience with attention to biomedicine, innovations that seek to alleviate the burden of psychiatric and neurologic disease, including spinal cord injury, both expected and unexpected incidental findings, holism, human rights and health disparities. With this open and broad perspective, she capably leads the seven-nation International Brain Initiative dedicated to global neuroscience that is inclusive and politically free.

Dr. Illes was awarded the Order of Canada, one of the country’s highest recognition of its citizens, in 2017.

Affiliations and expertise

Professor of Neurology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada

Life Sciences

Physical Sciences & Engineering

Social Sciences & Humanities

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