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HRB Centre for Primary Care Research Department of General Practice RCSI Medical School

HRB Centre for Primary Care Research Department of General Practice RCSI Medical School. Trends in psychostimulant prescribing in Irish children Udo Reulbach, Nicola Motterlini, Claire Keogh, Kathleen Bennett and Tom Fahey. Overview. HRB Centre for Primary Care Research

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HRB Centre for Primary Care Research Department of General Practice RCSI Medical School

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  1. HRB Centre for Primary Care ResearchDepartment of General PracticeRCSI Medical School Trends in psychostimulant prescribing in Irish children Udo Reulbach, Nicola Motterlini, Claire Keogh, Kathleen Bennett and Tom Fahey

  2. Overview • HRB Centre for Primary Care Research • Prescribing of medication in children • Ongoing research with respect to psychotropic medications • Prevalence, core symptoms and diagnostic criteria of Attention deficit hyperactivity disorder (ADHD) • Clinical evidence for treatment • Trends in psychostimulant prescribing

  3. HRB Centre for Primary Care Research • Prescribing of medication is one of the most common interventions that patients will experience. • The quality and standard of drug prescribing and the potential for medication error in patients is a relevant public health concern. • The HRB Centre for Primary Care Research is interested in vulnerable groups particularly older people, pregnant women, children and drug users (Workpackage 1).

  4. Prescribing of medication in children • Antibiotics are the most commonly prescribed drugs in children, representing one third of all prescriptions in this population. • High rates of antibiotic prescribing are an increasing worldwide concern, in terms of increased antimicrobial resistance and associated burden to health services. • Another trend is an increase in the prescription of psycholeptics and psychoanaleptics in Children.

  5. Psychotropic medications • Most of the psychotropic medications are prescribed on an off-label basis. However, there is still a lack of paediatric population-based pharmacoepidemiological research. • Study Design: A retrospective study (2002-2008) in a national Irish population aged ≤ 15 years using the Irish Primary Care Reimbursement Service (HSE-PCRS) pharmacy claims database .

  6. Ongoing research Analyses of off-label prescription and time trends in prescribing of • Benzodiazepine related drugs • Benzodiazepine derivates • Antipsychotic medication • Antiepileptic drugs • Antidepressant medication • Psychostimulant drugs

  7. Attention deficit hyperactivity disorder • Prevalence estimates of attention deficit hyperactivity disorder (ADHD) vary according to the diagnostic criteria used and the population sample: • Among school children in US: 3-5% • No objective tests exist to confirm the diagnosis of ADHD (remains a clinical diagnosis) • Formal diagnostic criteria are most applicable to boys aged 6-12 years Keen and Hadjikoumi, BMJ Clinical Evidence 2008;10:312

  8. Core symptoms and diagnostic criteria of ADHD • Inattention, hyperactivity and impulsiveness • Other conditions frequently coexist with ADHD, including developmental disorders and psychiatric disorders (particularly oppositional defiant and conduct disorder, anxiety and depressive symptoms) • Symptoms must be present for at least 6 months, are generally observed in children before the age of 7 years and cause clinically important impairment Keen and Hadjikoumi, BMJ Clinical Evidence 2008;10:312

  9. Clinical evidence • Methylphenidate improves core symptoms. • Dexamfetamineand atomoxetine may be also beneficial. Atomoxetine may cause rare but serious liver injury. • Clonidine and modafinil may improve symptoms, but are associated with an increased risk of adverse effects • Effectiveness of buproprion is unknown • Long-term effectiveness of all psychostimulants is unknown. Keen and Hadjikoumi, BMJ Clinical Evidence 2008;10:312

  10. Prevalence of psychostimulant prescriptions in Ireland (2002-2008)

  11. Time trend of psychostimulant prescriptions in Ireland (2002-2008)

  12. Time trend of psychostimulant prescriptions in Ireland (2002-2008)

  13. Time trend of psychostimulant prescriptions in Ireland (2002-2008)

  14. Non-psychostimulant prescriptions for ADHD in Ireland (2002-2008)

  15. Summary • Methylphenidate is the main substance prescribed for ADHD children in Ireland • The prevalence of psychostimulant prescriptions is increasing • Further research required with respect to • Male-dominated prescription patterns • Co-medications • Practive variations

  16. U.R., N.M. and C.K. are supported by the Health Research Board of Ireland through the HRB Centre for Primary Care Research under Grant HRC/2007/1

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