Correlates of Psychiatric Polypharmacy Among Child and Adolescent Psychiatric Inpatients

Background Rates of psychiatric illness among the child and adolescent population have increased over the past several decades. As social and government agencies work to expand access to mental health treatment, more and more children and adolescents are receiving medications for their symptoms. However, many drugs used in this population are not approved for people under the age of 18, and have not been studied in terms of long-term impact on the developing brain. A significant proportion of these patients receive psychiatric polypharmacy, or the prescription of 2 or more psychotropic agents. This rate has increased from about 8% in 1996 to over 40% in 2005. Factors correlated with polypharmacy include older age, male gender, White race, and low socioeconomic status. Polypharmacy can increase the risk of drug-drug interactions, increase morbidity/mortality through cumulative toxicity, and cause decreased medication adherence. Study Aims: This study aimed to examine psychiatric polypharmacy specifically among psychiatrically hospitalized patients in a New York City hospital, and to determine the impact of the COVID-19 pandemic. Methods This IRB-approved study reviewed the medical records of 1101 child and adolescent patients that were psychiatrically hospitalized between June 1 2018 and November 30 2021 at Mount Sinai Morningside. Sociodemographic and clinical information was collected and analyzed using SPSS. Results In this sample, 29.4% of patients received psychotropic polypharmacy. The polypharmacy group contained a higher percentage of males, White patients, and fewer Asian/South Asian patients. They had on average more hospitalizations, a longer hospitalization period, and were more likely to be diagnosed with an impulsive/behavioral disorder, developmental disorder, or bipolar spectrum disorder. The polypharmacy group were twice as likely to receive medication for agitation while hospitalized. A regression model identified positive predictors of polypharmacy as having a history of violence and a higher number of psychiatric hospitalizations. Negative predictors included non-White race. White patients had the highest average number of medications and Asian/South Asian patients had the lowest. No impact of the COVID-19 pandemic was found. Conclusion Psychiatric polypharmacy is extremely common in the child and adolescent population that requires psychiatric hospitalization. Increased behavioral needs, such as episodes of violence, as well as greater illness severity, as indicated by greater number of hospitalizations, may be the driving factors behind polypharmacy. Further investigation is indicated to determine other contributing causal factors and to track long-term consequences of psychiatric polypharmacy. Funding No Funding