Jureidini, JonGonzalez-Chica, DavidRaven, MelissaKlau, Julie Marie2025-07-162025-07-162024https://hdl.handle.net/2440/145986Prescribing of psychotropic drugs to children and adolescents has increased worldwide over several decades despite concerns about the safety and effectiveness of these drugs in paediatric populations. To date, no studies have examined psychotropic prescribing to children and adolescents in Australian primary care settings. This thesis aims to examine patterns of psychotropic prescribing from 2011 to 2018 for children aged 0-18 years, using electronic health records in the large primary care database, MedicineInsight. This thesis consisted of three main studies. Firstly, trends in the prevalence of five classes of psychotropics were examined: antidepressants, antipsychotics, attention deficit hyperactivity disorder (ADHD) drugs, anxiolytics and sedatives/hypnotics. The neurohormone melatonin was examined separately. The second study examined patterns of antipsychotic prescribing, focusing on off-label prescribing (for conditions not approved by Australia’s drug regulatory body) comparing 2011 to 2017. An examination of prescribing by social disadvantage was included, and an analysis of psychotropic co-prescribing. The third study examined the extent to which patients receiving antipsychotics were undergoing guideline-recommended monitoring for adverse events. Health monitoring included weight, waist circumference, blood pressure, blood lipids, glucose and liver function. The extent of off-label prescribing for the other four psychotropic classes was also briefly examined. Three of the five classes of psychotropics demonstrated an increase in prescribing from 2011 to 2018. The largest increase was for ADHD drugs (+9.6%, 95% CI [8.8, 10.5] annual; overall 95.8%), followed by antipsychotics (+6.2%, 95% CI [5.1, 7.2] annual; overall +62.8%) and antidepressants (+4.5%, 95% CI [4.0, 5.0] annual; overall +42.8%). The neurohormone, melatonin, showed the highest increase in prescribing (+24.7%, 95% CI [23.7, 25.8] annual; overall +606.7%). Anxiolytic prescribing remained stable, while sedative/hypnotic prescribing declined significantly (-6.5%, 95% CI [-8.0, -5.0] annual; overall -40.2%) For the antidepressants, antipsychotics and ADHD drugs there was a monotonic increase across IRSAD quintiles, with more patients receiving prescriptions as socio-economic disadvantage increased. Off-label antipsychotics prescribing increased from 69.8% of patients in 2011 to 79.7% in 2017. Antipsychotics were mainly prescribed to children and adolescents with depression/anxiety diagnoses in both years (26.8% of patients, 2011; 30.8%, 2017). 70% of all patients were co-prescribed another psychotropic with the antipsychotic in both years. Off-label prescribing of antidepressants and melatonin was also prevalent in general practice, and largely guideline-concordant, although near 100% off-label. Monitoring of health parameters in patients receiving antipsychotics was low. Within 12 months of incident prescription, 55.9% had at least one parameter measured at least once. Weight was measured most frequently (39.1%), followed by blood pressure (29.0%) and glucose (12.9%). Using target trial methodology to compare antipsychotic users to non-users, a significant but small increase in monitoring of patients starting antipsychotics was observed. Antipsychotic users recorded an average 1.157 visits with any kind of monitoring occurring within 12 months, compared to 0.691 for non-users. This thesis highlights problematic psychotropic prescribing to children and adolescents in Australian primary care settings. Public health initiatives are needed to curb the trends in psychotropic prescribing in the paediatric population and improve health outcome monitoring.enpsychotropic prescribingchildrenadolescentsantidepressantsantipsychoticsattention-deficit hyperactivity drugsmelatoninoff-labeladverse effectscardiometabolic monitoringThesis