Predictors and Correlates of Psychiatric Polypharmacy Among Child and Adolescent Psychiatric Inpatients: A Retrospective Study.

Purpose/background: Rates of prescriptions of psychotropic medications to youth have increased, a significant proportion of which are recipients of psychiatric polypharmacy. Polypharmacy can increase the risk of multiple negative outcomes. Prior studies attempting to identify predictors/correlates of polypharmacy have been heterogeneous. This study aimed to examine factors associated with polypharmacy among psychiatrically hospitalized youth, and measure changes in polypharmacy over time throughout the COVID-19 pandemic.

Methods/procedures: The medical records of 1101 patients were reviewed. Sociodemographic and clinical information was collected and analyzed using SPSS.

Findings/results: About one-third of patients received psychotropic polypharmacy; this 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. They 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. The rate of polypharmacy was relatively stable throughout the study time period, and no impact of the COVID-19 pandemic was found.

Implications/conclusions: Pediatric psychiatric polypharmacy is relatively common and may be associated with poorer outcomes. Certain sociodemographic and clinical characteristics may aid clinicians in predicting which youth may be at risk for polypharmacy. Longitudinal studies are indicated to examine outcomes of polypharmacy so that providers can effectively implement judicious prescribing practices in the community.