Prescribing Practices of Inpatient Child Psychiatrists Under Three Auspices of Care

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Abstract
To study prescribing practices of inpatient child psychiatrists under 3 auspices of care, 137 medicated patients were compared to 122 nonmedicated patients at a state hospital, a private hospital and a county–university hospital in New York during 1991. Overall, 79% of state, 76% of private, and 68% of county–university hospital patients received at least one dose of psychotropic medication, with the state versus county–university comparison significant (p < 0.05). Significantly more medicated patients at the private hospital (80%) than at the state or county–university hospitals (each 26%) received antidepressants (p's < 0.001). Significantly more county–university (74%) than private (35%) patients received antipsychotic medications, but the proportion of nonpsychotic patients receiving antipsychotic medication was statistically similar across the three hospitals. In nonpsychotic patients, antipsychotic agents were used to treat aggressive behavior. Patients 12 years of age or younger received more stimulants, and patients 13 years of age or older received more lithium (p's < 0.01). In a clinical review of medical charts of medicated patients from the 3 auspices of care, approximately 90% of the medication-treated patients were treated at an acceptable dose level and with an acceptable rationale based on symptom or diagnosis. These and other findings and other suggest that children in state hospitals are not over-medicated in comparison to children in private hospitals or university–county hospitals, and that prescribing practices among the three hospitals, despite their different funding sources, are comparable.

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