gms | German Medical Science

Background: Only a few psychoactive medications (e.g. aripiprazole, risperidone, fluoxetine, sertraline, melatonin) are authorised for use in children and adolescents. Nevertheless, even before the pandemic, prescriptions of antipsychotics to 12- to 19-year-olds rose steadily (e.g. quetiapine in girls) [1]. Post-pandemic, there has been an increase in the incidence of mental disorders [2], [3]. Girls tend to show internalising disorders (e.g. depression), boys tend to show externalising disorders (e.g. social behaviour disorders) in adolescence. Given the strong psychosocial burden on this age group in recent years, this analysis of anonymized routine data examines the question of which diagnostical categories (according to ICD 10) were used by physicians before and after the coronavirus pandemic in prescriptions of antipsychotics and antidepressants to AOK-insured adolescents.

Materials and Methods: We analysed the most common mental diagnostical categories (ICD 10) associated with prescriptions of antidepressants and antipsychotics to 12- to 17-year-old AOK insured persons (2017–2023) with regard to quarterly prevalence and DDDs per day per 1000 insured persons.

Results: The diagnosis group most frequently selected for boys and girls in connection with a psychotropic drug prescription before, during and after the pandemic was ‘Behavioural and emotional disorders with onset usually occurring in childhood and adolescence’ (ICD 10: F9, postpandemic prevalence: males 1.36%, females 0.67%). This diagnosis group includes, for example, ‘hyperkinetic disorders’ and ‘emotional disorders with onset specific to childhood’. For girls, F4 (i.e., neurotic, stress-related and somatoform disorders, e.g. adjustment disorders) and F8 (disorders of psychological development) follow, while for boys F8 is in second place and F4 is in third place. Post-pandemic, for the F9 diagnostic category slight changes in the preference for the psychotropic drugs selected can be seen. Risperidone, pipamperone, aripiprazole and fluoxetine were most frequently prescribed to male patients pre-pandemic, and risperidone, aripiprazole, melatonin and pipamperone post-pandemic. Risperidone, fluoxetine, quetiapine and pipamperone were most frequently prescribed to girls before the pandemic. Melatonin moved up to 4^th place post-pandemic. DDD per insured person remained almost the same. Overall, psychotropic drug prescriptions to adolescents increased in the period under review.

Conclusion: The qualitative and quantitative analysis of the substances prescribed for diagnosed behavioural and emotional disorders suggests above all an intended treatment of behavioural disorders, sleep disorders and depressive-anxious symptoms. Affective disorders, which are more common in girls than in boys at this age, also appear to be more frequently the target of psychopharmacological prescriptions in girls. In the case of prescribed second-generation antipsychotics, it can be assumed that the prescription is often outside the indication (i.e. off-label). Although girls and boys in adolescence suffer from different mental disorders, the prescriptions of antipsychotics in particular are similar in terms of the amount prescribed (DDDs) and prevalence. The overall increase in psychotropic drug prescriptions in this age group, which has not yet shown a downward trend post-pandemic, should prompt further analyses, the initiation of longitudinal studies and measures to reverse the trend.