Use of pharmacotherapy for insomnia in child psychiatry practice: A national survey.

Abstract

OBJECTIVE:

To examine clinical practice patterns regarding non-prescription and prescription medication use for insomnia by child and adolescent psychiatrists.

METHODS:

Survey mailed to 6018 members of the American Academy of Child and Adolescent Psychiatry.

RESULTS:

The final sample (N=1273) reported that insomnia was a major problem in almost a third of their school-aged and adolescent patients and endorsed using medication to treat the insomnia in at least a quarter of these patients. Overall, 96% of respondents recommended at least one of the listed prescription medications in a typical month, and 88% recommended an over-the-counter medication. Alpha agonists were the most commonly prescribed insomnia medication for ADHD (81%), significantly higher than in MR/DD (67%), mood (40%), or anxiety disorders (31%). Trazodone was the most commonly prescribed insomnia medication for children with mood (78%) and anxiety disorders (72%). Antidepressants as a class were also commonly used for children in these diagnostic groups. Atypical antipsychotics, anticonvulsants, and short-acting hypnotics were also more likely to be used in children with mood disorders. Melatonin was recommended by more than one-third of respondents. Mitigation of the effects of sleep disruption on daytime functioning was endorsed as an important rationale for the use of sleep medication; concerns about side effects and the lack of empirical support regarding efficacy were cited as significant barriers to their use.

CONCLUSIONS:

Insomnia is a significant clinical problem in children treated by child psychiatrists for a variety of behavioral, neurodevelopmental, and psychiatric conditions. Management with a broad array of psychotropic medications is common and indicates a highly variable clinical approach to insomnia in this pediatric population.

• Authors: Judith A Owens, Carol L Rosen, Jodi A Mindell, Hal L Kirchner
• Journal: Sleep medicine (Sleep Med) Vol. 11 Issue 7 Pg. 692-700 (Aug 2010) ISSN: 1878-5506 [Electronic] Netherlands
• PMID: 20621556 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2010 Elsevier B.V. All rights reserved.

Chemical References

• Histamine Antagonists
• Hypnotics and Sedatives
• Melatonin

Topics

• Adolescent
• Attention Deficit Disorder with Hyperactivity (drug therapy)
• Attitude of Health Personnel
• Child
• Child Psychiatry (statistics & numerical data)
• Health Care Surveys
• Herbal Medicine (statistics & numerical data)
• Histamine Antagonists (therapeutic use)
• Humans
• Hypnotics and Sedatives (therapeutic use)
• Melatonin (therapeutic use)
• Practice Patterns, Physicians' (statistics & numerical data)
• Sleep Initiation and Maintenance Disorders (drug therapy)
• Surveys and Questionnaires