REVIEW OF: Albers C et al, J Child Adolesc Psychopharmacol 2021;31(5):358–363

STUDY TYPE: Retrospective review

Antipsychotic agents are increasingly used for children and adolescents in psychiatric inpatient units. These medications’ tranquilizing effects are thought to decrease the length of time that kids require seclusion and restraints (S&R)—but is this actually true? 

To examine this question, the authors conducted a retrospective analysis of the impact of antipsychotic use on duration of S&R in a pediatric inpatient cohort (n=96). Subjects consisted of children ages 5–17 who were hospitalized at the University of Missouri’s pediatric inpatient psychiatric unit between 2012 and 2014 and required S&R during their hospitalizations. Diagnoses included mood, anxiety, developmental, cognitive, and behavioral disorders. 

Patients who received antipsychotic medications spent significantly more time in S&R compared to patients who did not receive medications (p=0.001) or patients who received medications other than antipsychotics, such as diphenhydramine (p=0.002). Female patients were almost three times more likely than male patients to receive antipsychotic medications while in S&R. Average times spent in S&R for the antipsychotic group, other-medication group, and no-medication group were 76 minutes, 54 minutes, and 44 minutes, respectively. 

It’s possible that patients who received antipsychotics were more agitated in the first place, thus requiring longer time in S&R. Alternatively, they may have first received other medications that were found to be ineffective, then subsequently placed on antipsychotics. The study did not include information on the severity of subjects’ agitation and did not provide time-based data on the administration of medications—two significant limitations. 

The authors acknowledged that their findings are preliminary and require further exploration. They encouraged alternative strategies, like behavioral approaches and milieu management, until more is known about antipsychotics’ effectiveness for this population—particularly since kids are uniquely vulnerable to side effects like neuroleptic malignant syndrome, dystonia, and metabolic derangements. 

Carlat Take

This study reports that antipsychotic medications don’t reduce kids’ time in S&R. Many factors confound these findings, but until we have better data on the efficacy of antipsychotics in this context, it’s reasonable to try alternative interventions like behavioral ­approaches.