A new study has uncovered troubling trends in how antipsychotic drugs are prescribed and monitored for children and young people in England. Published in BMJ Mental Health, the research found signs of inappropriate prescribing, low levels of follow-up care, and unclear treatment guidelines.
Led by Dr. Yana Vinogradova from the University of Nottingham’s School of Medicine, the study used anonymised general practice records linked to hospital data. It focused on patients aged 5 to 17 and examined how antipsychotic treatments were used between 2006 and 2021.
Antipsychotics can cause serious physical side effects in young patients. NICE (National Institute for Health and Care Excellence) guidelines recommend that for conditions like psychosis and bipolar disorder, these drugs should be prescribed and initially monitored by specialist doctors for at least a year.
After that, GPs may continue care under a “shared care” model. For autism or Tourette’s, where antipsychotics may be used off-label for severe symptoms, the guidance is less detailed.
The study found that antipsychotic prescriptions have increased, especially among adolescent girls. However, fewer than half of these prescriptions were tied to conditions that NICE guidelines specifically address.
Many were for children with autism, while about 20% had no clear mental health diagnosis in their records. Some treatment durations were also longer than expected, especially for autism, ADHD, Tourette’s, learning disabilities, and self-harm.
Health monitoring after prescriptions was often lacking. Fewer lab tests were recorded than basic checks like weight or heart rate. Monitoring was slightly better for psychosis and bipolar disorder, but much lower for autism or Tourette’s.
Dr. Vinogradova said the findings could indicate poor adherence to guidelines. However, she also noted that missing or incomplete GP records might hide important details. Often, treatment begins in specialist care and is only later passed to GPs. When this information isn’t fully transferred or recorded, it becomes harder to assess whether care meets standards.
The researchers call for unified best practice guidelines and better data sharing between health systems. These changes could ensure safer, more consistent treatment for children receiving antipsychotics.
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