Ten-year patterns of psychiatric medications dispensed to adolescent in Finland: Open dialogue-informed practice in Western Lapland as compared to practice in other Finnish regions

Abstract

The iatrogenic risks of long-term psychotropic treatment can be minimized by reducing the amount of medication prescribed, which may be a factor in the promising outcomes of need-adapted treatment strategies such as the Open Dialogue (OD) approach. However, there is no comparison between long-term psychotropic treatment patterns in adolescents under OD-based and standard psychiatric care. This longitudinal register-based cohort study study aimed to describe the long-term medication patterns in Finland for all adolescents aged 13–20 receiving first-time psychiatric treatment from 2003 to 2008 (N = 44,685). Adolescents treated in other parts of Finland (n = 44,088) were compared to those in the Western Lapland catchment area (n = 780), where OD covered the entire mental healthcare service. Data on medication dispensation from the start of treatment until the 10-year follow-up or death were analyzed.

Adolescents who started treatment outside OD were more likely to be dispensed antipsychotics (aOR: 2.4, 95 %CI: 1.9–2.9), antidepressants (aOR: 1.8, 95 %CI: 1.5–2), and benzodiazepines (aOR: 2.4, 95 %CI: 1.9–3). The proportion of those receiving antipsychotics and antidepressants remained stable, with a slight increase in the OD group. Both groups showed an increasing percentage of benzodiazepine and stimulant use in the final follow-up years. Most drug treatment periods lasted less than two years. Under OD, adolescents had lower cumulative medication exposure, suggesting lower dosages than standard care.

Organizing mental health services based on OD may reduce psychotropic treatment in young people, but further research is needed to assess its clinical significance.