Dean Angela J, McDermott Brett M, Marshall Robert T
Kids in Mind Research, Mater Child and Youth Mental Health Service, South Brisbane, QLD 4001, Australia.
J Child Adolesc Psychopharmacol. 2006 Jun;16(3):273-85. doi: 10.1089/cap.2006.16.273.
This study aimed to identify rates and correlates of psychotropic drug utilization in children and adolescents in inpatient and outpatient settings.
A retrospective chart review examined 122 inpatient and 126 outpatient charts from a metropolitan child and youth mental health service in Brisbane, Australia.
Inpatients received more psychotropic medication than outpatients (71% vs. 25%; p < 0.01). Patients receiving medication were older, had longer hospital admissions, and more complex presentations, including history of abuse or suicide attempts and more diagnoses (all p < 0.01). Selective serotonin reuptake inhibitors (SSRIs) were the most frequently used drug class (44% inpatients; 14% outpatients), primarily indicated for mood disorders (31%). SSRIs and newer antidepressants (ADs) were used more frequently in patients with a high suicide risk (p < 0.01). Atypical antipsychotics (APs) were also used (inpatients 23%; outpatients 3%), primarily for behavioral disturbances. Half of those receiving medication (51%) received polypharmacy (>1 concurrent drug), with up to four drugs used at one time. Rates of polypharmacy were highest among patients receiving antipsychotics.
Use of psychotropic medication is frequent in this population. Future research should initially focus on inpatients and intensive treatment settings and examine both safety and efficacy of interventions for depression in young people, atypical antipsychotics for behavioral disturbances, and polypharmacy.
本研究旨在确定儿童和青少年在住院和门诊环境中使用精神药物的比例及其相关因素。
通过回顾性病历审查，对澳大利亚布里斯班一家大都市儿童和青少年心理健康服务机构的122份住院病历和126份门诊病历进行了检查。
住院患者比门诊患者接受更多的精神药物治疗（71%对25%；p<0.01）。接受药物治疗的患者年龄更大，住院时间更长，临床表现更复杂，包括有虐待史或自杀未遂史以及更多的诊断（所有p<0.01）。选择性5-羟色胺再摄取抑制剂（SSRIs）是最常用的药物类别（住院患者中占44%；门诊患者中占14%），主要用于治疗情绪障碍（31%）。SSRIs和新型抗抑郁药（ADs）在自杀风险高的患者中使用更频繁（p<0.01）。非典型抗精神病药物（APs）也有使用（住院患者中占23%；门诊患者中占3%），主要用于治疗行为障碍。接受药物治疗的患者中有一半（51%）接受了联合用药（同时使用>1种药物），一次最多使用四种药物。联合用药率在接受抗精神病药物治疗的患者中最高。
该人群中精神药物的使用很常见。未来的研究应首先关注住院患者和强化治疗环境，并研究针对年轻人抑郁症的干预措施、用于行为障碍的非典型抗精神病药物以及联合用药的安全性和有效性。
