Aparasu Rajender R, Bhatara Vinod
College of Pharmacy, University of Houston, Houston, TX 77030, USA.
Curr Med Res Opin. 2007 Jan;23(1):49-56. doi: 10.1185/030079906X158075.
This study examined patterns and determinants of antipsychotic prescribing in children and adolescents receiving outpatient care in the United States.
Antipsychotic prescribing practices for patients younger than 20 years were examined using the 2003-2004 National Ambulatory Medical Care Survey and the outpatient department portion of the 2003-2004 National Hospital Ambulatory Medical Care Survey. The analysis focused on outpatient visits involving 11 typical and six atypical antipsychotic agents. National visit estimates were used to characterize the nature and extent of antipsychotic prescribing for patients younger than 20 years. Multiple logistic regression analysis was applied to visits involving children and adolescents to examine the need, predisposing, and enabling factors associated with antipsychotic prescribing.
Antipsychotic medications were prescribed in two million outpatient visits annually involving children and adolescents, representing 1% of overall visits by children and adolescents in 2003-2004. Most (99%) of these visits involved prescribing of atypical agents. The most frequently prescribed atypical agents were risperidone, quetiapine, and aripiprazole. The majority of the visits involving antipsychotic medications in children were seen in patients over 9 years, males, and whites. Factors positively associated with antipsychotic prescribing in children and adolescents included age over 9 years, diagnoses (bipolar disorder, psychoses, depression, disruptive behavior, and anxiety), and visits to specialists. Private insurance was negatively associated with antipsychotic prescribing.
Although the findings were based on cross-sectional analyses of outpatient visit data, the study revealed that atypical antipsychotic medications are being commonly and extensively prescribed to children and adolescents despite the relatively limited scientific evidence to support their pediatric use. Well-designed studies are urgently needed in children and adolescents to address atypical antipsychotic use for a variety of psychiatric disorders.
本研究调查了在美国接受门诊治疗的儿童和青少年中抗精神病药物的处方模式及决定因素。
利用2003 - 2004年国家门诊医疗护理调查以及2003 - 2004年国家医院门诊医疗护理调查的门诊部分，对20岁以下患者的抗精神病药物处方情况进行研究。分析聚焦于涉及11种典型和6种非典型抗精神病药物的门诊就诊情况。使用全国就诊估计数来描述20岁以下患者抗精神病药物处方的性质和范围。对涉及儿童和青少年的就诊情况进行多因素逻辑回归分析，以研究与抗精神病药物处方相关的需求、易患因素和促成因素。
每年有200万次涉及儿童和青少年的门诊就诊开具了抗精神病药物，占2003 - 2004年儿童和青少年总就诊次数的1%。其中大多数（99%）就诊涉及非典型药物的处方。最常开具的非典型药物是利培酮、喹硫平和阿立哌唑。儿童中涉及抗精神病药物的就诊多数见于9岁以上患者、男性和白人。与儿童和青少年抗精神病药物处方呈正相关的因素包括9岁以上年龄、诊断（双相情感障碍、精神病、抑郁症、破坏性行为和焦虑症症）以及专科就诊。私人保险与抗精神病药物处方呈负相关。
尽管研究结果基于门诊就诊数据的横断面分析，但该研究表明，尽管支持其儿科使用的科学证据相对有限，但非典型抗精神病药物仍在儿童和青少年中被普遍且广泛地处方。迫切需要针对儿童和青少年开展精心设计的研究，以解决非典型抗精神病药物在各种精神疾病中的使用问题。
