Zito Julie M, Safer Daniel J, Valluri Satish, Gardner James F, Korelitz James J, Mattison Donald R
Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland 21201, USA.
J Child Adolesc Psychopharmacol. 2007 Apr;17(2):195-203. doi: 10.1089/cap.2007.0006.
To update knowledge of the prevalence of the use of psychotherapeutic medications in preschoolers with Medicaid insurance as requested by the Best Pharmaceuticals for Children Act of 2002 (BPCA).
Prescription, enrollment, and outpatient visit data from 7 state Medicaid programs were used to identify 274,518 youths continuously enrolled in 2001 and aged 2 to 4 on January 1, 2001. Annual prevalence of use was defined as one or more dispensed prescriptions for a psychotherapeutic medication and adjusted for anticonvulsant and anxiolytic/sedative/hypnotic use according to ICD-9 diagnostic groupings. Prevalence ratios adjusted for age, race/ethnicity, and gender were estimated.
2.30% (CI = 2.24, 2.36) of preschoolers received one or more dispensings for a psychotherapeutic medication in 2001, approximately doubling the usage of comparable youth from 2 other state Medicaid programs studied in 1995. Boys were 2.4 times more likely than girls to receive psychotherapeutic medication. Whites were 4 times more likely than Hispanics and twice as likely as Blacks to receive medication for psychiatric or behavioral conditions. Since the mid-1990s, usage increased, especially for atypical antipsychotics and antidepressants. The prominent use of anticonvulsants (78.8%) and anxiolytic/sedative/hypnotic drugs (91.4%) in those with no psychiatric diagnosis, but with other medical diagnoses, shows that much use therein reflects treatment for seizures, rather than mood stabilization, and for minor medical conditions, rather than psychiatric disorders.
Preschool psychotherapeutic medication use increased across ages 2 to 4 for stimulants, antipsychotics, and antidepressants, reflecting use for psychiatric/behavioral disorders. However, the use of anxiolytic/sedative/hypnotics and anticonvulsants was more stable across these years, suggesting medical usage. Additional research to assess the benefits and risks of psychotherapeutic drugs is needed, particularly when such usage is off-label for both psychiatric and nonpsychiatric conditions.
应2002年《儿童最佳药物法案》（BPCA）的要求，更新有关医疗补助保险学龄前儿童使用精神治疗药物的流行情况的知识。
使用来自7个州医疗补助计划的处方、登记和门诊就诊数据，确定了2001年连续登记且在2001年1月1日年龄为2至4岁的274,518名青少年。使用的年流行率定义为开具一种或多种精神治疗药物的处方，并根据ICD - 9诊断分组对使用抗惊厥药和抗焦虑/镇静/催眠药进行调整。估计了根据年龄、种族/族裔和性别调整后的流行率比值。
2001年，2.30%（CI = 2.24，2.36）的学龄前儿童接受了一种或多种精神治疗药物的配药，这一比例约为1995年研究的其他两个州医疗补助计划中类似青少年使用率的两倍。男孩接受精神治疗药物的可能性是女孩的2.4倍。白人接受治疗精神或行为疾病药物的可能性是西班牙裔的4倍，是黑人的两倍。自20世纪90年代中期以来，使用率有所上升，尤其是非典型抗精神病药物和抗抑郁药物。在没有精神疾病诊断但有其他医学诊断的人群中，抗惊厥药（78.8%）和抗焦虑/镇静/催眠药（91.4%）的大量使用表明，其中许多使用反映的是对癫痫发作的治疗，而非情绪稳定，以及对轻微医疗状况的治疗，而非精神疾病。
2至4岁儿童中，用于治疗精神疾病/行为障碍的兴奋剂、抗精神病药物和抗抑郁药物的使用有所增加。然而，这些年抗焦虑/镇静/催眠药和抗惊厥药的使用较为稳定，表明是用于医疗。需要进行更多研究来评估精神治疗药物的益处和风险，特别是当这种使用在精神和非精神疾病情况下均为非适应症用药时。
