Koelch M, Prestel A, Singer H, Keller F, Fegert J M, Schlack R, Hoelling H, Knopf H
Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Ulm, Germany.
J Child Adolesc Psychopharmacol. 2009 Dec;19(6):765-70. doi: 10.1089/cap.2009.0018.
The aim of this study was to identify the "real-life" prevalence of psychotropic medications in children and adolescents in Germany and related behavioral and emotional problems. Data from the nationwide representative National German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were analyzed.
A total of 17,450 subjects aged 0-17 years from 167 communities were examined as part of the KiGGS in Germany between 2003 and 2006 to determine their use of antidepressants, antipsychotics, anxiolytics, and sedatives within the 7 days prior to being interviewed. Medication use was assessed by a medical doctor who conducted a computer-assisted personal interview (CAPI) with the parents, and related emotional and behavioral problems were assessed using the Strength and Difficulties Questionnaire (SDQ).
The overall prevalence for these medications was moderate (4.81/1000; 95% confidence interval [CI], 3.70-6.26), but prevalence varied across the different classes of drugs (sedatives > antipsychotics > antidepressants > anxiolytics). Rates of off-label use were high for antipsychotics and antidepressants. About 30% of the medication, especially sedatives, was used without prescription. Subjects using psychotropic medication obtained higher scores in the screening for emotional or behavioral problems than the total sample, but 40% of the children did not show abnormal scores.
The indication for antipsychotics was mostly behavioral symptomatology, while antidepressants were used for a wide variety of symptoms. The high proportion of children and adolescents using psychotropic medication with normal scores in the emotional and behavioral screening was remarkable. It cannot be determined whether in these cases low scores were related to improvement in symptoms or whether medication was being misused.
本研究旨在确定德国儿童和青少年中精神药物的“实际”患病率以及相关的行为和情绪问题。分析了来自具有全国代表性的德国儿童和青少年健康访谈与检查调查（KiGGS）的数据。
2003年至2006年间，作为德国KiGGS的一部分，对来自167个社区的17450名0至17岁的受试者进行了检查，以确定他们在接受访谈前7天内使用抗抑郁药、抗精神病药、抗焦虑药和镇静剂的情况。用药情况由一名医生通过与家长进行计算机辅助个人访谈（CAPI）来评估，相关的情绪和行为问题则使用优势与困难问卷（SDQ）进行评估。
这些药物的总体患病率为中等水平（4.81/1000；95%置信区间[CI]，3.70 - 6.26），但不同类别的药物患病率有所不同（镇静剂>抗精神病药>抗抑郁药>抗焦虑药）。抗精神病药和抗抑郁药的超说明书用药率很高。约30%的药物，尤其是镇静剂，是在没有处方的情况下使用的。使用精神药物的受试者在情绪或行为问题筛查中的得分高于总样本，但40%的儿童没有显示出异常得分。
抗精神病药的适应证主要是行为症状，而抗抑郁药则用于多种症状。在情绪和行为筛查中得分正常的儿童和青少年使用精神药物的比例很高，这一点值得注意。无法确定在这些情况下低分是与症状改善有关还是药物被滥用。
