Hamrin Vanya, McCarthy Erin M, Tyson Veda
Yale University School of Nursing, Yale Univsersity, New Haven, Connecticut, USA.
J Child Adolesc Psychiatr Nurs. 2010 Aug;23(3):151-72. doi: 10.1111/j.1744-6171.2010.00237.x.
Psychotropic medication initiation and adherence is an identified problem. This literature review explores factors that determine families' decisions to initiate, sustain, or discontinue use of psychotropic medication in children and adolescents. Social exchange theory is used as a framework to explore decisions to initiate and adhere to psychotropic medications.
Contributing factors related to psychotropic medication initiation, adherence, and discontinuation are explored. Themes in the literature encompassing costs and benefits of psychotropic medication adherence include family experiences with adverse effects, previous psychotropic medication experience, medication psychoeducation, stigma, societal views about psychotropic medication, particular diagnosis, the effect of comorbid diagnosis on adherence, attitudes and beliefs about medication by both children and parents, and relationships with the provider. The impact of family demographics including parent gender, age of the child, ethnicity, and parent educational level on psychotropic medication adherence is evaluated.
International and U.S. studies from Medline, Cumulative Index for Nursing and Allied Health Literature and PsychInfo evaluating medication initiation and adherence in the pediatric psychiatric population and social exchange theory was incorporated from relevant textbook resources.
Rewards experienced from medication treatment include improvement in symptoms, school performance and family relationships, and reduced level of parenting stress. Identified costs include impact of adverse side effects, social stigma, lack of response, fears of addiction, and changing the child's personality. Acceptance of the diagnosis influences adherence while medication education has varying effects. Families' attitudes, beliefs and perceptions about psychiatric illness and treatment play a large role in medication treatment decisions. A trusting provider relationship has a positive effect on adherence. Psychosocial treatment alternatives are preferred. With maturation, adolescents have more influence on decisions related to adherence.
启动和坚持使用精神药物是一个已被确认的问题。本综述探讨了决定家庭启动、持续或停止在儿童和青少年中使用精神药物的因素。社会交换理论被用作探讨启动和坚持使用精神药物决策的框架。
探讨与启动、坚持和停止使用精神药物相关的促成因素。文献中的主题包括精神药物坚持使用的成本和收益，涵盖家庭对不良反应的经历、先前使用精神药物的经验、药物心理教育、耻辱感、社会对精神药物的看法、特定诊断、共病诊断对坚持使用的影响、儿童和父母对药物的态度和信念，以及与医疗服务提供者的关系。评估了包括父母性别、孩子年龄、种族和父母教育水平在内的家庭人口统计学因素对精神药物坚持使用的影响。
来自Medline、护理及相关健康文献累积索引和PsychInfo的国际和美国研究，评估儿科精神病患者群体中药物的启动和坚持使用情况，并从相关教科书资源中纳入社会交换理论。
药物治疗带来的回报包括症状改善、学业成绩提高和家庭关系改善，以及育儿压力水平降低。已确定的成本包括副作用的影响、社会耻辱感、无反应、对成瘾的恐惧以及改变孩子的性格。对诊断的接受程度会影响坚持使用情况，而药物教育的效果则各不相同。家庭对精神疾病和治疗的态度、信念和认知在药物治疗决策中起着很大作用。信任的医疗服务提供者关系对坚持使用有积极影响。心理社会治疗替代方案更受青睐。随着年龄增长，青少年对与坚持使用相关的决策有更大影响。
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