Florida Mental Health Institute, University of South Florida, FL 33612, USA.
Pharmacoepidemiol Drug Saf. 2012 Feb;21(2):152-60. doi: 10.1002/pds.2189. Epub 2011 Jul 26.
This study aims the following: (i) to describe the exposure to antipsychotic medications over a 4-year period experienced by a cohort of children who initiated antipsychotic treatment before their sixth birthday; and (ii) to identify variables associated with the risk of antipsychotic exposure.
Children were identified who initiated an index episode of antipsychotic treatment before their sixth birthday in Florida's fee for service Medicaid program. With the use of claims data, the medication utilization of these children was tracked during the year before and the 4 years following the start of their index episodes (pre-index and four post-index periods). Generalized estimating equations were used to identify variables associated with the risk of additional days of antipsychotic exposure.
Five hundred twenty-eight children were included in the cohort. The mean total number of days of exposure was 821.9 (± 431.9), representing 56.3% of all days during the four post-index periods. The mean days of exposure to combinations of antipsychotics and other classes of psychotherapeutic medications were 623.8 ± 447.6 days. Children with primary diagnoses of pervasive developmental disorders and affective disorders were at greater risk of additional days of exposure than children with attention deficit/hyperactivity disorder. Exposure tended to be greater among children with indicators of clinical complexity including the presence of secondary diagnoses and the use of other classes of psychotherapeutic medications in addition to antipsychotics.
Exposure to antipsychotic mediations was extensive. Although these children may have had complex and severe problems, additional research is urgently needed on the benefits and risks of long-term antipsychotic exposure among very young children.
本研究旨在：(i)描述在 6 岁生日之前开始接受抗精神病药物治疗的患儿队列在 4 年内接触抗精神病药物的情况；(ii)确定与抗精神病药物暴露风险相关的变量。
在佛罗里达州的自费医疗补助计划中，确定了在 6 岁生日之前开始服用抗精神病药物指数发作的儿童。利用索赔数据，在这些儿童开始服用指数药物之前的一年和之后的 4 年（前指数和后 4 个指数期）中跟踪他们的药物使用情况。使用广义估计方程来确定与抗精神病药物暴露风险相关的变量。
共有 528 名儿童纳入队列。暴露总天数的平均值为 821.9(±431.9)，代表后 4 个指数期所有天数的 56.3%。抗精神病药物与其他类别的精神治疗药物联合使用的暴露天数的平均值为 623.8±447.6 天。与注意力缺陷/多动障碍患儿相比，广泛性发育障碍和情感障碍的患儿有更多的额外暴露天数的风险。存在二级诊断和除抗精神病药物外还使用其他类别的精神治疗药物等临床复杂性指标的患儿，其暴露程度往往更高。
抗精神病药物的暴露程度很广泛。尽管这些儿童可能存在复杂和严重的问题，但迫切需要对非常年幼的儿童长期使用抗精神病药物的益处和风险进行进一步研究。
