Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
Pediatrics. 2011 Dec;128(6):e1459-66. doi: 10.1542/peds.2010-2970. Epub 2011 Nov 21.
Despite national concerns over high rates of antipsychotic medication use among youth in foster care, concomitant antipsychotic use has not been examined. In this study, concomitant antipsychotic use among Medicaid-enrolled youth in foster care was compared with disabled or low-income Medicaid-enrolled youth.
The sample included 16 969 youths younger than 20 years who were continuously enrolled in a Mid-Atlantic state Medicaid program and had ≥1 claim with a psychiatric diagnosis and ≥1 antipsychotic claim in 2003. Antipsychotic treatment was characterized by days of any use and concomitant use with ≥2 overlapping antipsychotics for >30 days. Medicaid program categories were foster care, disabled (Supplemental Security Income), and Temporary Assistance for Needy Families (TANF). Multicategory involvement for youths in foster care was classified as foster care/Supplemental Security Income, foster care/TANF, and foster care/adoption. We used multivariate analyses, adjusting for demographics, psychiatric comorbidities, and other psychotropic use, to assess associations between Medicaid program category and concomitant antipsychotic use.
Average antipsychotic use ranged from 222 ± 110 days in foster care to only 135 ± 101 days in TANF (P < .001). Concomitant use for ≥180 days was 19% in foster care only and 24% in foster care/adoption compared with <15% in the other categories. Conduct disorder and antidepressant or mood-stabilizer use was associated with a higher likelihood of concomitant antipsychotic use (P < .0001).
Additional study is needed to assess the clinical rationale, safety, and outcomes of concomitant antipsychotic use and to inform statewide policies for monitoring and oversight of antipsychotic use among youths in the foster care system.
尽管全国上下都对寄养青少年中使用抗精神病药物的高比率感到担忧，但尚未对同时使用抗精神病药物的情况进行研究。本研究比较了在医疗补助计划中接受治疗的寄养青少年与残疾或低收入医疗补助计划受助人同时使用抗精神病药物的情况。
该样本包括 16969 名年龄在 20 岁以下的青少年，他们持续参加了一个中大西洋州的医疗补助计划，在 2003 年有≥1 次有精神科诊断和≥1 次抗精神病药物的索赔。抗精神病药物的治疗情况通过使用天数和≥2 种重叠抗精神病药物超过 30 天的同时使用情况来描述。医疗补助计划类别包括寄养、残疾（补充保障收入）和贫困家庭临时援助（TANF）。对于寄养的青少年，多类别参与被分为补充保障收入/寄养、TANF/寄养和领养/寄养。我们使用多元分析方法，根据人口统计学、精神共病和其他精神药物使用情况进行调整，以评估医疗补助计划类别与同时使用抗精神病药物之间的关联。
平均抗精神病药物使用时间从寄养的 222±110 天到 TANF 的 135±101 天不等（P<0.001）。仅在寄养中，≥180 天的同时使用比例为 19%，在寄养和领养中为 24%，而其他类别则<15%。品行障碍和抗抑郁药或情绪稳定剂的使用与同时使用抗精神病药物的可能性更高相关（P<0.0001）。
需要进一步研究，以评估同时使用抗精神病药物的临床原理、安全性和结果，并为监测和监督寄养系统中青少年使用抗精神病药物的全州政策提供信息。
