Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Psychiatr Serv. 2011 Dec;62(12):1443-9. doi: 10.1176/appi.ps.000452011.
This study examined the extent to which children with bipolar I disorder received recommended treatment of mood-stabilizer or second-generation antipsychotic monotherapy and factors associated with its receipt.
Administrative claims data collected from January 1, 2005, to December 31, 2007, were used to construct a cohort of 412 privately insured children with bipolar I disorder. The primary outcome measure was the receipt of mood-stabilizer or second-generation antipsychotic monotherapy within 90 days of an index diagnosis of bipolar disorder.
Only 82 (20%) children received recommended first-line treatment for bipolar I disorder within 90 days of the index diagnosis, and 130 (32%) received no psychotropic medications. Of children receiving any medications, 200 (71%) received nonrecommended pharmacotherapy, most commonly antidepressant monotherapy (N=67, 24%) and combination pharmacotherapy (N=51, 18%). Youths who had been treated by a psychiatrist on the day of or 180 days before the fill date of medication were more likely to receive guideline-recommended care (risk ratio [RR]=1.64, 95% confidence interval [CI]=1.10-2.45) and to receive any psychotropic medications (RR=1.13, CI=1.02-1.24). Nevertheless, only 51 of the 209 (24%) children who visited a psychiatrist and 31 of the 203 (15%) who visited a nonpsychiatrist received recommended pharmacotherapy.
This study highlights significant gaps in the treatment of pediatric bipolar disorder. Most children in this sample received either no medications or nonrecommended pharmacotherapies. Additional research is needed to further assess factors related to the nonuse of recommended psychotropic medications and to the persistent use of nonrecommended pharmacotherapies for children with bipolar disorder.
本研究旨在调查患有 I 型双相情感障碍的儿童接受推荐的心境稳定剂或第二代抗精神病药单药治疗的程度，以及与这种治疗相关的因素。
使用 2005 年 1 月 1 日至 2007 年 12 月 31 日收集的行政索赔数据，构建了一个 412 名患有 I 型双相情感障碍的私人保险儿童队列。主要结局指标是在双相情感障碍指数诊断后 90 天内接受心境稳定剂或第二代抗精神病药单药治疗的情况。
仅有 82 名（20%）儿童在指数诊断后 90 天内接受了 I 型双相情感障碍的推荐一线治疗，130 名（32%）儿童未接受任何精神药物治疗。在接受任何药物治疗的儿童中，200 名（71%）接受了非推荐的药物治疗，最常见的是抗抑郁药单药治疗（N=67，24%）和联合药物治疗（N=51，18%）。在药物治疗填单日或 180 天前接受精神科医生治疗的青少年更有可能接受指南推荐的治疗（风险比[RR]=1.64，95%置信区间[CI]=1.10-2.45），并接受任何精神药物治疗（RR=1.13，CI=1.02-1.24）。然而，只有 209 名（24%）接受精神科医生治疗的儿童和 203 名（15%）接受非精神科医生治疗的儿童接受了推荐的药物治疗。
本研究突出了儿童双相情感障碍治疗中的显著差距。该样本中的大多数儿童要么没有接受药物治疗，要么接受了非推荐的药物治疗。需要进一步研究以进一步评估与不使用推荐的精神药物治疗和持续使用非推荐的药物治疗儿童双相情感障碍相关的因素。
