Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch St., Baltimore, MD 21201, USA.
Psychiatr Serv. 2012 Nov;63(11):1095-101. doi: 10.1176/appi.ps.201100547.
This research study aimed to assess national trends in pediatric use of anticonvulsants for seizures and psychiatric disorders.
In a cross-sectional design, data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey were analyzed. Outpatient visit information for youths (ages 0-17 years) was grouped by year for 1996-1997, 2000-2001, 2004-2005, and 2008-2009. Six of the most common anticonvulsant drugs used for psychiatric conditions were examined. Psychiatric diagnoses and seizure or convulsion diagnoses were identified with ICD-9-CM codes. The primary outcome measure was percentage prevalence of visits for anticonvulsants that included a psychiatric diagnosis as a proportion of total youth visits for an anticonvulsant. Total, diagnosis-stratified, and drug-specific visits, as well as visits for concomitant anticonvulsants and psychotropics, were analyzed.
As a proportion of total youth visits for anticonvulsants, visits with a psychiatric diagnosis increased 1.7 fold (p<.001), whereas the proportion of seizure-related visits did not change significantly. Regardless of diagnosis, anticonvulsant use significantly increased, from .33% to .68% of total youth visits in the 14-year period. There were significant increases in anticonvulsant use to treat pediatric bipolar disorder and disruptive behavior disorders. Visits noting divalproex decreased while visits noting lamotrigine increased among visits involving a psychiatric diagnosis. The concomitant use of stimulants and anticonvulsants significantly increased in visits noting a psychiatric diagnosis.
Whereas anticonvulsant use for seizure disorders across the 14-year period was stable, the use of these drugs for psychiatric conditions rose to a dominant position. The growth of concomitant and off-label use to treat behavioral disorders raises questions about effectiveness and safety in community populations of youths.
本研究旨在评估全国儿童癫痫和精神障碍抗癫痫药物使用的趋势。
采用横断面设计，分析了 1996-1997 年、2000-2001 年、2004-2005 年和 2008-2009 年全国门诊医疗调查和全国医院门诊医疗调查的数据。将青少年（0-17 岁）的门诊就诊信息按年份分组。研究了用于精神疾病的六种最常见的抗癫痫药物。使用 ICD-9-CM 编码识别精神疾病诊断和癫痫或抽搐诊断。主要观察指标是包括精神疾病诊断的抗癫痫药物就诊比例占青少年总抗癫痫药物就诊的百分比。分析了总就诊、诊断分层就诊和药物特异性就诊，以及同时使用抗癫痫药物和精神药物的就诊。
与青少年总抗癫痫药物就诊相比，有精神疾病诊断的就诊比例增加了 1.7 倍（p<.001），而与癫痫相关的就诊比例无显著变化。无论是否有诊断，抗癫痫药物的使用显著增加，在 14 年内从青少年就诊的 0.33%增加到 0.68%。用于治疗小儿双相情感障碍和破坏性行为障碍的抗癫痫药物使用率显著增加。在涉及精神疾病诊断的就诊中，注意到丙戊酸钠的就诊减少，而注意到拉莫三嗪的就诊增加。在注意到有精神疾病诊断的就诊中，同时使用兴奋剂和抗癫痫药物的比例显著增加。
在 14 年期间，癫痫发作性疾病的抗癫痫药物使用保持稳定，而这些药物用于精神疾病的使用上升到主导地位。同时使用和超适应证使用来治疗行为障碍的情况增加，这引发了对社区青少年人群的疗效和安全性的疑问。
