Mount Sinai School of Medicine, Adolescent Health Center, New York, New York, United States of America.
PLoS One. 2013;8(1):e54152. doi: 10.1371/journal.pone.0054152. Epub 2013 Jan 9.
The purpose of this study is to examine the use of prescribed psychoactive medications in a prospective cohort of children shortly after they entered foster homes; and to identify demographics, maltreatment history, psychiatric diagnoses including ADHD comorbidity, and level of aggression that contribute to prescribed use of stimulant and atypical antipsychotic medication over time.
The sample included N = 252 children (nested in 95 sibling groups) followed for three years up to 4 yearly waves.
Nearly all (89%) met criteria for at least one of eight psychiatric diagnoses and 31% (75/252) used one or more prescribed psychoactive medications. Over half (55%) were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD); of these 38% used stimulants and 36% used atypical antipsychotics. Of the 75 medicated children, 19% received ≥3 different classes of drugs over the course of the study. Stimulants (69%) and atypical antipsychotics (65%) were the most frequently used drugs among medicated children. Adjusted odds ratios (AOR) showed that male gender (AOR = 3.2; 95% CI = 1.5-9.3), African American vs Latino ethnicity (AOR = 5.4; 95% CI = 2.1-14.2), ADHD regardless of Oppositional Defiant (ODD) or Conduct (CD) comorbidity (AOR = 6.0, 95% CI = 1.3-27.5), ODD or CD (AOR = 11.1, 95% CI = 2.1-58.6), and Separation Anxiety (AOR = 2.0, 95% CI = 1.0-4.0) psychiatric disorders were associated with the use of prescribed stimulants; while male gender (AOR = 3.8, 95% CI = 1.5-9.3), African American vs Latino (AOR = 5.1, 95% CI = 1.2-9.2) or Mixed/Other ethnicity (AOR = 3.3, 95% CI = 1.9-13.7), ADHD regardless of ODD or CD comorbidity (AOR = 5.8, 95% CI = 1.2-28.7), ODD or CD (AOR = 13.9, 95% CI = 3.3-58.5), Major Depression/Dysthymia (AOR = 2.8, 95% CI = 1.1-6.7) psychiatric disorders, and history of sexual abuse (AOR = 4.6, 95% CI = 1.3-18.4) were associated with the use of prescribed atypical antipsychotics.
The aggressive use of atypical antipsychotics, which has unknown metabolic risks, suggests that the efficacy and safety of such treatment strategies for psychiatrically ill children in foster care should be monitored.
本研究旨在观察刚进入寄养家庭的儿童在前瞻性队列中使用规定的精神药物的情况；并确定人口统计学、虐待史、精神科诊断（包括 ADHD 共病）以及导致兴奋剂和非典型抗精神病药物使用随时间变化的攻击性水平。
该样本包括 252 名儿童（嵌套在 95 个兄弟姐妹组中），随访 3 年，共进行了 4 次年度随访。
几乎所有（89%）儿童都符合至少 8 种精神科诊断标准中的一种，31%（75/252）使用了一种或多种规定的精神药物。超过一半（55%）被诊断为注意力缺陷多动障碍（ADHD）；其中 38%使用兴奋剂，36%使用非典型抗精神病药物。在 75 名接受药物治疗的儿童中，有 19%在研究过程中接受了≥3 种不同类别的药物。兴奋剂（69%）和非典型抗精神病药物（65%）是接受药物治疗的儿童中最常使用的药物。调整后的优势比（AOR）显示，男性（AOR=3.2；95%CI=1.5-9.3）、非裔美国人与拉丁裔（AOR=5.4；95%CI=2.1-14.2）、ADHD 无论是否存在对立违抗性障碍（ODD）或品行障碍（CD）共病（AOR=6.0；95%CI=1.3-27.5）、ODD 或 CD（AOR=11.1；95%CI=2.1-58.6）和分离焦虑（AOR=2.0；95%CI=1.0-4.0）精神障碍与规定兴奋剂的使用相关；而男性（AOR=3.8；95%CI=1.5-9.3）、非裔美国人与拉丁裔（AOR=5.1；95%CI=1.2-9.2）或混合/其他族裔（AOR=3.3；95%CI=1.9-13.7）、ADHD 无论是否存在 ODD 或 CD 共病（AOR=5.8；95%CI=1.2-28.7）、ODD 或 CD（AOR=13.9；95%CI=3.3-58.5）、重度抑郁症/心境恶劣（AOR=2.8；95%CI=1.1-6.7）精神障碍和性虐待史（AOR=4.6；95%CI=1.3-18.4）与规定使用非典型抗精神病药物有关。
对非典型抗精神病药物的过度使用，具有未知的代谢风险，这表明对于寄养家庭中患有精神疾病的儿童，应该监测这种治疗策略的疗效和安全性。
