Toteja Nitin, Gallego Juan A, Saito Ema, Gerhard Tobias, Winterstein Almut, Olfson Mark, Correll Christoph U
The Zucker Hillside Hospital, Psychiatry Research,North Shore - Long Island Jewish Health System,Glen Oaks, NY,USA.
Department of Pharmacy Practice and Administration,Ernest Mario School of Pharmacy, Rutgers University,Piscataway, NJ,USA.
Int J Neuropsychopharmacol. 2014 Jul;17(7):1095-105. doi: 10.1017/S1461145712001320. Epub 2013 May 14.
Antipsychotic polypharmacy (APP), which is common in adults with psychotic disorders, is of unproven efficacy and raises safety concerns. Although youth are increasingly prescribed antipsychotics, little is known about APP in this population. We performed a systematic PubMed search (last update 26 January 2013) of studies reporting the prevalence of APP in antipsychotic-treated youth. Summary statistics and statistical tests were calculated at the study level and not weighted by sample size. Fifteen studies (n = 58 041, range 68-23 183) reported on APP in youth [mean age = 13.4 ± 1.7 yr, 67.1 ± 10.2% male, 77.9 ± 27.4% treated with second-generation antipsychotics (SGAs)]. Data collected in these studies covered 1993-2008. The most common diagnoses were attention-deficit hyperactivity disorder (ADHD; 39.9 ± 23.5%) and conduct disorder/oppositional defiant disorder (CD/ODD; 33.6 ± 24.8). In studies including predominantly children (mean age = <13 yr, N = 5), the most common diagnosis were ADHD (50.6 ± 25.4%) and CD/ODD (39.5 ± 27.5%); while in studies with predominantly adolescents (mean age = ⩾13 yr, N = 7) the most common diagnoses were schizophrenia-spectrum disorders (28.6 ± 23.8%), anxiety disorders (26.9 ± 14.9%) and bipolar-spectrum disorders (26.6 ± 7.0%), followed closely by CD/ODD (25.8 ± 17.7). The prevalence of APP among antipsychotic-treated youth was 9.6 ± 7.2% (5.9 ± 4.5% in child studies, 12.0 ± 7.9% in adolescent studies, p = 0.15). Higher prevalence of APP was correlated with a bipolar disorder or schizophrenia diagnosis (p = 0.019) and APP involving SGA+SGA combinations (p = 0.0027). No correlation was found with APP definition [⩾1 d (N = 10) vs. >30-⩾90 d (N = 5), p = 0.88]. Despite lacking safety and efficacy data, APP in youth is not uncommon, even in samples predominantly consisting of non-psychotic patients. The duration, clinical motivations and effectiveness of this practice require further study.
抗精神病药物联合使用（APP）在患有精神障碍的成年人中很常见，但其疗效未经证实，且引发了安全方面的担忧。尽管越来越多的青少年被开了抗精神病药物，但对于这一人群中的APP情况却知之甚少。我们对PubMed进行了系统检索（最后更新时间为2013年1月26日），以查找报告接受抗精神病药物治疗的青少年中APP患病率的研究。汇总统计数据和统计检验是在研究层面进行计算的，未按样本量加权。15项研究（n = 58041，范围68 - 23183）报告了青少年中的APP情况[平均年龄 = 13.4 ± 1.7岁，男性占67.1 ± 10.2%，77.9 ± 27.4%接受第二代抗精神病药物（SGA）治疗]。这些研究收集的数据涵盖了1993年至2008年。最常见的诊断是注意力缺陷多动障碍（ADHD；39.9 ± 23.5%）和品行障碍/对立违抗障碍（CD/ODD；33.6 ± 24.8）。在主要包括儿童的研究（平均年龄 = <13岁，N = 5）中，最常见的诊断是ADHD（50.6 ± 25.4%）和CD/ODD（39.5 ± 27.5%）；而在主要为青少年的研究（平均年龄 = ⩾13岁，N = 7）中，最常见的诊断是精神分裂症谱系障碍（28.6 ± 23.8%）、焦虑障碍（26.9 ± 14.9%）和双相谱系障碍（26.6 ± 7.0%），紧随其后的是CD/ODD（25.8 ± 17.7）。接受抗精神病药物治疗的青少年中APP的患病率为9.6 ± 7.2%（儿童研究中为5.9 ± 4.5%，青少年研究中为12.0 ± 7.9%，p = 0.15）。APP较高的患病率与双相情感障碍或精神分裂症诊断相关（p = 0.019），以及与涉及SGA + SGA组合的APP相关（p = 0.0027）。未发现与APP定义相关[⩾1天（N = 10）与>30 - ⩾90天（N = 5），p = 0.88]。尽管缺乏安全性和有效性数据，但青少年中的APP并不罕见，即使在主要由非精神病患者组成的样本中也是如此。这种做法的持续时间、临床动机和有效性需要进一步研究。
