Rajakannan Thiyagu, Zito Julie M, Burcu Mehmet, Safer Daniel J
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore MD-21201, USA.
Departments of Psychiatry and Pediatrics, Johns Hopkins Medical Institutions, Baltimore MD-21287, USA.
J Clin Med. 2014 Mar 20;3(1):310-22. doi: 10.3390/jcm3010310.
The diagnosis of pediatric bipolar disorder (PBD) has increased dramatically in community-treated youth in the past 20 years. No previous study has assessed the trend in PBD subtype diagnoses or the impact of clinician-reported behavioral comorbidities (BC) on psychotropic medication prescribing patterns. This study aims: (1) to characterize national trends in PBD visits in relation to PBD subtypes; and (2) to assess differences in socio-demographic PBD subtype diagnostic patterns and psychotropic medications prescribed in PBD visits with and without behavioral comorbidities (w/w/o BC). PBD visits for 1999-2010 from the National Ambulatory Medical Care Survey (NAMCS) data were assessed using population-weighted chi-square and logistic regression analyses. While PBD visit rates were stable across 12 years, the proportional shift of subtype diagnosis from Bipolar I (89.0%) in 1999-2002 to Bipolar Not Otherwise Specified (NOS) (74.1%) in 2007-2010 was notable. Compared with PBD without behavioral comorbidities (w/o BC), PBD visits w/BC had greater proportions of the bipolar-NOS subtype, more males, 2-14-year-olds, and more publicly-insured visits. The prescription of antipsychotics (60% vs. 61%) was common in PBD visits regardless of the presence of behavioral comorbidities. Stimulants were the predominant class prescribed for PBD visits with BC (67.8% vs. 9.4%). Antidepressants were significantly greater in PBD visits without BC (41.6% vs. 21.0%). Overall one-third of PBD youth visits were prescribed antipsychotics concomitant with other psychotropic classes. Behavioral conditions accompanying PBD visits were prominent, suggesting the need for monitoring and evaluating the outcomes of complex medication regimens in community populations.
在过去20年中，社区治疗的青少年中儿童双相情感障碍（PBD）的诊断率急剧上升。此前尚无研究评估PBD亚型诊断的趋势或临床医生报告的行为共病（BC）对精神药物处方模式的影响。本研究旨在：（1）描述与PBD亚型相关的全国PBD就诊趋势；（2）评估有和没有行为共病（有/无BC）的PBD就诊中社会人口统计学PBD亚型诊断模式和开具的精神药物的差异。使用人口加权卡方检验和逻辑回归分析评估了1999 - 2010年国家门诊医疗调查（NAMCS）数据中的PBD就诊情况。虽然PBD就诊率在12年中保持稳定，但亚型诊断的比例从1999 - 2002年的双相I型（89.0%）显著转变为2007 - 2010年的未特定型双相情感障碍（NOS）（74.1%）。与无行为共病的PBD（无BC）相比，有BC的PBD就诊中双相NOS亚型、男性、2 - 14岁儿童以及公费就诊的比例更高。无论是否存在行为共病，抗精神病药物的处方在PBD就诊中都很常见（分别为60%和61%）。兴奋剂是有BC的PBD就诊中开具的主要药物类别（67.8%对9.4%）。无BC的PBD就诊中抗抑郁药的处方显著更多（41.6%对21.0%）。总体而言，三分之一的PBD青少年就诊开具了与其他精神药物类别联用的抗精神病药物。PBD就诊伴随的行为状况较为突出，表明需要监测和评估社区人群中复杂药物治疗方案的效果。
