抗精神病药物在自闭症谱系障碍和/或智力残疾青少年中的使用趋势：一项荟萃分析。
Antipsychotic Use Trends in Youth With Autism Spectrum Disorder and/or Intellectual Disability: A Meta-Analysis.
机构信息
Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY.
Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY; Institute for Maternal and Child Health, Trieste, Italy and University of Padua, Trieste.
出版信息
J Am Acad Child Adolesc Psychiatry. 2016 Jun;55(6):456-468.e4. doi: 10.1016/j.jaac.2016.03.012. Epub 2016 Apr 7.
OBJECTIVE
Although irritability and aggression are relevant treatment targets in autism spectrum disorders (ASDs) and intellectual disability (ID) that may prompt antipsychotic use, antipsychotic prescribing patterns in such youth have not been systematically reviewed.
METHOD
We systematically searched PubMed/MEDLINE/PsycInfo until March 2015 for studies reporting data on the frequency of youth diagnosed with ASDs and/or ID among antipsychotic-treated youth, as well as antipsychotic use in youth with ASD/ID, conducting a meta-analysis and meta-regression analysis of potential moderators, including publication year, study time point, country, setting, sample size, age, sex, and race/ethnicity.
RESULTS
A total of 39 studies were meta-analyzed (n = 365,449, age = 11.4 ± 6.2 years, males = 70.0% ± 10.0%). Among 27 studies (n = 273,139, age = 11.9 ± 8.0 years, males = 67.0% ± 12.9%) reporting on antipsychotic-treated youth, 9.5% (95% CI = 7.8%-11.5%) were diagnosed with ASD/ID. In 20 studies (n = 209,756) reporting data separately for ASD, 7.9% (95% CI = 6.2%-9.9%) had an ASD diagnosis. In 5 longitudinal studies, the proportion of antipsychotic-treated youth with ASD did not change significantly from 1996 to 2011 (6.7% to 5.8%, odds ratio = 0.9, 95% CI = 0.8-1.0, p =.17). However, later study time point moderated greater ASD/ID proportions (β = 0.12, p < .00001). In 13 studies (n = 96,688, age = 9.8 ± 1.2 years, males = 78.6% ± 2.0%) reporting on antipsychotic use in ASD samples, 17.5% (95% CI = 13.7%-22.1%) received antipsychotics. Again, later study time point moderated higher antipsychotic use among patients with ASD (β = 0.10, p = .004).
CONCLUSION
Almost 1 in 10 antipsychotic-treated youth were diagnosed with ASD and/or ID, and 1 in 6 youth with ASD received antipsychotics. Both proportions increased in later years; however, clinical reasons and outcomes of antipsychotic use in ASD/ID require further study.
目的
虽然易激惹和攻击性是自闭症谱系障碍（ASD）和智力障碍（ID）的相关治疗目标，可能促使使用抗精神病药物，但此类青少年的抗精神病药物使用情况尚未得到系统审查。
方法
我们系统地检索了 PubMed/MEDLINE/PsycInfo 数据库，截至 2015 年 3 月，以获取报告 ASD 和/或 ID 青年在接受抗精神病药物治疗的青年中的频率数据的研究，以及 ASD/ID 青年使用抗精神病药物的研究，并对潜在的调节因素进行了荟萃分析和荟萃回归分析，包括发表年份、研究时间点、国家、环境、样本量、年龄、性别和种族/民族。
结果
共对 39 项研究进行了荟萃分析（n=365449，年龄=11.4±6.2 岁，男性=70.0%±10.0%）。在 27 项（n=273139，年龄=11.9±8.0 岁，男性=67.0%±12.9%）报告接受抗精神病药物治疗的青年的研究中，有 9.5%（95%置信区间为 7.8%-11.5%）被诊断为 ASD/ID。在 20 项（n=209756）分别报告 ASD 数据的研究中，有 7.9%（95%置信区间为 6.2%-9.9%）患有 ASD。在 5 项纵向研究中，从 1996 年到 2011 年，接受抗精神病药物治疗的 ASD 青年的比例没有明显变化（6.7%至 5.8%，优势比=0.9，95%置信区间=0.8-1.0，p=0.17）。然而，较晚的研究时间点调节了更高的 ASD/ID 比例（β=0.12，p<.00001）。在 13 项（n=96688，年龄=9.8±1.2 岁，男性=78.6%±2.0%）报告 ASD 样本中使用抗精神病药物的研究中，有 17.5%（95%置信区间为 13.7%-22.1%）接受了抗精神病药物治疗。同样，较晚的研究时间点调节了 ASD 患者中更高的抗精神病药物使用率（β=0.10，p=0.004）。
结论
近十分之一接受抗精神病药物治疗的青年被诊断为 ASD 和/或 ID，六分之一的 ASD 青年接受了抗精神病药物治疗。这两个比例都在逐年增加；然而，ASD/ID 中抗精神病药物使用的临床原因和结果需要进一步研究。
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