Ansermot Nicolas, Jordanov Véronique, Smogur Michal, Holzer Laurent, Eap Chin B
1 Unit of Pharmacogenetics and Clinical Psychopharmacology, Department of Psychiatry, Center for Psychiatric Neuroscience, Lausanne University Hospital , Hospital of Cery, Prilly-Lausanne, Switzerland .
2 School of Pharmaceutical Sciences, University of Geneva, University of Lausanne , Geneva, Switzerland .
J Child Adolesc Psychopharmacol. 2018 Apr;28(3):192-204. doi: 10.1089/cap.2017.0054. Epub 2017 Nov 13.
This retrospective study aims to evaluate off-label prescriptions and administrations of psychotropic medications in adolescents in a university psychiatric hospital in Switzerland.
Data were collected during the entire stays from the electronic database for 76 inpatients in 2008 and 76 inpatients in 2014. Data collected included gender, age, psychiatric diagnosis, duration of hospitalization, and psychotropic drug prescriptions and administrations.
A total of 224 psychotropic drugs (mean 2.9 drugs/patient) were prescribed in 2008 and 268 (mean 3.5 drugs/patient) in 2014. Due to the prescriptions of some drugs as required, only 76% of the prescriptions were actually administered in 2008 (mean 2.3 drugs/patient) and 55% in 2014 (mean 1.9 drugs/patient). Antipsychotics were the most frequently prescribed drugs in 2008 (74% of patients) and 2014 (86% of patients). Anxiolytics were also highly prescribed in 2008 (54% of patients) and 2014 (66% of patients), as well as antidepressants in 2008 (30% of patients), but less in 2014 (13% of patients). Overall, 69% of prescriptions were found to be off label in 2008 and 68% in 2014, according to age, diagnosis, dose, or formulation as approved by Swissmedic. The medication classes with the highest rate of off-label prescriptions were antidepressants (100% for both years), antipsychotics (94% in 2008 and 92% in 2014), and hypnotics (67% in 2008 and 100% in 2014). For both study periods, at least one off-label psychotropic drug prescription and administration was recorded in 96% and 79% of the patients, respectively.
The high rate of off-label psychotropic drug use strengthens the need for clinical trials to better evaluate the efficacy and safety of these treatments in adolescents.
这项回顾性研究旨在评估瑞士一家大学精神病医院中青少年精神药物的非标签处方及用药情况。
收集了2008年76名住院患者和2014年76名住院患者整个住院期间电子数据库中的数据。收集的数据包括性别、年龄、精神科诊断、住院时间以及精神药物的处方和用药情况。
2008年共开出224种精神药物（平均每位患者2.9种药物），2014年为268种（平均每位患者3.5种药物）。由于部分药物按要求开具处方，2008年实际用药的处方仅占76%（平均每位患者2.3种药物），2014年为55%（平均每位患者1.9种药物）。抗精神病药物是2008年（74%的患者）和2014年（86%的患者）最常开具的药物。2008年（54%的患者）和2014年（66%的患者）抗焦虑药物的开具率也很高，2008年（30%的患者）抗抑郁药物的开具率也较高，但2014年（13%的患者）有所下降。总体而言，根据瑞士药品管理局批准的年龄、诊断、剂量或剂型，2008年69%的处方和2014年68%的处方被认定为非标签处方。非标签处方率最高的药物类别是抗抑郁药（两年均为100%）、抗精神病药（2008年为94%，2014年为92%）和催眠药（2008年为67%，2014年为100%）。在两个研究期间，分别有96%和79%的患者记录到至少一种非标签精神药物的处方和用药情况。
精神药物非标签使用的高比例凸显了开展临床试验以更好评估这些治疗方法在青少年中的疗效和安全性的必要性。
