Department of Child- and Adolescent Psychiatry, University Medical Center Groningen, University Center of Child and Adolescent Psychiatry, University of Groningen, P.O. Box 660, 9700 AR, Groningen, The Netherlands.
Department of Biomedical Sciences of Cells and Systems, Section of Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Eur Child Adolesc Psychiatry. 2020 Dec;29(12):1717-1727. doi: 10.1007/s00787-020-01488-6. Epub 2020 Feb 12.
Antipsychotics are often prescribed to children and adolescents, mostly off-label. We aimed to assess adherence to recommendations of guidelines for antipsychotic prescription. We reviewed 436 medical records from 155 clinicians from 26 clinics within three Dutch child and adolescent psychiatry organizations (n = 398 outpatient, n = 38 inpatient care). We assessed target symptoms, diagnostic process, prior and concomitant treatment, and consideration of contra-indications. Multiple logistic regression assessed the role of age, sex, and psychiatric diagnosis on adherence to three main recommendations: to (1) prescribe antipsychotics only after other treatments proved insufficient, (2) always combine antipsychotics with psychosocial interventions, and (3) not prescribe multiple antipsychotics simultaneously. Most patients received off-label antipsychotics. Main target symptoms were inattention/hyperactivity (25%), aggression (24%), and other disruptive behaviors (41%). Most patients underwent diagnostic evaluation before the first prescription; however, screening of contra-indications was low (0.2-19%). About 84% had previously received psychosocial treatment and 48% other psychoactive medication, but 9% had not received any treatment. Notably, only 37% continuously received concomitant psychosocial treatment. Simultaneous use of multiple antipsychotics occurred in 3.2%. Younger children were at higher risk of non-adherence to guideline recommendations regarding prior and concomitant treatment, children with autism spectrum disorder or attention-deficit/hyperactivity disorder more likely not to receive concomitant psychosocial treatment. Sex did not significantly affect adherence. Our findings implicate insufficient adherence to important recommendations regarding antipsychotic use in children and adolescents. Especially younger children are at higher risk of receiving suboptimal care. There is an urgency to consistently offer psychosocial interventions during antipsychotic treatment.
抗精神病药常用于儿童和青少年，大多为超适应证用药。我们旨在评估抗精神病药处方指南推荐的遵从性。我们回顾了来自荷兰三个儿童和青少年精神病学组织的 26 个诊所的 155 位临床医生的 436 份病历（n=398 名门诊患者，n=38 名住院患者）。我们评估了目标症状、诊断过程、既往和同时治疗以及禁忌证的考虑。多变量逻辑回归评估了年龄、性别和精神诊断对遵守三个主要建议的作用：（1）仅在其他治疗无效后处方抗精神病药，（2）始终将抗精神病药与心理社会干预相结合，以及（3）不同时开多种抗精神病药。大多数患者接受了超适应证抗精神病药治疗。主要目标症状是注意力不集中/多动（25%）、攻击性（24%）和其他破坏性行为（41%）。大多数患者在首次处方前接受了诊断评估；然而，禁忌证筛查率较低（0.2-19%）。约 84%的患者既往接受过心理社会治疗，48%的患者接受过其他精神药物治疗，但 9%的患者未接受任何治疗。值得注意的是，只有 37%的患者连续接受了同时的心理社会治疗。同时使用多种抗精神病药的情况占 3.2%。年幼的儿童更有可能不遵守关于既往和同时治疗的指南建议，患有自闭症谱系障碍或注意力缺陷/多动障碍的儿童更不可能接受同时的心理社会治疗。性别并未显著影响遵医行为。我们的研究结果表明，儿童和青少年抗精神病药使用的重要建议的遵从性不足。尤其是年幼的儿童更有可能接受不充分的治疗。迫切需要在抗精神病药治疗期间持续提供心理社会干预。
