Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway.
J Child Adolesc Psychopharmacol. 2021 Jun;31(5):350-357. doi: 10.1089/cap.2020.0123. Epub 2021 Feb 25.
To assess the use of three commonly prescribed psychotropic medications in youth placed in residential care (RC). Participants were youth aged 0-20 years placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of antidepressants, antipsychotics, and stimulants in RC with the age- and gender-adjusted general child population (GenPop) and how this co-varied with reasons for RC placement, age, and gender. One thousand eight hundred fifty-six children and adolescents were identified in RC, with mean age 14 (range 0-20 years), 46% girls, 81% ≥ 13 years. Among those, 423 or 23% used any of the 3 psychotropics, which was significantly more than the 3.7% in GenPop. The prevalence ratios RC/GenPop were 6.6 for antidepressants, 17.9 for antipsychotics, and 4.4 for stimulants. The median number of days per year for the dispensed defined daily doses varied from 8.3 to 244.0 for the different antipsychotics, indicating short time use for most of the people. Polypharmacy was not frequent in RC, as only 26% used ≥2 classes of medication, but still significantly more frequent than the 10% in GenPop. Youth placed in RC for serious behavior problems had significantly higher use of stimulants than those with other placement reasons. Psychotropics were not used below age 6 years, and although the use of antidepressants and antipsychotics overall increased with age, stimulants were mostly used by 6-16-year olds. The girl/boy ratio for any psychotropic medication use in RC was 1.4 (95% confidence interval [95% CI]: 1.1-1.6), significantly higher than the corresponding ratio in GenPop: 1.0 (95% CI: 0.9-1.0). The present findings do not necessarily suggest an overtreatment with medication in RC. However, the frequent short-term use of antipsychotics, presumably for non-psychotic symptoms, is a concern, as it may reflect that the youth are not provided with the recommended first-line psychological treatments.
评估三种常见精神药物在被安置于住宿照料（RC）的青少年中的使用情况。参与者为 2016 年期间至少一次被安置于 RC 机构的 0-20 岁青少年。通过挪威处方数据库获取了用药处方数据，以比较 RC 中抗抑郁药、抗精神病药和兴奋剂的使用情况与年龄和性别调整后的一般儿童人群（GenPop）的使用情况，并探讨了这种差异与 RC 安置原因、年龄和性别之间的关系。在 RC 中确定了 1856 名儿童和青少年，平均年龄 14 岁（0-20 岁），女孩占 46%，81%≥13 岁。其中，423 名（23%）或 3 种精神药物中的任何一种，明显高于 GenPop 的 3.7%。RC/GenPop 的患病率比分别为抗抑郁药 6.6、抗精神病药 17.9 和兴奋剂 4.4。不同抗精神病药的每年配药限定日剂量的天数中位数从 8.3 到 244.0 不等，表明大多数人的用药时间都很短。RC 中多药治疗并不常见，只有 26%的人使用≥2 类药物，但仍明显高于 GenPop 的 10%。因严重行为问题而被安置于 RC 的青少年使用兴奋剂的比例明显高于因其他原因被安置的青少年。精神药物在 6 岁以下儿童中不使用，虽然抗抑郁药和抗精神病药的使用总体上随年龄增长而增加，但兴奋剂主要由 6-16 岁的儿童使用。RC 中任何精神药物使用的男女比例为 1.4（95%置信区间[95%CI]：1.1-1.6），明显高于 GenPop 的相应比例：1.0（95%CI：0.9-1.0）。本研究结果不一定表明 RC 中存在过度用药。然而，经常短期使用抗精神病药，可能是用于非精神病症状，这令人担忧，因为这可能反映出没有向这些青少年提供推荐的一线心理治疗。
