Department Rottmannshöhe, Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, KBO-Heckscher-Klinikum gGmbH, Deisenhofener Str. 28, 81539, Munich, Germany.
Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany.
Eur Arch Psychiatry Clin Neurosci. 2022 Dec;272(8):1559-1568. doi: 10.1007/s00406-022-01385-w. Epub 2022 Feb 16.
Non-suicidal self-injury (NSSI) in children and adolescents is a frequent phenomenon. NSSI at any time is a significant predictor of future NSSI but also, and more importantly, for suicide attempts. Less evidence is available for the impact, or more specifically, the therapeutic effect of psychotropic drugs on the emergence of NSSI in this population. The phenomenon is clinically highly relevant since adolescent psychiatric inpatients are often affected by NSSI and most of them are treated with psychotropic drugs. While previous reviews on NSSI comprised suicidal self-injury (SSI), this review aims at elucidating the potential impact of psychotropic drugs on the emergence of specifically NSSI in children and adolescents. Systematic searches of articles indexed electronically in PubMed, Embase and PsycInfo were conducted (PROSPERO CRD42020209505). Studies included in the quantitative synthesis were evaluated using the SIGN level of evidence rating. Meta-analyses were performed using RevMan (Version 5.4). 2227 records were identified through database searches. Two additional records were identified manually. In total, seven studies were included in qualitative and four studies in quantitative analyses. In a meta-analysis, selective serotonin reuptake inhibitors (SSRIs) were compared vs. control medication (placebo or serotonin-norepinephrine reuptake inhibitor) and here, no statistically significant difference between the groups could be observed regarding the frequency of NSSI events (Risk Ratio (RR) = 1.07, 95% confidence interval (CI) 0.60-1.91, p = 0.82, I = 12%). Evidence regarding the association of SSRI use and NSSI among children and adolescents is sparse and the impact of psychotropic drugs in general on NSSI rates in this population should be addressed in future clinical and observational studies.
儿童和青少年的非自杀性自伤 (NSSI) 是一种常见现象。任何时候的 NSSI 都是未来 NSSI 的重要预测指标，而且更重要的是，也是自杀企图的重要预测指标。关于精神药物对该人群 NSSI 出现的影响，或者更具体地说，关于精神药物治疗效果的证据较少。这一现象在临床上非常重要，因为青少年精神科住院患者经常受到 NSSI 的影响，而且他们大多数人都接受精神药物治疗。虽然之前关于 NSSI 的综述包括自杀性自伤 (SSI)，但本综述旨在阐明精神药物对儿童和青少年特定的 NSSI 出现的潜在影响。系统地检索了电子索引在 PubMed、Embase 和 PsycInfo 中的文章（PROSPERO CRD42020209505）。对纳入定量综合分析的研究使用 SIGN 证据等级进行评估。使用 RevMan（版本 5.4）进行荟萃分析。通过数据库搜索确定了 2227 条记录。另外手动确定了两条记录。总共纳入了 7 项定性研究和 4 项定量分析研究。在荟萃分析中，将选择性 5-羟色胺再摄取抑制剂 (SSRIs) 与对照药物（安慰剂或 5-羟色胺-去甲肾上腺素再摄取抑制剂）进行比较，结果显示两组之间 NSSI 事件的频率没有统计学上的显著差异（风险比 (RR) = 1.07，95%置信区间 (CI) 0.60-1.91，p = 0.82，I = 12%）。关于儿童和青少年中 SSRI 使用与 NSSI 之间关联的证据较少，一般来说，精神药物对该人群 NSSI 发生率的影响应在未来的临床和观察性研究中得到解决。
