Hach Isabel, Bertsch Thomas, Nonell Patrick
Department of Education and Science, Klinikum Nürnberg, Paracelsus Medical University Nürnberg, Nürnberg, Germany.
Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Klinikum Nürnberg, Paracelsus Medical University Nürnberg, Nürnberg, Germany.
Front Psychiatry. 2024 Jan 17;14:1240681. doi: 10.3389/fpsyt.2023.1240681. eCollection 2023.
Adolescents with mental disorders show an increased risk of suicidal phenomena. Vice versa, suicidality is a serious adverse event of psychotropic drug therapy in adolescents. There are only a few new psychotropic agents approved for this young age group. We evaluated the (pre-pandemic) prevalence of off-label use as well as detailed blood concentrations of outpatient psychotropic medication and sex differences in a clinical population of suicidal adolescents.
The urine presence and serum levels of psychotropic substances of adolescents hospitalized due to their acute suicidality but without a known actual suicide attempt (i.e., no acute intoxication or serious self-injuries) were investigated routinely between 01.03.2017 and 31.01.2018. Urine ( = 205) and blood samples ( = 193) were taken at the beginning of closed inpatient admission, i.e., the results of the laboratory analysis reflect outpatient drug intake. The serum levels of psychopharmacological medication and OTC medication were measured.
Our sample consists of 231 cases (boys: = 54; girls: = 177, ratio: 1:3.3), aged 12-17 years (average age: 15,4 years). The most prevalent psychiatric diagnoses were depressive episodes (54%) and adjustment disorders (25%), and girls were more often diagnosed with depressive disorders than boys (boy/girl ratio: 1:9.5, < 0.0001). More than half of adolescents (56%) used at least one prescribed psychotropic drug at admission (24.8% ≥ two psychotropic drugs). Off-label use of second-generation antipsychotics was significantly more frequent than off-label use of antidepressants (85% vs. 31%, < 0.01). Adolescents suffering from depressive disorders were significantly more often on-label treated than adolescents with neurotic or stress-related disorders (56% vs. 10%). Female cases with prescribed psychotropic drug use showed significantly more frequent supratherapeutic drug levels than male cases (5% vs. 27%, < 0.05).
Female adolescents may have an increased risk of supratherapeutic blood levels, especially when outpatient prescribed psychotropic drugs are off-label used. Measurement of blood levels of outpatient-prescribed psychotropic drugs could be used to enhance the safety and efficacy of the individual psychopharmacological treatment of adolescent suicidal patients. There is an urgent need for more real-world evidence on the effective treatment of adolescents with psychotropic drugs.
患有精神障碍的青少年出现自杀现象的风险增加。反之，自杀倾向是青少年精神药物治疗的严重不良事件。仅有少数新型精神药物被批准用于这个年轻年龄组。我们评估了（疫情前）门诊精神药物在有自杀倾向青少年临床人群中的超说明书用药患病率、详细血药浓度以及性别差异。
对2017年3月1日至2018年1月31日期间因急性自杀倾向住院但无已知实际自杀未遂情况（即无急性中毒或严重自伤）的青少年的精神药物尿液存在情况和血清水平进行常规调查。在封闭式住院治疗开始时采集尿液（n = 205）和血液样本（n = 193），即实验室分析结果反映门诊药物摄入情况。测量精神药物和非处方药的血清水平。
我们的样本包括231例病例（男孩：n = 54；女孩：n = 177，比例：1:3.3），年龄在12 - 17岁（平均年龄：15.4岁）。最常见的精神科诊断是抑郁发作（54%）和适应障碍（25%），女孩比男孩更常被诊断为抑郁障碍（男孩/女孩比例：1:9.5，P < 0.0001）。超过一半的青少年（56%）在入院时使用至少一种处方精神药物（24.8%使用≥两种精神药物）。第二代抗精神病药物的超说明书用药显著比抗抑郁药物更频繁（85%对31%，P < 0.01）。患有抑郁障碍的青少年比患有神经症或与压力相关障碍的青少年更常接受说明书用药治疗（56%对10%）。使用处方精神药物的女性病例超治疗药物水平显著比男性病例更频繁（5%对27%，P < 0.05）。
女性青少年超治疗血药水平的风险可能增加，尤其是当门诊处方精神药物超说明书使用时。测量门诊处方精神药物的血药水平可用于提高青少年自杀患者个体精神药物治疗的安全性和有效性。迫切需要更多关于青少年精神药物有效治疗的真实世界证据。
