School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.
Specialist Neurodevelopmental ADHD Pathway (SNAP), Cork and Kerry Mental Health Services, Cork, Ireland.
Eur Child Adolesc Psychiatry. 2024 Nov;33(11):3861-3870. doi: 10.1007/s00787-024-02428-4. Epub 2024 Apr 12.
Antipsychotic prescribing trends vary internationally, albeit off-label use remains high (i.e., target symptoms). We aim to describe antipsychotic use, target conditions, target symptoms and dosing regimens in children and adolescents in Ireland. We used a sampled cohort from a national audit of children and adolescents attending mental health services with predefined inclusion and exclusion criteria from Jul-2021 to Dec-2021 who were prescribed at least one psychotropic medication and up to and including 17-years of age (n = 3528). Each service provided anonymised data. We described the frequency of antipsychotic medication, medication type, target condition, target symptom and medication doses. We used multivariable logistic regression, adjusted with available co-variates to assess the association of being prescribed an antipsychotic medication. Twelve percentage (n = 437) were prescribed an antipsychotic and 16-17-years (n = 211, 48.3%) was the most common age category. The commonest reason for prescribing an antipsychotic was target symptoms (i.e., off-label use) (n = 329; 75.%) and of these symptoms, agitation (n = 77/329; 25%) and irritability (56/239; 25%) were the most common. Quetiapine (n = 127; 29%) was the most common antipsychotic, followed by risperidone (n = 125; 28.6%), aripiprazole (n = 107; 24.5%), and olanzapine (n = 66; 15.1%). In adjusted analysis, having a psychotic disorder ((adjusted-odds-ratio) aOR: 39.63, CI 95%, 13.40-117.22), bipolar disorder (aOR: 16.96, CI 95%, 3.60-80.00), autism spectrum disorder (aOR: 3.24, CI 95%, 2.45-4.28) or aggression symptoms (aOR: 16.75, CI 95%, 7.22-38.89) was associated with prescribing an antipsychotic medication. This is the first study in children and adolescents that describes the target conditions and target symptoms for antipsychotic use in Ireland. Our results show a high proportion of antipsychotic prescribing based on target symptoms rather than target condition or diagnosis.
抗精神病药物的处方趋势在国际上有所不同，尽管标签外使用仍然很高（即，目标症状）。我们旨在描述爱尔兰儿童和青少年使用抗精神病药物的情况、目标病症、目标症状和剂量方案。我们使用了一项全国性的儿童和青少年精神健康服务审计中的抽样队列，该队列的纳入和排除标准是在 2021 年 7 月至 12 月期间至少服用一种精神药物且年龄在 17 岁以下（n=3528）。每个服务机构都提供了匿名数据。我们描述了抗精神病药物的使用频率、药物类型、目标病症、目标症状和药物剂量。我们使用多变量逻辑回归，结合可用的协变量进行调整，以评估被开处抗精神病药物的关联。有 12%（n=437）被开处了抗精神病药物，16-17 岁（n=211，48.3%）是最常见的年龄组。开处抗精神病药物的最常见原因是目标症状（即标签外使用）（n=329；75.0%），其中最常见的症状是激越（n=77/329；25.0%）和易怒（56/239；25.0%）。喹硫平（n=127；29.0%）是最常用的抗精神病药物，其次是利培酮（n=125；28.6%）、阿立哌唑（n=107；24.5%）和奥氮平（n=66；15.1%）。在调整分析中，患有精神病性障碍（调整后优势比[aOR]：39.63，95%置信区间[CI]，13.40-117.22）、双相情感障碍（aOR：16.96，CI 95%，3.60-80.00）、自闭症谱系障碍（aOR：3.24，CI 95%，2.45-4.28）或攻击症状（aOR：16.75，CI 95%，7.22-38.89）与开处抗精神病药物相关。这是第一项在儿童和青少年中描述爱尔兰抗精神病药物使用的目标病症和目标症状的研究。我们的研究结果表明，很大一部分抗精神病药物的处方是基于目标症状，而不是目标病症或诊断。
