Bartel Roxanne L, Knight Jacob R, Worsham Whitney, Bilder Deborah A
Department of Psychiatry, Huntsman Mental Health Institute (Bartel, Bilder); and School of Medicine (Knight), University of Utah, Salt Lake City; Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Worsham).
Focus (Am Psychiatr Publ). 2024 Apr;22(2):150-161. doi: 10.1176/appi.focus.20230027. Epub 2024 Apr 10.
Autistic individuals experience high rates of behavioral crises that present to healthcare providers for medication management. Co-occurring psychiatric conditions and psychotropic medication use are common among this patient population. Particularly for those with limited expressive language, evaluating for the presence of psychiatric and medical conditions that could contribute to distress is a critical component of crisis management. A records review study was completed on 126 autistic individuals for whom medical decision-making support was requested from The Huntsman Mental Health Institute Neurobehavior Consultation Service. Crisis manifestations and historical information were provided by the parent or caregiver through an online questionnaire. Nearly all individuals presented with behavioral (96.8%) and emotional (96.8%) symptoms; 97.6% received at least one co-occurring psychiatric diagnosis. Additionally, 75.4% of parents or caregivers endorsed the presence of a medical condition that they believed could be contributing to the crisis presentation. Most individuals (92.1%) were prescribed at least one psychotropic medication; 69.8% were taking an antipsychotic, suggesting a history of treatment resistance. The alignment between psychotropic medications and psychiatric diagnoses was evaluated in the context of prior studies and reviews on psychiatric management in autistic and neurotypical populations. Several individuals were taking a combination of medications that included both indicated and contraindicated medications for the psychiatric disorder diagnosed, likely contributing to treatment resistance. Identifying discordance between psychotropic medication use and psychiatric conditions present offers an opportunity to pursue better treatment outcomes for autistic individuals, particularly for those experiencing treatment-resistant agitation.
自闭症患者出现行为危机的比例很高，这些危机需要医疗服务提供者进行药物管理。同时存在的精神疾病和使用精神药物在这一患者群体中很常见。特别是对于那些表达性语言有限的患者，评估是否存在可能导致痛苦的精神和身体疾病是危机管理的关键组成部分。对126名自闭症患者进行了一项病历回顾研究，这些患者向亨斯迈心理健康研究所神经行为咨询服务部门寻求医疗决策支持。危机表现和历史信息由父母或照顾者通过在线问卷提供。几乎所有患者都出现了行为（96.8%）和情绪（96.8%）症状；97.6%的患者至少有一项共病精神疾病诊断。此外，75.4%的父母或照顾者认可存在一种他们认为可能导致危机表现的身体疾病。大多数患者（92.1%）至少被开了一种精神药物；69.8%的患者正在服用抗精神病药物，这表明存在治疗抵抗史。在先前关于自闭症和神经典型人群精神疾病管理的研究和综述的背景下，评估了精神药物与精神疾病诊断之间的一致性。有几名患者正在服用包括针对已诊断精神疾病的适应证药物和禁忌证药物的组合药物，这可能导致了治疗抵抗。识别精神药物使用与存在的精神疾病之间的不一致，为自闭症患者，特别是那些经历治疗抵抗性激越的患者追求更好的治疗结果提供了机会。
