Hong Jennifer, Mattingly Gregory W, Carbray Julie A, Cooper Takesha V, Findling Robert L, Gignac Martin, Glaser Paul E, Lopez Frank A, Maletic Vladamir, McIntyre Roger S, Robb Adelaide S, Singh Manpreet K, Stein Mark A, Stahl Stephen M
Department of Psychiatry and Neuroscience, University of California Riverside, Riverside, CA, USA.
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA.
CNS Spectr. 2024 May 20:1-12. doi: 10.1017/S1092852924000208.
Changing practice patterns caused by the pandemic have created an urgent need for guidance in prescribing stimulants using telepsychiatry for attention-deficit hyperactivity disorder (ADHD). A notable spike in the prescribing of stimulants accompanied the suspension of the Ryan Haight Act, allowing the prescribing of stimulants without a face-to-face meeting. Competing forces both for and against prescribing ADHD stimulants by telepsychiatry have emerged, requiring guidelines to balance these factors. On the one hand, factors weighing in favor of increasing the availability of treatment for ADHD via telepsychiatry include enhanced access to care, reduction in the large number of untreated cases, and prevention of the known adverse outcomes of untreated ADHD. On the other hand, factors in favor of limiting telepsychiatry for ADHD include mitigating the possibility of exploiting telepsychiatry for profit or for misuse, abuse, and diversion of stimulants. This Expert Consensus Group has developed numerous specific guidelines and advocates for some flexibility in allowing telepsychiatry evaluations and treatment without an in-person evaluation to continue. These guidelines also recognize the need to give greater scrutiny to certain subpopulations, such as young adults without a prior diagnosis or treatment of ADHD who request immediate-release stimulants, which should increase the suspicion of possible medication diversion, misuse, or abuse. In such cases, nonstimulants, controlled-release stimulants, or psychosocial interventions should be prioritized. We encourage the use of outside informants to support the history, the use of rating scales, and having access to a hybrid model of both in-person and remote treatment.
由疫情导致的医疗实践模式转变，使得在使用远程精神病学为注意力缺陷多动障碍（ADHD）患者开具兴奋剂方面迫切需要指导。随着《瑞安·海特法案》的暂停实施，兴奋剂处方量显著飙升，该法案允许在没有面对面会诊的情况下开具兴奋剂。支持和反对通过远程精神病学开具ADHD兴奋剂的相互竞争的力量已经出现，这就需要制定指导方针来平衡这些因素。一方面，支持通过远程精神病学增加ADHD治疗可及性的因素包括改善医疗服务可及性、减少大量未治疗病例以及预防未治疗ADHD的已知不良后果。另一方面，支持限制ADHD远程精神病学的因素包括降低利用远程精神病学谋取利益或滥用、误用和转移兴奋剂的可能性。本专家共识小组制定了众多具体指导方针，并主张在允许在没有面对面评估的情况下继续进行远程精神病学评估和治疗方面具有一定灵活性。这些指导方针还认识到有必要对某些亚群体进行更严格的审查，比如那些没有ADHD既往诊断或治疗史却要求开具速释兴奋剂的年轻人，这应该会增加对可能的药物转移、误用或滥用的怀疑。在这种情况下，应优先选择非兴奋剂、控释兴奋剂或心理社会干预措施。我们鼓励利用外部信息提供者来辅助病史采集、使用评定量表，并采用面对面和远程治疗相结合的模式。
