Li Wenqing, Bao Chenxi, Ye Yupei, Liu Qingxiang, Chu Kangkang, Wang Ya, Ruan Xiaoyan, Lü Huimin, Liu Xi, Ke Xiaoyan
Child Mental Health Research Center, the Affiliated Brain Hospital of Nanjing Medical University, NO.264 Guangzhou Road, Nanjing, 210029, China.
J Autism Dev Disord. 2025 Mar 27. doi: 10.1007/s10803-025-06779-y.
Children and adolescents with autism spectrum disorder (ASD) frequently present with mental health comorbidities and behavioral crises, necessitating inpatient care. However, evidence-based guidelines for psychotropic medication use in specialized inpatient settings remain limited, particularly in non-Western contexts. This study examined the clinical characteristics and prescribing patterns among 269 hospitalized ASD patients (2012-2023), with a focus on how intellectual disability (ID) influences medication decisions. A retrospective analysis was conducted using electronic medical records to assess mental disorders, behavioral challenges, and psychotropic medication use at discharge. Logistic regression analyses was performed to examine factors associated with medication prescribing patterns, including the impact of ID status. Psychotropic medication use was highly prevalent (96.7%), with antipsychotics (89.96%) being the most frequently prescribed class, followed by anxiolytics (35.32%) and antidepressants (33.09%). ID was significantly associated with distinct prescribing patterns: patients with ID had 63% lower odds of antidepressant use (aOR = 0.37, p = 0.001) and 80% lower odds of ADHD medication use (aOR = 0.20, p = 0.009), while being more likely to receive antipsychotics (aOR = 2.74, p = 0.049) and experience polypharmacy (aOR = 1.89, p = 0.028). Additionally, disruptive behaviors and age were key predictors of antipsychotic use, whereas suicidal thoughts/attempts or SIBs independently predicted antidepressant prescribing. These findings suggest that ID status plays a critical role in shaping psychotropic prescribing practices beyond symptom severity alone, potentially reflecting diagnostic overshadowing and safety concerns. Future research should focus on developing tailored clinical assessment tools and treatment protocols for ASD populations with and without ID, while enhancing individualized medication monitoring to optimize therapeutic outcomes.
患有自闭症谱系障碍（ASD）的儿童和青少年经常出现心理健康合并症和行为危机，需要住院治疗。然而，在专门的住院环境中使用精神药物的循证指南仍然有限，尤其是在非西方背景下。本研究调查了269名住院ASD患者（2012年至2023年）的临床特征和用药模式，重点关注智力残疾（ID）如何影响用药决策。使用电子病历进行回顾性分析，以评估出院时的精神障碍、行为挑战和精神药物使用情况。进行逻辑回归分析以检查与用药模式相关的因素，包括ID状态的影响。精神药物的使用非常普遍（96.7%），抗精神病药物（89.96%）是最常开具的类别，其次是抗焦虑药（35.32%）和抗抑郁药（33.09%）。ID与不同的用药模式显著相关：患有ID的患者使用抗抑郁药的几率降低63%（调整后比值比[aOR]=0.37，p=0.001），使用治疗注意力缺陷多动障碍（ADHD）药物的几率降低80%（aOR=0.20，p=0.009），而更有可能接受抗精神病药物治疗（aOR=2.74，p=0.049）并经历联合用药（aOR=1.89，p=0.028）。此外，破坏性行为和年龄是使用抗精神病药物的关键预测因素，而自杀念头/企图或自伤行为独立预测抗抑郁药的开具。这些发现表明，ID状态在塑造精神药物处方实践中起着关键作用，不仅仅是症状严重程度，这可能反映了诊断掩盖和安全问题。未来的研究应专注于为有或没有ID的ASD人群开发量身定制的临床评估工具和治疗方案，同时加强个体化药物监测以优化治疗效果。
