Connor D F, Ozbayrak K R, Harrison R J, Melloni R H
Department of Psychiatry, University of Massachusetts Medical Center, Worcester 01655, USA.
J Child Adolesc Psychopharmacol. 1998;8(1):27-38. doi: 10.1089/cap.1998.8.27.
The prevalence and patterns of use of psychiatric and anticonvulsant medications were studied in 83 seriously emotionally disturbed children and adolescents at the time of their admission to a residential treatment facility. Youths (aged 5-19, mean = 13.6 years), consecutively admitted over 17 months, were assessed for the prevalence and patterns of use of psychotropic and anticonvulsant treatments. At admission, 76% of the youths were receiving psychiatric pharmacotherapy, 40% with more than one psychiatric agent, and 15% with a combination of psychotropic and anticonvulsant medications. Frequently prescribed medications were neuroleptics (35 % of the medicated youths), sedative-hypnotics (26 %), and anticonvulsants (15%). Psychostimulants (16%) and antidepressants (22%) were under-prescribed relative to their diagnostic indications. Over 50 different medication combinations were used. The neuroleptic + lithium combination was most common (25 % of the polypharmacological treatments). Neuroleptics were the most commonly prescribed medication and mostly used for nonpsychotic, nontic, and nonbipolar indications (55% of neuroleptic trials). Neuroleptics were used primarily for aggression regardless of diagnosis. Neuroleptics were used more in symptomatic treatments than in treatments for indicated diagnoses. The high prevalence of psychiatric and antiepileptic medication use in children and adolescents admitted to a residential treatment facility, and especially the pattern of their use, raises questions about prescribing practices for youths entering residential treatment and about pediatric psychopharmacotherapy in general.
对83名严重情绪障碍儿童和青少年在进入寄宿治疗机构时使用精神科药物和抗惊厥药物的患病率及用药模式进行了研究。在17个月内连续入院的青少年（年龄5 - 19岁，平均13.6岁）接受了精神药物和抗惊厥治疗的患病率及用药模式评估。入院时，76%的青少年正在接受精神科药物治疗，40%使用一种以上精神科药物，15%同时使用精神科药物和抗惊厥药物。常用药物为抗精神病药（用药青少年中的35%）、镇静催眠药（26%）和抗惊厥药（15%）。相对于诊断适应症，精神兴奋剂（16%）和抗抑郁药（22%）的处方量不足。使用了50多种不同的药物组合。抗精神病药 + 锂盐组合最为常见（多药联合治疗中的25%）。抗精神病药是最常处方的药物，主要用于非精神病性、非抽动性和非双相性适应症（抗精神病药试验的55%）。无论诊断如何，抗精神病药主要用于攻击行为。抗精神病药在对症治疗中的使用多于针对明确诊断的治疗。在进入寄宿治疗机构的儿童和青少年中，精神科和抗癫痫药物的高使用率，尤其是其用药模式，引发了关于进入寄宿治疗的青少年的处方实践以及总体儿科精神药理学的问题。
