Treatment of Young People With Antipsychotic Medications in the United States
Treatment of Young People With Antipsychotic Medications in the United States
复制标题
DOI：
10.1001/jamapsychiatry.2015.0500
复制
发表时间：
2015-09-01
期刊：
影响因子：
25.8
通讯作者：
Schoenbaum, Michael
中科院分区：
文献类型：
--
作者：
Olfson, Mark;King, Marissa;Schoenbaum, Michael
重要性 尽管人们担心年轻人抗精神病药物治疗的增加，但人们对其在美国的使用趋势和模式知之甚少。 目的 描述美国年轻人的抗精神病药物处方模式，重点关注年龄和性别。 设计、环境和参与者 利用 2006 年的数据（n = 765）对 1 至 24 岁患者的抗精神病药物处方进行回顾性描述性分析。 829)、2008 年 (n = 858 216) 和 2010 年 (n = 851 874)，包括 2009 日历年的服务索赔数据子集 (n = 53 896)。数据取自 IMS LifeLink LRx 纵向处方数据库，该数据库包含美国约 60% 的零售药店。对分母进行了调整，以将估计值推广到美国人口。 主要结果和测量 按性别和年龄组（年龄较小的儿童，1-6 岁；年龄较大的儿童，7-12 岁；青少年，13-18 岁；年轻人，19-24 岁）计算研究年内服用 1 种或多种抗精神病药物处方的年轻人的百分比。在使用抗精神病药物的年轻人中，还确定了具有特定临床精神病学诊断以及精神科医生以及儿童和青少年精神科医生开具的一种或多种抗精神病药物处方的百分比。 结果 2006 年和 2010 年使用抗精神病药物的年轻人百分比分别为：年龄较小的儿童为 0.14% 和 0.11%，年龄较大的为 0.85% 和 0.80%儿童、青少年分别为1.10%和1.19%，青壮年分别为0.69%和0.84%。 2010年，男性比女性更有可能使用抗精神病药物，尤其是在儿童期和青春期：年幼儿童为0.16% vs 0.06%，年长儿童为1.20% vs 0.44%，青少年为1.42% vs 0.95%，年轻人为0.88% vs 0.81%。在2010年接受抗精神病药物治疗的年轻人中，接受精神科医生处方的情况在年龄较小的儿童中（57.9%）比其他年龄组（范围，70.4%-77.9%）要少见。 2010 年，大约 29.3% 接受抗精神病药物治疗的幼儿接受了儿童和青少年精神科医生开出的 1 种或多种抗精神病药物处方。在 2009 年声称患有精神障碍并接受抗精神病药物治疗的年轻人中，最常见的诊断是年幼儿童 (52.5%)、年龄较大儿童 (60.1%) 和青少年 (34.9%) 的注意力缺陷/多动障碍以及年轻人 (34.5%) 的抑郁症。 结论和相关性 从 2006 年到 2010 年，青少年和年轻人的抗精神病药物使用有所增加但不适用于 12 岁或以下的儿童。抗精神病药物的使用高峰出现在青春期，尤其是男孩，临床诊断模式与发育受限的冲动和攻击行为的管理一致，而不是精神病症状。
IMPORTANCE Despite concerns about rising treatment of young people with antipsychotic medications, little is known about trends and patterns of their use in the United States.OBJECTIVE To describe antipsychotic prescription patterns among young people in the United States, focusing on age and sex.DESIGN, SETTING, AND PARTICIPANTS A retrospective descriptive analysis of antipsychotic prescriptions among patients aged 1 to 24 years was performed with data from calendar years 2006 (n = 765 829), 2008 (n = 858 216), and 2010 (n = 851 874), including a subset from calendar year 2009 with service claims data (n = 53 896). Data were retrieved from the IMS LifeLink LRx Longitudinal Prescription database, which includes approximately 60% of all retail pharmacies in the United States. Denominators were adjusted to generalize estimates to the US population.MAIN OUTCOMES AND MEASURES The percentage of young people filling 1 or more antipsychotic prescriptions during the study year by sex and age group (younger children, 1-6 years; older children, 7-12 years; adolescents, 13-18 years; and young adults, 19-24 years) was calculated. Among young people with antipsychotic use, percentages with specific clinical psychiatric diagnoses and 1 or more antipsychotic prescriptions from a psychiatrist and from a child and adolescent psychiatrist were also determined.RESULTS The percentages of young people using antipsychotics in 2006 and 2010, respectively, were 0.14% and 0.11% for younger children, 0.85% and 0.80% for older children, 1.10% and 1.19% for adolescents, and 0.69% and 0.84% for young adults. In 2010, males were more likely than females to use antipsychotics, especially during childhood and adolescence: 0.16% vs 0.06% for younger children, 1.20% vs 0.44% for older children, 1.42% vs 0.95% for adolescents, and 0.88% vs 0.81% for young adults. Among young people treated with antipsychotics in 2010, receiving a prescription from a psychiatrist was less common among younger children (57.9%) than among other age groups (range, 70.4%-77.9%). Approximately 29.3% of younger children treated with antipsychotics in 2010 received 1 or more antipsychotic prescriptions from a child and adolescent psychiatrist. Among young people with claims for mental disorders in 2009 who were treated with antipsychotics, the most common diagnoses were attention-deficit/hyperactivity disorder in younger children (52.5%), older children (60.1%), and adolescents (34.9%) and depression in young adults (34.5%).CONCLUSIONS AND RELEVANCE Antipsychotic use increased from 2006 to 2010 for adolescents and young adults but not for children aged 12 years or younger. Peak antipsychotic use in adolescence, especially among boys, and clinical diagnosis patterns are consistent with management of developmentally limited impulsive and aggressive behaviors rather than psychotic symptoms.