National Trends in Child and Adolescent Psychotropic Polypharmacy in Office-Based Practice, 1996-2007
National Trends in Child and Adolescent Psychotropic Polypharmacy in Office-Based Practice, 1996-2007
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DOI：
10.1016/j.jaac.2010.07.007
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发表时间：
2010-10-01
影响因子：
13.3
通讯作者：
Mojtabai, Ramin
中科院分区：
文献类型：
--
作者：
Comer, Jonathan S.;Olfson, Mark;Mojtabai, Ramin
目的：研究美国年轻人就诊于办公室医生的多类精神病治疗的模式和最新趋势。方法：对1996 - 2007年全国门诊医疗调查的年度数据进行了分析，以检查在全国代表性样本中多类精神药物治疗的模式和趋势，该样本为3，466名儿童和青少年访问办公室医生，其中开有精神药物。结果如下：开出至少包括两种精神药物类别的精神药物的儿童就诊百分比有所增加。在12年期间，多类精神病治疗从1996 - 1999年的14.3%上升到2004 - 2007年的20.2%（调整后的比值比[AOR]= 1.89，95%置信区间[CI]= 1.22 - 2.94，p <0.01）。在诊断为当前精神障碍的医疗就诊中，接受多类精神药物治疗的比例从22.2%（1996 - 1999年）增加到32.2%（2004 - 2007年）（AOR = 2.23，95%CI = 1.42 - 3.52，p <0.001）。随着时间的推移，有显着增加，在多类精神病患者的访问中，ADHD药物，抗抑郁药，或抗精神病药物的处方，并在这些访问中，情绪稳定剂的处方减少。ADHD药物和抗精神病药物的联合处方（AOR = 6.22，95% CI = 2.82 - 13.70，p <0.001）以及抗抑郁药和抗精神病药物的联合处方（AOR = 5.77，95% CI = 2.88 - 11.60，p <0.001）也有特定增加。结论：虽然对儿童和青少年同时使用两种或两种以上精神药物的安全性和有效性知之甚少，但多类精神药物在门诊实践中越来越普遍。J. Am. Acad.儿童青少年精神病学，2010; 49（10）：1001 - 1010.
Objective: To examine patterns and recent trends in multiclass psychotropic treatment among youth visits to office-based physicians in the United States. Method: Annual data from the 1996-2007 National Ambulatory Medical Care Surveys were analyzed to examine patterns and trends in multiclass psychotropic treatment within a nationally representative sample of 3,466 child and adolescent visits to office-based physicians in which a psychotropic medication was prescribed. Results: There was an increase in the percentage of child visits in which psychotropic medications were prescribed that included at least two psychotropic classes. Across the 12 year period, multiclass psychotropic treatment rose from 14.3% of child psychotropic visits (1996-1999) to 20.2% (2004-2007) (adjusted odds ratio [AOR] = 1.89, 95% confidence interval [CI] = 1.22-2.94, p < .01). Among medical visits in which a current mental disorder was diagnosed, the percentage with multiclass psychotropic treatment increased from 22.2% (1996-1999) to 32.2% (2004-2007) (AOR = 2.23, 95% CI = 1.42-3.52, p < .001). Over time, there were significant increases in multiclass psychotropic visits in which ADHD medications, antidepressants, or antipsychotics were prescribed, and a decrease in those visits in which mood stabilizers were prescribed. There were also specific increases in co-prescription of ADHD medications and antipsychotic medications (AOR = 6.22, 95% CI = 2.82-13.70, p < .001) and co-prescription of antidepressant and antipsychotic medications (AOR = 5.77, 95% CI = 2.88-11.60, p < .001). Conclusions: Although little is known about the safety and efficacy of regimens that involve concomitant use of two or more psychotropic agents for children and adolescents, multiclass psychotropic pharmacy is becoming increasingly common in outpatient practice. J. Am. Acad. Child Adolesc. Psychiatry, 2010;49(10):1001-1010.