Management of Excessive Psychotropic Medication for Youth in Out-of-Home Care

描述(由申请人提供)：据估计，在美国有超过500,000名儿童被寄养，另有200,000名儿童接受住院治疗服务。许多这些离家安置的儿童都有严重的情绪和行为障碍，精神药物在他们的治疗中往往扮演着重要的角色。儿科精神药物治疗研究虽然是基本的，而且还在不断增长，但其范围相对有限，不能满足这一高度脆弱人群的实际日常实践所提出的研究需要。在家庭护理的年轻人中，有很高比例的人在服用药物，其中许多药物是标签外的，而且多药联用很常见。非标签药物和多药联用都与儿童不良反应风险增加有关。许多研究人员认为，现有的经验证据不足以充分理解和支持目前青少年精神药物处方的水平。拟议的科学会议将允许家庭药物治疗方面的专家形成合作并计划研究，以便为实践和政策提供信息。会议将有三个具体目标：(1)确定在治疗有行为和情绪问题的青少年时避免过度和不适当使用精神药物的有前景的战略；(2)促进基础研究人员和应用研究人员之间的合作研究联盟，这将延伸到科学会议之外；以及(3)为联邦资助的研究制定长期计划，以研究和改进青少年在家庭护理中的药物治疗实践。会议将在两天内举行，来自大学和提供者组织的24名与会者。所有参与者都将在户外治疗环境中体验当前的药物治疗研究和实践。会议将在内布拉斯加州的博伊斯镇举行。预计这次会议将导致：(1)创建一个网站，以促进这一领域的研究和推进相关的公共政策努力；(2)在总体战略范围内发表几篇相关的合作手稿，为未来NIMH研究资助申请的成功奠定必要的基础；以及(3)将提交给NIMH的机构间合作研究提案。 与公共卫生的相关性：至关重要的是，在户外环境中的行为和情感问题青年应得到适当的心理药理护理。目标是让年轻人接受他们需要的药物，而不是更多，以便最大限度地提高治疗效益，最大限度地减少不利成本和后果的可能性。为了实现这一目标，本次会议将确定在治疗有行为和情绪问题的青少年时避免过度和不适当使用精神药物的有前景的战略。

DESCRIPTION (provided by applicant): It is estimated that in the United States over 500,000 children are in foster care and another 200,000 receive residential treatment services. Many of these out-of-home placement children have severe emotional and behavioral impairments, with psychotropic medication often playing an important role in their treatment. Pediatric psychopharmacotherapy research, while essential and growing, has been relatively limited in its scope and does not answer the research needs presented by actual day-to- day practice for this highly vulnerable population. A high percentage of youth in out-of- home care are on medications, with many of the medications being off-label and polypharmacy being common. Off-label medications and polypharmacy are both linked to increased adverse effect risk in children. Many researchers have argued that the empirical evidence available is not adequate to fully understand and support the current level of psychotropic prescribing for youth. The proposed scientific meeting will allow experts in out-of-home pharmacotherapy to form collaborations and plan research that will inform practice and policy. The meeting will have three specific aims: (1) To identify promising strategies for avoiding excessive and inappropriate use of psychotropic medications in the treatment of youth with behavioral and emotional problems; (2) To promote collaborative research alliances between basic and applied researchers that will extend beyond the scientific meeting; and (3) To produce a long- term plan for federally-funded studies to research and improve pharmacotherapy practice for youth in out-of-home care. The meeting will occur over a two-day period, with 24 participants coming from both university and provider organizations. All participants will be experienced with current pharmacotherapeutic research and practice in out-of-home treatment settings. The meeting will be held at Boys Town, Nebraska. It is anticipated that this meeting will result in (1) a website being created to facilitate research and advance related public policy efforts in this area, (2) several related collaborative manuscripts within the overall strategy laying the groundwork necessary for successful future NIMH research grant applications, and ultimately, (3) inter-agency collaborative research proposals that will be submitted to the NIMH. PUBLIC HEALTH RELEVANCE: It is critical that behaviorally and emotionally troubled youth in out-of-home settings receive appropriate psychopharmacological care. The goal is for youth to receive the medications they need and no more, in order to maximize the therapeutic benefit and minimize the potential for adverse costs and consequences. To achieve this goal, this meeting will identify promising strategies for avoiding excessive and inappropriate use of psychotropic medications in the treatment of youth with behavioral and emotional problems.