Antipsychotic Prescription Pattern among Child and Adolescent Patients with Psychiatric Illnesses in Taiwan

兒童與青少年抗精神病藥物處方型態的研究

鄭淑文(Shu-Wen Cheng)；詹宏裕(Hung-Yu Chan)

children and adolescents ； psychiatric illnesses ； antipsychotic drugs ； prescription patterns ； 兒童與青少年 ； 精神疾病 ； 抗精神病藥物 ； 處方型態

台灣精神醫學

31卷3期（2017 / 09 / 01）

222 - 231+iv

英文

Objectives: The prevalence of antipsychotic prescription for child and adolescent patients with psychiatric illnesses is increasing over the world. No studies exist to focus on the prescription pattern and trend of antipsychotic use for child and adolescent patients in psychiatric hospitals of Taiwan. Methods: In this retrospective study for all outpatients equal or below 18 years of age in a psychiatric hospital, we collected related study variables from the study hospital from 2004 to 2013. Reviewing the electronic medical information system, we extracted both patients’ demographic data (information for sex, age, psychiatric diagnosis, and prescriptions of antipsychotic drugs). Results: During the study period, the proportion of participants received antipsychotics was increased significantly (from 13.63% in 2004, to 15.02% in 2013, p ＜ 0.001). The proportion of participants received second generation antipsychotics (SGAs) was increased (from 5.84% in 2004, to 10.59% in 2013, p ＜ 0.001), but first-generation antipsychotics (FGAs) was decreased (from 8.05% to 4.97%, p ＜ 0.001). The age group of 16-18 years of age showed that the highest increase (from 7.53% to 9.11%, p ＜ 0.001). The male gender was found to be significantly increased (from 7.89% to 9.51%, p ＜ 0.001). Conclusion: The results are in line with the trend of the world about the increasing SGA use for psychiatric patients below 18 years of age. In spite of the potential benefits of SGAs on treating illnesses or symptoms, we need caution the potential side effects of long-term SGA use. We expect the appropriate use of antipsychotics for psychiatric patients of children and adolescents, to improve the care quality for this population.

目的：近來世界各國兒童與青少年抗精神病藥物的使用率逐漸上升，其臨床適應症與使用的安全性成為重要議題。研究主要目的乃藉由個案醫院之資料進行分析，以瞭解該院兒童與青少年抗精神病藥物處方態樣。方法：回溯性資料庫研究，分析某一精神專科醫院門診健保資料庫，針對18 歲以下人口為研究對象，探討2004 年至2013 年兒童與青少年抗精神病藥物之處方型態與趨勢。結果：於2004 至2013 年間，兒童與青少年抗精神病藥物使用由13.63% 顯著的增加至15.02% (p ＜ 0.001)。其中，第一代抗精神病藥物使用由8.05% 顯著的下降至4.97%，降幅率為38.26% (p ＜ 0.001)；第二代抗精神病藥物使用由5.84% 顯著的增加至10.59%，增幅率達81.33% 以上 (p ＜ 0.001)。抗精神病藥物使用，隨年齡增長呈顯著線性增加。結論：兒童與青少年抗精神病藥物使用率的上昇台灣與歐、美各國均為一普遍趨勢，然其使用是否符合臨床使用之適應症以及是否有實證醫學之支持，仍需要更多臨床研究，以期在臨床使用中兼顧藥物療效與安全，同時增進兒童與青少年之身心健康。

1. Huang, SS(2013).The prescriptions of antipsychotic poly- pharmacy and antiparkinson drugs have been changed in psychiatric practice.Taiwanese Journal of Psychiatry,27,263-266.
   連結：
2. Warren, CR,Serrato, JJ,Maguire, GA(2012).Off-label uses of second-generation antipsychotic drugs.Taiwanese Journal of Psychiatry,26,162-176.
   連結：
3. Almandil, NB,Wong, IC(2011).Review on the current use of antipsychotic drugs in children and adolescents.Arch Dis Child Educ Pract Ed,96,192-196.
4. Argo, TR,Carnahan, RM,Perry, PJ(2004).Aripiprazole, a novel atypical antipsychotic drug.Pharmacotherapy,24,212-228.
5. Bridget, M(2010).Studies shed light on risks and trends in pediatric antipsychotic.JAMA,303,1901-1903.
6. Casey, DE(1991).Neuroleptic drug-induced extrapyramidal syndromes and tardive dyskinesia.Schizophr Res,4,109-120.
7. Correll, CU,Kratochvil, CJ,March, JS(2011).Developments in pediatric psychopharmacology: focus on stimu- lants, antidepressants and antipsychotics.J Clin Psychiatry,72,655-670.
8. Gersing, K,Burchett, B,March, J(2007).Predicting an- tipsychotic use in children.Psychopharmacol Bull,40,116-124.
9. Harrison, JN,Cluxton-Keller, F(2012).Gross Antipsychotic medication prescribing trends in chil- dren and adolescents.J Pediatr Health Care,26,139-145.
10. Hert, MD,Dobbelaere, M,Sheridan, EM(2011).Metabolic and endocrine adverse effects of second- generation antipsychotics in children and adoles- cents: a systematic review of randomized, placebo controlled trials and guidelines for clinical practice.Eur Psychiatry,26,144-158.
11. Janicak, PG,Davis, JM,Preskorn, SH(1993).Principles and Practice of Psychopharmacotherapy.Baltimore:Williams & Wilkins.
12. Jerrell, JM,McIntyre, RS(2008).Adverse events in children and adolescents treated with antipsychotic medica- tions.Hum Psychopharmacol,23,283-290.
13. Kalverdijk, LJ,Tobi, H,van den Berg, PB(2008).Use of antipsychotic drugs among Dutch youths between 1997 and 2005.Psychiatr Serv,59,554-560.
14. Kupfer, DJ,Sartorius, N(2002).The usefulness and use of second-generation antipsychotic medications.Curr Opin Psychiatry,15,1-51.
15. Maršanić, VB,Dodig-Ćurković, K,Juretić, Z(2012).Outpatient treatment of children and adolescents with antipsychotic drugs in Croatia.Nord J Psychiatry,66,2-7.
16. Martin, A,Leslie, D(2003).Trends in psychotropic medica- tion costs for children and adolescents, 1997-2000.Arch Pediatr Adolesc Med,157,997-1004.
17. McConville, BJ,Sorter, MT(2004).Treatment challenges and safety considerations for antipsychotic use in children and adolescents with psychoses.J Clin Psychiatry,65,20-29.
18. Merritt, RJ(1982).Obesity.Curr Probl Pediatr,12,1-58.
19. Olfson, M,Blanco, C,Liu, L(2006).National trends in the outpatient treatment of children and adolescents with antipsychotic drugs.Arch Gen Psychiatry,63,679-685.
20. Olfson, M,Blanco, C,Liu, SM(2012).National trends in the office-based treatment of children, adolescents, and adults with antipsychotics.Arch Gen Psychiatry,69,1247-1256.
21. Olfson, M,Crystal, S,Huang, C(2010).Trends in anti- psychotic drug use by very young, privately insured children.J Am Acad Child Adolesc Psychiatry,49,13-23.
22. Panagiotopoulos, C,Ronsley, R,Elbe, D(2010).First do no harm: promoting an evidence-based approach to atypical antipsychotic use in children and adoles- cents.J Can Acad Child Adolesc Psychiatry,19,124-137.
23. Patel, NC,Crismon, ML,Hoagwood, K(2005).Trends in the use of typical and atypical antipsychotics in children and adolescents.J Am Acad Child Adolesc Psychiatry,44,548-556.
24. Patel, NC,Crismon, ML,Shafer, A(2006).Diagnoses and an- tipsychotic treatment among youths in a public men- tal health system.Ann Pharmacother,40,205-211.
25. Seida, JC,Schouten, JR,Boylan, K(2012).Antipsychotics for children and young adults: a com- parative effectiveness review.Pediatrics,129,771-784.
26. Seida, Jennifer C.,Janine R(2012).Antipsychotics for children and young adults: a comparative effective- ness review.Pediatrics,129,771-784.
27. Vitiello, B,Correll, C,van Zwieten-Boot, B(2009).Antipsychotics in children and adolescents: increas- ing use, evidence for efficacy and safety concerns.Eur Neuropsychopharmacol,19,629-635.
28. Zito, JM,Safer, DJ,DosReis, S(2003).Psychotropic practice patterns for youth: a 10-year perspective.Arch Pediatr Adolesc Med,157,17-25.

1. Shu-Wen Cheng,Hung-Yu Chan,Hsiao-Ju Sun(2021)。Prescription Patterns and Trends of Anxiolytics and Hypnotics/Sedatives among Child and Adolescent Patients with Psychiatric Illnesses in a Psychiatric Center of Northern Taiwan。臺灣精神醫學，35(2)，82-89。