Clinical predictors of antipsychotic use in children and adolescents with autism spectrum disorders: a historical open cohort study using electronic health recordsReportar como inadecuado




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European Child and Adolescent Psychiatry

, Volume 25, Issue 6, pp 649–658

First Online: 15 October 2015Received: 01 May 2015Accepted: 28 September 2015

Abstract

Children with autism spectrum disorders ASD are more likely to receive antipsychotics than any other psychopharmacological medication, yet the psychiatric disorders and symptoms associated with treatment are unclear. We aimed to determine the predictors of antipsychotic use in children with ASD receiving psychiatric care. The sample consisted of 3482 children aged 3–17 with an ICD-10 diagnosis of ASD referred to mental health services between 2008 and 2013. Antipsychotic use outcome, comorbid diagnoses, and other clinical covariates, including challenging behaviours were extracted from anonymised patient records. Of the 3482 children 79 % male with ASD, 348 10 % received antipsychotic medication. The fully adjusted model indicated that comorbid diagnoses including hyperkinetic OR 1.44, 95 %CI 1.01–2.06, psychotic 5.71, 3.3–10.6, depressive 2.36, 1.37–4.09, obsessive–compulsive 2.31, 1.16–4.61 and tic disorders 2.76, 1.09–6.95 were associated with antipsychotic use. In addition, clinician-rated levels of aggression, self-injurious behaviours, reduced adaptive function, and overall parental concern for their child’s presenting symptoms were significant risk factors for later antipsychotic use. In ASD, a number of comorbid psychiatric disorders are independent predictors for antipsychotic treatment, even after adjustment for familial, socio-demographic and individual factors. As current trial evidence excludes children with comorbidity, more pragmatic randomised controlled trials with long-term drug monitoring are needed.

KeywordsChild and adolescence Autism spectrum disorders Antipsychotic medications Psychiatric comorbidity Challenging behaviours Electronic supplementary materialThe online version of this article doi:10.1007-s00787-015-0780-7 contains supplementary material, which is available to authorized users.

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Autor: Johnny Downs - Matthew Hotopf - Tamsin Ford - Emily Simonoff - Richard G. Jackson - Hitesh Shetty - Robert Stewart - Richa

Fuente: https://link.springer.com/







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