Psychotropic medication use among adolescents participating in three randomized trials of DBT.

Lars Mehlum, Joan Asarnow, Sudan Prasad Neupane, Pilar Santamarina-Perez, Mireia Primé-Tous, Gabrielle A Carlson
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Abstract

Background: Frequently presenting with symptoms of mood or anxiety disorders, substance abuse or borderline personality disorder, suicidal and self-harming adolescents often are prescribed psychotropic medication. Though such treatment may be warranted, recurrent suicidal and self-harming behaviour is often linked to emotion dysregulation where pharmacological treatment has weak empirical support. There is a need for more clinical research into the frequency, type and rationale for pharmacological treatment in this group. In this secondary analysis of three randomized clinical trials of dialectical behaviour therapy for adolescents, we report on psychotropic medication use in the respective samples at the time of recruitment, compare use of psychotropic medication across trials and describe sample characteristics that may be associated with possible differences in psychotropic medication.

Findings: Trials were conducted in Norway, the US and Spain (labelled the Oslo, US and Barcelona samples). At baseline, 86% of the Barcelona sample, 67% of the US sample and 12% of the Oslo sample were taking at least one psychotropic medication with antidepressants as the most frequent, followed by antipsychotics (72%, 22% and 1.3% respectively) and mood stabilizers (14.2%, 16.2% and 0%). In the Oslo sample there was a significant association between receiving a diagnosis of major depression and the likelihood of receiving antidepressants, but no such association was found in the Barcelona and US samples. The overall 7-8 times higher proportion of participants in the US and Barcelona samples treated with psychotropic medication could only partially be explained by differences between the samples in diagnostic profiles, symptom severity or level of dysfunction.

Conclusions: Highly prevalent in use among suicidal and self-harming adolescents with borderline features, psychotropic medication was still very unevenly prescribed across trials, differences not explained by differences in sample characteristics suggesting that current treatment practices are not fully empirically supported. We call for continued medical education and increased availability of evidence-based psychosocial interventions.

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参与 DBT 三项随机试验的青少年使用精神药物的情况。
背景:有自杀和自残倾向的青少年通常伴有情绪障碍或焦虑症、药物滥用或边缘型人格障碍等症状,通常会被处以精神药物治疗。虽然这种治疗可能是有必要的,但反复出现的自杀和自残行为往往与情绪失调有关,而药物治疗在这方面的经验支持并不充分。需要对这一群体进行更多的临床研究,以了解药物治疗的频率、类型和合理性。在对三项针对青少年的辩证行为疗法随机临床试验的二次分析中,我们报告了招募时各自样本中精神药物的使用情况,比较了不同试验中精神药物的使用情况,并描述了可能与精神药物差异有关的样本特征:试验在挪威、美国和西班牙进行(分别称为奥斯陆样本、美国样本和巴塞罗那样本)。在基线期,86%的巴塞罗那样本、67%的美国样本和12%的奥斯陆样本至少服用一种精神药物,其中最常服用的是抗抑郁药,其次是抗精神病药(分别为72%、22%和1.3%)和情绪稳定剂(分别为14.2%、16.2%和0%)。在奥斯陆样本中,接受重度抑郁症诊断与接受抗抑郁药物治疗的可能性之间存在显著关联,但在巴塞罗那和美国样本中没有发现这种关联。在美国和巴塞罗那样本中,接受精神药物治疗的参与者比例总体上高出 7-8 倍,这只能部分归因于样本之间在诊断概况、症状严重程度或功能障碍程度方面的差异:有自杀倾向和自残倾向的边缘型青少年中,精神药物的使用非常普遍,但在不同的试验中,精神药物的处方仍然很不均衡,样本特征的差异无法解释这种差异,这表明目前的治疗方法并没有得到充分的经验支持。我们呼吁继续开展医学教育,并提供更多循证心理干预措施。
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来源期刊
CiteScore
6.00
自引率
9.80%
发文量
30
审稿时长
28 weeks
期刊介绍: Borderline Personality Disorder and Emotion Dysregulation provides a platform for researchers and clinicians interested in borderline personality disorder (BPD) as a currently highly challenging psychiatric disorder. Emotion dysregulation is at the core of BPD but also stands on its own as a major pathological component of the underlying neurobiology of various other psychiatric disorders. The journal focuses on the psychological, social and neurobiological aspects of emotion dysregulation as well as epidemiology, phenomenology, pathophysiology, treatment, neurobiology, genetics, and animal models of BPD.
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