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zoom RSS 小児への向精神薬使用量の増加

<<   作成日時 : 2008/05/05 02:28   >>

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 英国の子どもに対しますます多くの未認可の向精神薬が処方されている。多動から自閉症までいろいろな症状に対して使用されている。しかし、子どもへの使用に対して長期の安全性は確立していない。数はまだ少ないが、1992-2005年でみると、18才未満1,000人当たり 0.39-0.77とほぼ倍増している。特に7-12才に対しては3倍に大幅に増加している。
 短期試験では、risperidoneなどの薬が、自閉症といくつかの行動異常の子供を静めることにおいて非常に効果的であるかもしれないことを示唆している。しかし、15歳以下の使用には注意が必要である。発達している脳への長期的影響についてはわかっていない。
 成人に対しての認可がなされたが、統合失調症を除いて、小児に対する臨床試験が不足している。発達脳以外にも循環器系への影響も不明である。投薬中に死亡した子どもについて薬剤との直接の関係は示されたわけではないが、重大な潜在的条件となっている可能性は残っている。米国での爆発的な処方量の増大に続いて英国でも使用量が増加している。2才の子どもにADHDといった診断にて向精神薬の処方がされている報告がある。
 Cardiff大のDavid Healy教授は、子どもへの使用には細心の注意が必要であり、本当に必要であることは稀であるという。心臓血管と呼吸器の系に問題が出る可能性があり、体重増加はよく見られ糖尿病のリスクを増大させる。
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Page last updated at 09:24 GMT, Monday, 7 April 2008 10:24 UK
Fear over child tranquilliser use
http://news.bbc.co.uk/2/hi/health/7334067.stm

画像Pills
The drugs have not been fully tested in children

Increasing numbers of UK children are being prescribed unlicensed anti-psychotic drugs, research suggests.

The drugs are used to treat a range of conditions, from hyperactivity to autism, the study, to be published in Pediatrics found.
But the long-term safety of using them for children has not been established.
The numbers remain small, but grew from 0.39 per 1,000 under-18s in 1992 to 0.77 per 1,000 in 2005.
The largest increase was seen among the seven to 12 age group.

We do not know the long-term consequences - especially their impact on a young, developing brain
Professor Ian Wong
London School of Pharmacy

A number of short trials have suggested that drugs such as ripseridone for instance can be very effective in calming children with autism and some behavioural problems.
But experts have said it must be used with caution among the under 15s.
"There is no doubt these drugs can be very effective," says Professor Ian Wong of the London School of Pharmacy, who caried out the research.
"But we do not know the long-term consequences - especially their impact on a young, developing brain.
"Parents should not rush to take their child off the medication if it is working, but they should talk to regularly to a specialist and make sure there are frequent reviews."
Doctor's call
While these drugs are licensed for adults, there has been a lack of clinical trials to back up their use in children except for certain conditions such as schizophrenia.
This means that doctors can precribe them, but do so on their own responsibility.
Some experts have suggested that in addition to impacting upon a child's growing brain, there may also be implications for the cardiovascular system.
Professor Wong said while there were children who died while on the drugs, there was nothing to suggest that their deaths were caused by the medication itself.
"It is much more likely to be a serious underlying condition, of which the behavioural problems the drug treats are merely a symptom," he said.
The increasing use of the drugs in this country follows a huge rise in prescriptions in the US.
There, children as young as two are reportedly being diagnosed with conditions such as Attention Deficit Hyperactivity Disorder (ADHD) and prescribed such anti-psychotic drugs accordingly.
Professor Wong, whose research is due to be published next month, said while the UK did increasingly seem to be going down the same path as the US, he had yet to come across a single incident of an under four being placed on the drugs.
Professor David Healy, an expert in psychological medicine at Cardiff University said anti-psychotic drugs should only be used on children with extreme caution and very irregularly. He said it was rare that they were really necessary.
He said they had been shown to interefere with both the cardiovascular and respiratory systems. In addition, weight gain was a common side effect, raising the risk of diabetes.
Professor Healy said: "There is no end to the problems drugs can cause so we really need to restrict the conditions which people should get them for so that the risks are warranted."
The Medicines and Healthcare products Regulatory Agency (MHRA) said it was down to individual prescribers to decide whether the drugs would benefit a patient.
But a spokeswoman said drugs were monitored closely for adverse reactions.

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Published online May 1, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. 1002-1009 (doi:10.1542/peds.2007-2008)

ARTICLE
Epidemiologic Features of Antipsychotic Prescribing to Children and Adolescents in Primary Care in the United Kingdom
Fariz Rani, BPharma,b, Macey L. Murray, BSca,b,c, Patrick J. Byrne, FRCPsychd,e and Ian C. K. Wong, PhDa,b

a Centre for Paediatric Pharmacy Research, School of Pharmacy, University of London, London, England
b Institute of Child Health, University College London, London, England
c Task-force of European Drug Development for the Young (TEDDY)
d Department of Adolescent Psychiatry, Bethlem Royal Hospital, South London, England
e Maudsley National Health Service Trust, Beckenham, England

OBJECTIVE. The goal was to investigate the epidemiologic features of antipsychotic prescribing to children and adolescents in general practice in the United Kingdom.

METHODS. A total of 384 participating general practices from the United Kingdom General Practice Research Database were used to identify patients 0 to 18 years of age who were prescribed ≥1 antipsychotic medication between January 1, 1992, and December 31, 2005. Annual age-specific prevalences and incidences of antipsychotic prescribing were calculated.

RESULTS. The overall prevalence of use of all antipsychotics increased from 1992 (0.39 users per 1000 patient-years) to 2005 (0.77 users per 1000 patient-years). The prescribing prevalence for patients 7 to 12 years of age almost tripled between 1992 (0.23 users per 1000 patient-years) and 2005 (0.61 users per 1000 patient-years). Atypical antipsychotic prescribing increased 60-fold from 1994 (0.01 users per 1000 patient-years) to 2005 (0.61 users per 1000 patient-years). However, typical antipsychotic prescribing decreased significantly from 2000 (0.44 users per 1000 patient-years) to 2005 (0.18 users per 1000 patient-years). The incidences for typical and atypical antipsychotics showed trends similar to those of the respective prevalences. However, the overall incidence (number of new starters) for all antipsychotics was relatively stable between 1992 and 2005, which suggests that patients remain on treatment longer.

CONCLUSIONS. The overall prevalence of antipsychotics almost doubled between 1992 and 2005; however, the rate of increase was much lower than the reported figures in the United States. The prescribing of atypical antipsychotic drugs has increased despite the lack of conclusive evidence showing their superiority over older conventional antipsychotics. Additional investigation is required to evaluate their efficacy and safety in children and adolescents.

Key Words: drug utilization • pharmacoepidemiology • pediatric • antipsychotics

Abbreviations: GPRD―General Practice Research Database • CI―confidence interval

Accepted Sep 17, 2007.

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