RESUMEN
OBJECTIVE: To evaluate the prevalence, trends, and factors associated with psychotropic medication use and polypharmacy among children and adolescents initiating intensive behavioral therapy for severe challenging behavior over a 10-year period. STUDY DESIGN: In this retrospective observational study, we examined data from caregiver interviews and patient medical records on the number and types of psychotropic medications prescribed to patients initiating intensive behavioral therapy between January 1, 2013, and December 31, 2022. Trends in medication use and polypharmacy across the 10-year period were analyzed using regression analysis, while differences in demographics and clinical factors for patients with use and polypharmacy were analyzed using nonparametric statistical analysis with odds ratios presented for significant factors. RESULTS: Data from all 302 pediatric patients initiating intensive behavioral therapy across the 10-year period were analyzed. Among all patients and all years, 83.8% were taking at least 1 psychotropic medication and 68.2% experienced polypharmacy. There were no changes in the prevalence of use, mean number of medications taken, or polypharmacy across the 10-year period. Patients diagnosed with attention-deficit/hyperactivity disorder or anxiety disorder, as well as those exhibiting self-injurious behavior had higher use of psychotropic medication and polypharmacy and were taking more medications overall. CONCLUSIONS: Psychotropic medication use and polypharmacy were extremely high for children and adolescents with severe challenging behavior, but use and polypharmacy did not change over the 10-year period of data collection. Further research is needed to establish the generality of these findings to other regions of the US.
Asunto(s)
Terapia Conductista , Polifarmacia , Psicotrópicos , Humanos , Femenino , Masculino , Niño , Psicotrópicos/uso terapéutico , Estudios Retrospectivos , Adolescente , Terapia Conductista/métodos , Problema de Conducta , Preescolar , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológicoRESUMEN
INTRODUCTION: Few evidence on the use of antipsychotics in people with intellectual disabilities and challenging behaviors, generates the need to develop studies that contribute to collect, compare and synthesize the available information. The present systematic review and meta-analysis aims to determine the clinical efficacy of antipsychotic medication in reducing critical episodes in this population. METHODS: We searched Web of Science, Scopus, EBSCO, Embase, and PubMed for randomized controlled trials of antipsychotic medication versus placebo. Preliminarily yielded 1354 abstracts and citations; six studies with 274 subjects met the inclusion criteria of studies with experimental design, longitudinal type, with pre- and post-intervention measurements. RESULTS: There is evidence for the use of psychotropic drugs in the acute management of challenging behaviors in patients with intellectual disability (SMD=-0.85; 95% CI=-1.69 to -0.01; p=0.05). CONCLUSIONS: Our results coincide with the recommendations on the efficacy of the use of antipsychotics. Although our study provides evidence, the limited number of studies included in this research does not allow us to obtain totally conclusive results, although it can be considered as a guide for future studies.
RESUMEN
El propósito de este artículo está centrado en dar a conocer los avatares, es decir, las situaciones o vicisitudes contrarias o, que se presentan en la intervención psicológica de los trastornos disruptivos en niños y niñas, tarea que se lleva a cabo a través de una revisión desde la literatura científica que da cuenta de los tratamientos utilizados, de la adquisición de conductas adecuadas y eliminación de conductas inadecuadas como resultados obtenidos en el tratamiento que recibe el infante cuando padece un trastorno disruptivo.
The purpose of this article is focused on making known the avatars, that is, the situations or vicissitudes opposite or, that occur in the psychological intervention of disruptive disorders in boys and girls, a task that is carried out through a review from the scientific literature that accounts for the treatments used, the acquisition of appropriate behaviors and elimination of inappropriate behaviors as results obtained in the treatment received by the infant when he suffers from a disruptive disorder.