L’usage hors indication des médicaments en pédopsychiatrie : un phénomène d’une ampleur insoupçonnée
Bibliographic record
Abstract
Resume Objectif : Realiser la premiere etude canadienne evaluant l’usage hors indication des medicaments a visee psychiatrique aupres d’une clientele hospitalisee en pedopsychiatrie. Mise en contexte : Les patients de pedopsychiatrie sont vulnerables. Comme en psychiatrie adulte, ils sont touches par lesdifficultes d’acces geographique aux soins et specifiquement par le developpement inequitable des connaissances issues de la recherche donnant acces aux nouveaux medicaments. Resultats : Le taux de prescriptions hors indication etait de 83 % pour les 872 prescriptions s’appliquant aux 210 enfants de moins de 18 ans admis a l’Hopital Riviere-des-Prairies (HRDP) du 1er avril 2012 au 31 mars 2013. Cent pour cent des prescriptions d’anticonvulsivants, d’antidepresseurs, d’anxiolytiques / de sedatifs / d’hypnotiques et 99 % d’antipsychotiques etaient hors indication. Le taux n’etait que de 14 % pour les antihistaminiques et de 5 % pour les psychostimulants. Le taux diminuerait a 47 % si les patients etaient adultes et il serait de 48 % si les indications approuvees aux Etats-Unis etaient aussi reconnues au Canada. Discussion : La reglementation canadienne n’a pas reussi a inciter l’industrie a demander des indications en pedopsychiatrie pour refleter la realite clinique de cette population. Pour le pharmacien, cela complexifie l’evaluation du rapport risques/avantages des medicaments prescrits. Conclusion : Le pharmacien peut influer sur la volonte politique de modifier la reglementation s’il rapporte de maniere transparente l’ampleur du phenomene. Il doit exercer une vigilance vis-a-vis de la declaration d’effets indesirables, car les resultats d’etudes realisees aupres des adultes ne peuvent etre extrapoles pour l’enfant. Abstract Background: Child psychiatric patients are vulnerable. Like adult psychiatric patients, they are impacted by the unequal development of knowledge from research giving access to new drugs. Objective: To evaluate the off-label use of psychiatric drugs in hospitalized child psychiatric patients. Results: A number of 872 prescriptions were evaluated for off-label prescriptions in 210 children admitted to the Hopital Riviere-des-Prairies (HRDP) from April 1, 2012 to March 31, 2013. Off-label prescription rate was 83%. One hundred percent of the prescriptions for anticonvulsants, antidepressants, anxiolytics/sedatives/hypnotics and 99% of those for antipsychotics were off-label. The rate was only 14% for antihistamines and 5% for psychostimulants. The rate would decrease to 47% if the patients were adults and would be 48% if the indications approved in the United States were recognized in Canada as well. Discussion: Canadian regulations have not succeeded in spurring the industry to request child psychiatric indications to reflect the clinical reality of this population. For the pharmacist, this makes weighing the risks and benefits of the prescribed drugs more complicated. Conclusion: Pharmacists can influence the political will to amend the regulations if they report the extent of the phenomenon in a transparent fashion. They should exercise vigilance with regard to the reporting of adverse effects, since the results of studies involving adults cannot be extrapolated to children.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".