托莫西汀治疗小儿注意缺陷多动障碍合并焦虑的疗效分析

目的研究托莫西汀治疗小儿注意缺陷多动障碍(ADHD)并焦虑障碍的临床疗效。方法随机选取2015年1月~2016年1月于我院就诊的ADHD并焦虑患儿92例,随机均分为观察组(n=46)与对照组(n=46),观察组患儿接受托莫西汀治疗,对照组患儿接受哌甲酯治疗,对比两组患儿的临床疗效与安全性。结果治疗前,两组患儿的ADHD评定量表和儿童焦虑性情绪筛查量表(SCARED)评分,组间对比差异不显著(P0.05);治疗后,两组患者的上述两个量表评分均显著低于治疗前(P0.05);且观察组患儿的评分低于对照组(P0.05);治疗后,观察组不良反应发生率低于对照组(P0.05)。结论托莫西汀治疗小儿注意力缺陷多动障碍并焦虑,能够有效缓解患儿的ADHD症状,降低患儿的焦虑程度,且不良反应发生率较低,值得在临床上推广使用。     

盐酸托莫西汀对注意缺陷多动障碍儿童行为特征的影响

目的:探讨托莫西汀能否改善注意缺陷多动障碍(ADHD)患儿的行为问题.方法:评价65例ADHD患儿(男56例,女9例)在托莫西汀治疗前及治疗4周、8周的行为问题.使用Conners父母症状问卷(PSQ)及长处与困难问卷(SDQ)进行评定.结果:与治疗前相比,PSQ中冲动多动因子及多动指数在治疗第4周及第8周后均有明显改...     

重复经颅磁刺激联合托莫西汀治疗注意缺陷多动障碍患者的临床对照研究

目的:比较重复经颅磁刺激(rTMS)、托莫西汀(ATX)以及两者联合治疗注意缺陷多动障碍(ADHD)的效果。方法:64例ADHD患者随机分为rTMS组、ATX组、rTMS+ATX联合组,分别给予相应的治疗,疗程6周。分别在治疗前后应用SNAP-IV问卷评估临床症状;应用持续操作测验(CPT)、韦氏儿童智力测验(WISC)中算术、数字广度和编码测验、爱荷华赌博任务(IGT)评估执行功能。结果:60例患者完成6周疗程。治疗后3组SNAP-IV问卷的各因子分均较治疗前显著降低(P均0.01);且联合组注意缺陷因子及多动冲动因子评分明显低于rTMS组及ATX组(P均0.05);但对立违抗因子评分3组间差异无统计学意义。3组执行功能测验成绩较治疗前明显提高(P0.05或P0.01);联合组在算术、顺背、编码及IGT成绩明显好于rTMS组和ATX组(P均0.05);ATX组编码及IGT成绩明显好于rTMS组(P均0.05)。结论:rTMS、ATX及两者联合均可显著改善ADHD患者核心症状及执行功能;rTMS联合ATX效果更佳。     

拉莫三嗪治疗儿童癫痫合并注意障碍伴多动的自身对照研究

目的探讨拉莫三嗪对儿童癫痫合并注意障碍伴多动的治疗效果。方法对拉莫三嗪(LTG)治疗癫痫合并注意障碍伴多动(ADHD)的患儿进行开放性自身对照临床试验,治疗期为1~2年。结果ADHD症状好转者9例,有效率为75%;癫痫发作频度减少≥50%,10例(83%),EEG好转率为75%。结论LTG治疗儿童癫痫合并ADHD是有效的。     

惠州市小学生注意力缺陷多动障碍流行病学调查与矫治干预模式研究

目的调查惠州市小学生注意力缺陷多动障碍(ADHD)的发病特点和流行病学特征,并探究矫治干预模式对患儿的治疗效果。方法对惠州市5所小学6～12岁的小学生进行整体的抽样调查,7 259例学生为本次调查对象。通过SNAP-Ⅳ家长评定量表对上述儿童家长进行问卷调查,对调查结果经专科医师采取DSM-Ⅳ诊断标准进行确诊。将确诊为ADHD的患儿随机分为2组,观察组采取矫治干预模式治疗,对照组患儿采取一般治疗措施。结果男性ADHD发病率10.55%,明显高于女性的3.61%,ADHD在8～10岁儿童中的发病率最高(7.01%);ADHD女性患儿中学习问题的检出率83.08%,明显高于男性;观察组和对照组的总有效率分别为82.98%、56.60%,差异有统计学意义(P<0.05)。结论 ADHD的发病率男孩高于女孩,且在8～10岁儿童中的发病率最高,矫治干预能有效提高ADHD的临床疗效。     

成年起病的发作性睡病一例

发作性睡病(narcolepsy)是一种伴随终生、非进行性加重的睡眠疾患,发病率0.03%～0.16%~[1],发病年龄15～25岁,成年发病少见.我们诊断成年起病的发作性睡病1例,并使用盐酸托莫西汀成功治疗,现报道如下.     

成人注意缺陷与多动障碍的治疗概况

注意缺陷与多动障碍（attention deficit hyperactivity disor-der，ADHD）是儿童和青少年最常见的精神障碍，主要表现特点是注意分散，活动过度和冲动行为。Wood等于1976年首次报道了成人ADHD。美国大约3％-5％的儿童和4％～5％的成人患有ADHD，最近长程研究表明儿童时患ADHD有50％～70％持续至成年期，但接受治疗的远比儿童ADHD少。根据DSM-Ⅳ诊断成人ADHD的要点有三：①儿童期起病；②具有特征性的临床表现，须满足注意分散、多动与冲动等9条主要症状的6条：③症状造成的社会功能损害。目前关于儿童ADHD报道较多，而对成人罹患此症的研究还很有限。为此，本文就成人ADHD治疗方面的情况进行如下综述。     

抽动秽语综合征共患注意缺陷多动障碍的 临床特征分析

目的 调查影响抽动秽语综合征（TS）共患注意缺陷多动障碍（ADHD）患者的临床特征。 方法 本研究包括回顾性研究和横断面调查研究两部分，回顾2005—2007 年在北京安定医院就诊并登 记入库的TS 患者的人口学资料和病例特征，并对TS 患者及家长进行横断面调查研究；由临床医生对患 者进行简明儿童少年神经精神访谈问卷（MINI-Kid）、DSM-5 诊断评估以及斯诺佩评估量表（SNAP- Ⅳ）评 估，由家长完成Conners父母症状问卷评估，由患者本人完成Conners自评量表和儿童自我意识量表评 估，并由临床医生对患者采用耶鲁布朗大体抽动严重程度量表（YGTSS）进行抽动症状严重程度评估并 记录其是否规律治疗TS，以及是否服用治疗ADHD药物。结果 221例患者纳入分析，其中138例（62.4%） 为TS 共患ADHD 患者，TS 共患ADHD组患者在围产期不良事件、发病年龄、首次诊断年龄、首次治疗年 龄、是否规律治疗及精神疾病家族史方面与TS 未共患ADHD 组差异有统计学意义，其症状严重程度与 围产期不良事件、是否规律治疗、是否接受ADHD 药物治疗及精神疾病家族史有关。明显症状组患者 接受ADHD 治疗比例低于轻微症状组。结论 TS 共患ADHD 治疗效果与围产期不良事件、是否规律治 疗、是否接受ADHD治疗以及精神疾病家族史有关。     

家长培训对注意缺陷多动障碍儿童的干预

目的探讨家长培训对注意缺陷多动障碍(ADHD)儿童的干预效果。方法将30例符合DSM-Ⅳ诊断标准的ADHD患儿作为干预组,进行为期8周的家长培训;30例符合DSM-Ⅳ诊断标准的ADHD患儿作为对照组,不给予任何干预措施。干预前评诂Connem父母症状问卷(PSQ),干预8周后再次评诂Conners父母症状问卷、临床疗效总评和培训满意度调查问卷。结果干预组的PSQ各项因子分干预后比干预前均有下降,品行问题、学习问题、多动指数因子分改变有统计学显著性差异。主观评价家长认为培训方式容易接受、培训内容有帮助。结论家长培训对ADHD儿童干预效果较好,药物治疗结合家长培训可以增加干预效果,家长培训方式容易接受,方法值得推广。     

脑电生物反馈治疗注意缺陷多动障碍疗效分析

目的评价脑电生物反馈治疗儿童注意缺陷多动障碍的疗效。方法对2008-03~2010-03在郑州市儿童医院心理科确诊注意缺陷多动障碍的36例儿童采用脑电生物反馈治疗40次,治疗前后分别进行视听整合连续执行测试,对比综合尺度控制商数、综合尺度注意力商数、多动商数,且治疗前后进行Conners简明症状问卷对比。同期在我科确诊ADHD但未接受任何治疗的30例ADHD儿童为对照组,研究组接受40次脑电生物反馈治疗后与对照组进行视听整合连续执行测试及Conners简明症状问卷对比。结果 36例ADHD儿童经脑电生物反馈治疗40次后,各项观察指标均有明显改善,经统计学处理,差异有统计学意义。且研究组与对照组对比,各项观察指标差异均有统计学意义。结论脑电生物反馈治疗是ADHD综合治疗中一种有效的治疗方法,值得临床推广。     

An open-label trial of tomoxetine in pediatric attention deficit hyperactivity disorder.

OBJECTIVE: To collect pilot data assessing the safety, tolerability, and efficacy of tomoxetine, a nonstimulant norepinephrine enhancer, in pediatric attention deficit hyperactivity disorder (ADHD). METHODS: An open-label trial of tomoxetine in pediatric ADHD was conducted as part of a multisite clinical trial. Following a baseline assessment, an ascending dose titration was completed during 10 weekly visits. RESULTS: Ten subjects were enrolled at baseline, with eight completing the study. Seven of the eight remaining subjects met efficacy criteria. Significant decreases in symptom severity ratings by parents and study investigators were found. The medication was well tolerated, with transient appetite suppression the most frequently reported side effect. However, subjects' weights remained stable across study visits. DISCUSSION: These preliminary findings suggest that tomoxetine may hold promise as a treatment for pediatric ADHD.     

Non-stimulant treatments for ADHD

We reviewed the literature of medication trials in ADHD to evaluate the scope of the available non-stimulant treatments. A variety of compounds with a common noradrenergic/ dopaminergic activity have shown documented anti-ADHD activity. There is a substantial body of literature documenting the efficacy of tricyclic antidepressants on ADHD in over 1,000 subjects. In addition, the atypical antidepressant bupropion and the novel noradrenergic specific antidepressant tomoxetine have also been documented to be effective in the treatment of ADHD in controlled clinical trials. Despite wide use, the scientific base supporting the efficacy of alpha-2, noradrenergic agonists continues to be limited. Several lines of evidence provide preliminary support for the potential benefits of cholinergic cognitive enhancing drugs in such as anticholinesterase inhibitors (tacrine, donepezil) as well as novel nicotinic analogues (ABT-418). Despite these promising results, more research is needed on alternative pharmacologic treatments for the treatment of ADHD.

     

The impact of attention deficit/hyperactivity disorder (ADHD) in mothers on the treatment of their ADHD children--review and summary of the study protocol of a randomized controlled multi-centre trial on parent training

Given its high heritability, ADHD frequently affects both children and their parents. In addition to co-morbid psychiatric disorders, adults with ADHD often complain of psychosocial difficulties, including family conflicts and poor parenting skills. Inconsistent childrearing practices and parent-child conflicts negatively affect the course of ADHD in children. Moreover, in the case of parental ADHD, the efficacy of parent training as part of the treatment for the child's ADHD seems to be reduced. This article presents a review of the impact of ADHD in mothers on the treatment of their ADHD children. Subsequently, the study protocol of a randomized controlled multi-centre trial to resolve the question of the efficacy of combined treatment of mothers and children is outlined. The main objective of the study is to evaluate whether the treatment of maternal ADHD enhances the efficacy of subsequent parent training as part of the treatment of ADHD in their children. 144 mother-child-pairs (both affected by ADHD according to DSM-IV criteria) are allocated to the trial. Mothers are randomized either to the treatment group (cognitive-behavioural group psychotherapy in combination with open methylphenidate treatment (Medikinet retard) titrated upward individually until the maximum dose of 1.3 mg/kg/day) or to the control group (supportive counselling). After 13 weeks of treatment individualised parent training is administered to both groups of mothers. Treatment comparisons of the primary endpoint (externalizing symptoms in the children) will be performed within a linear regression model.     

Retrospective comparison of Adderall and methylphenidate in the treatment of attention deficit hyperactivity disorder

Methylphenidate is the most frequently prescribed stimulant medication for the treatment of attention deficit hyperactivity disorder (ADHD). However, the short duration of action of methylphenidate requires that patients take multiple daily doses for optimal efficacy. Recent studies suggest that Adderall, a psychostimulant indicated for the treatment of ADHD, may provide an efficacious, less frequently dosed alternative to methylphenidate. This retrospective review compares the efficacy, safety, dosing frequency, and medication switch rates of Adderall with methylphenidate in children and adolescents with ADHD treated in a private, outpatient psychiatric clinic. Of the evaluable patients, 54 received Adderall, and 75 received methylphenidate. No statistically significant differences were noted between Adderall and methylphenidate in efficacy or safety parameters. Fewer patients receiving Adderall required twice daily, thrice daily, or in-school dosing than those receiving methylphenidate (p < 0.001). During the initial 6-month treatment period, patients treated with Adderall were less likely to switch medications than those receiving methylphenidate (p = 0.0002). In this analysis, Adderall and methylphenidate provided comparable efficacy and safety in children and adolescents with ADHD. The use of Adderall allowed patients to extend their dosing interval and reduced the need for in-school dosing, a measure that may substantially influence compliance.     

The Use of Psychostimulants in Pervasive Developmental Disorders

Many children with Pervasive Developmental Disorders (PDD) display problematic behaviors similar to those seen in children with Attention Deficit Hyperactivity Disorder (ADHD). This paper will look at the controversy concerning diagnosing comorbid ADHD in children who meet criteria for PDD and review the existing literature examining the efficacy of stimulants in these particular set of behaviors or symptom clusters (hyperactivity, impulsivity and inattention). The potential drawbacks of using stimulants in a population of children and adolescents who exhibit symptoms of PDD and ADHD will be discussed. Finally, this review will also attempt to define potential areas of future research to examine the utility of the psychostimulants in children and adolescents with PDD and symptoms of ADHD.     

Amfetamine and methylphenidate medications for attention-deficit/hyperactivity disorder: complementary treatment options

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among school-aged children. It is highly symptomatic and associated with significant impairment. This review examines the role of stimulant medications in the treatment of children and adolescents with ADHD. Published clinical studies that compared methylphenidate- and amfetamine-based stimulants in children and adolescents with ADHD support the therapeutic utility of stimulant treatments, and suggest robust efficacy and acceptable safety outcomes in groups treated with either stimulant. Evidence-based guidelines agree that each patient with ADHD is unique and individual treatment strategies that incorporate both drug and non-drug treatment options should be sought. In seeking to optimize individual response and outcomes to stimulant therapy, important considerations include the selection of stimulant class, the choice of long- or short-acting stimulant formulations, addressing effectively any emergent adverse effects and strategies aimed at enhancing adherence to dosing regimen and persistence on therapy.     

Evidence based therapy of children and adolescents with attention deficit/hyperactivity hyperkinetic syndrome (ADHS)

The article reviews the empirical research on the efficacy of pharmacological and psychological treatment of children and adolescents with attention deficit hyperactivity disorders (ADHD). The importance of evidence based treatment is stressed. Then the results of the internationally most important treatment study in this field, the US Multimodal Treatment Study of Children with ADHD (MTA-Study) are summarized. The study shows the efficacy of both pharmacological therapy (mainly stimulant treatment) and behaviour therapy. The combination of both interventions was not clearly superior to drug treatment plus counselling (medical management). However, Reanalyses show better effects of combined treatment. In the German speaking countries the Cologne Multimodal Interventions Study (COMIS) was conducted. Some main results of this study are summarised. Evidence based conclusions regarding the efficacy of different psychological and pharmacological interventions based on meta analyses, review articles and empirical studies are summarised.     

Antipsychotic and Psychostimulant Drug Combination Therapy in Attention Deficit/Hyperactivity and Disruptive Behavior Disorders: A Systematic Review of Efficacy and Tolerability

This systematic review examines treatment guidelines, efficacy/effectiveness, and tolerability regarding the use of antipsychotics concurrently with psychostimulants in treating aggression and hyperactivity in children and adolescents. Articles examining the concurrent use of antipsychotics and psychostimulants to treat comorbid attention deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBDs) were identified and their results were summarized and critically analyzed. Antipsychotic and stimulant combination therapy is recommended by some guidelines, but only as a third-line treatment following stimulant monotherapy and stimulants combined with behavioral interventions to treat aggression in patients with ADHD. Some studies suggest efficacy/effectiveness for an antipsychotic and stimulant combination in the treatment of aggression and hyperactivity in children and adolescents. However, the data do not clearly demonstrate superiority compared to antipsychotic or psychostimulant monotherapy. Most studies were performed over short time periods, several lacked blinding, few studies used any placebo control, and no comparisons were made with behavioral interventions. There are concerns about the tolerability of combination therapy, but data do not suggest significantly worse adverse effects for combination compared to either antipsychotic or stimulant monotherapy. Conversely, and contrary to speculation, use of a stimulant does not significantly reduce metabolic effects of antipsychotics. Combination treatment with antipsychotics and psychostimulants is used frequently, and increasingly more often. Few studies have directly examined this combination for the treatment of ADHD and DBDs. Further studies are necessary to confirm the efficacy and tolerability of the concurrent use of antipsychotics and psychostimulants in children and adolescents.     

Psychodynamic psychotherapy of ADHD: A review of the literature

Contributions of psychodynamic psychotherapy to the treatment of children with attention deficit hyperactivity disorder (ADHD) have been sparse. However, mixed results of other interventions, including behavior therapy and medication, call for a systematic examination of psychodynamic contributions to treatment of ADHD children. A systematic review of the literature on psychodynamic psychotherapy with ADHD children yielded a combination of 23 case studies, research reports, and theoretical writings. Questions relevant to the practice of psychodynamic psychotherapy were the focus and included a review of psychodynamic diagnosis of ADHD, theoretical orientations of psychodynamic psychotherapy, identification of core treatment issues, clinical examples, and theoretical perspectives on therapeutic change as well as practice techniques. A review of 231 abstracts resulted from key word searches including ADHD, Psychotherapy, Psychodynamic, and Psychoanalytic. Once inclusion criteria were met, the information from the literature was organized according to categories reflecting the review's focus. Findings of the review are provided to guide psychodynamic psychotherapists in their treatment of ADHD children. Recommendations for future individual and group studies are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Stimulant medications

OBJECTIVE: To review the short- and long-term safety and efficacy of stimulants for the treatment of children with attention-deficit/hyperactivity disorder (ADHD). METHOD: A Medline search was conducted for both randomized controlled trials and reviews to determine the efficacy and safety of stimulant drugs for treating children with ADHD. Information was obtained on adverse events associated with their use, including their impact on height and weight gain during childhood. Animal data were reviewed for information on tolerance, sensitization, and the impact of high-dose stimulant effects on neurons and on the development of hepatic tumors. Human data on dopamine transporter occupancy by stimulants were also included. RESULTS: Stimulant treatment studies show robust short-term efficacy and a good safety profile. Longer-term studies are few in number but have produced no conclusive evidence that careful therapeutic use of these medications is harmful. CONCLUSION: Current evidence indicates that stimulants show efficacy and safety in studies lasting up to 24 months.