感觉统合训练联合盐酸哌甲酯治疗儿童注意缺陷多动障碍临床疗效分析

目的探讨感觉统合训练（SIT）联合盐酸哌甲酯治疗儿童注意缺陷多动障碍（ADHD）的临床疗效。方法对2009年1月-2013年3月就诊的96例ADHD患儿的临床资料行回顾性分析,并按随机数字表分组,研究组（n=48）联合SIT及盐酸哌甲酯治疗,对照组（n=48）单用盐酸哌甲酯治疗,比较两组儿童感觉统合能力发展评定量表、视听连续整合测试（IVA-CPT）、Conner行为评定量表、韦氏儿童智力量表（C-WISC）评分及不良反应情况。结果两组ADHD患儿治疗后感觉统合评定量表各项目评分,IVA-CPT中综合反应控制商数及综合注意力商数,C-WISC中操作量表智商、言语量表智商、全量表智商及注意/不分心因子评分均较之治疗前有明显提高;Conner行为评定量表中学习、品行、身心障碍、冲动、多动指数、焦虑因子评分均有下降,治疗前后比较差异有统计学意义（P〈0.05）。研究组加行SIT后感觉统合评定量表、IVA-CPT、Conner行为评定量表、C-WISC各项评分改善均较对照组明显,且不良反应明显少,两组比较差异有统计学意义（P〈0.05）。结论对于ADHD患儿,SIT联合盐酸哌甲酯治疗,有效且安全,值得推广。     

哌甲酯对注意缺陷多动障碍儿童探究性眼动的影响

目的 探讨哌甲酯对注意缺陷多动障碍儿童探究性眼动的影响.方法 将50例注意缺陷多动障碍患儿设为研究组,抽取同期体检的38名健康少年儿童设为对照组.研究组于口服哌甲酯前后进行探究性眼动检测,对照组进行常规探究性眼动检测,对两组检测结果进行对比分析.结果 研究组口服哌甲酯2 h后凝视点数目、反应性探究分测定结果均高于治疗前(P＜0.05);服药前后凝视点数目、反应性探究分测定结果均低于对照组(P＜0.01).结论 哌甲酯能显著改善注意缺陷多动障碍患儿的视觉认知功能.     

注意缺陷多动障碍患儿盐酸哌甲酯治疗依从性影响因素的质性研究

目的:探讨影响儿童注意缺陷多动障碍盐酸哌甲酯治疗依从性的因素.方法:应用质性研究中的现象学研究方法,对2019年2月—2019年6月在医院进行盐酸哌甲酯治疗的17例依从性差的注意缺陷多动障碍患儿家长进行半结构式访谈,应用Colaizzi 7步分析法分析资料.结果:影响注意缺陷多动障碍患儿盐酸哌甲酯治疗依从性的因素归纳为3个主题:家长疾病应对能力不足、患儿主观能动性差、社会支持系统缺乏.结论:儿童注意缺陷多动障碍患儿哌甲酯治疗依从性的影响因素来自其自身及社会诸多方面,在患儿治疗过程中医护人员应采取针对性的个性化护理干预,以提高患儿治疗依从性.     

盐酸托莫西汀与盐酸哌甲酯治疗儿童注意缺陷多动障碍的对比研究

目的比较盐酸托莫西汀(ATX)与盐酸哌甲酯(MPH)治疗儿童注意缺陷多动障碍(ADHD)的临床疗效及安全性。方法 78例ADHD患儿随机分为ATX组(n=39)和MPH组(n=39),分别口服ATX及MPH治疗8周后,依照注意缺陷多动障碍筛查(SNAP-Ⅳ)量表和Conners儿童行为问卷父母用量表(PSQ)分别评估2组临床疗效及ADHD症状的严重程度,采用副反应量表(TESS)比较2组安全性。结果治疗后,2组SNAP-Ⅳ量表中各因子评分、总评分及PSQ中各因子评分均显著降低(P0.01),而2组间SNAP-Ⅳ量表中各因子评分△值均无显著差异(P0.05),PSQ中ATX组焦虑因子及冲动因子△值显著大于MPH组(P0.05),其他因子△值、2组有效率及完全缓解率无显著差异(P0.05)。MHP组不良反应发生率41.03%(16/39)显著高于ATX组20.51%(8/39)(P0.05)。结论 ATX与MPH治疗ADHD的疗效相当,但ATX不良反应少,更具安全性。     

阿托莫西汀与哌甲酯治疗儿童注意缺陷多动障碍疗效与安全性的Meta分析

目的系统评价阿托莫西汀与哌甲酯治疗儿童注意缺陷多动障碍的临床疗效。方法计算机检索Cochrane图书馆（2008年第2期）、PubMed（1970～2008）、EMbase（1971～2008）、Medscape（1990～2008）、CBM（1978～2008）、NRR（1950～2008）,手工检索已发表与未发表的资料,收集有关阿托莫西汀与哌甲酯比较治疗儿童注意缺陷多动障碍的随机对照试验（RCT）。由两名评价者独立选择试验、提取资料和评估方法学质量,采用Cochrane协作网RevMan4．2．8软件进行统计分析。结果最终纳入3个RCT,共1597例患者。Meta分析结果显示,两组ADHD—RS量表总分数、多动／冲动分量表分值及CGI—ADHD—S量表分值差异均无统计学意义,其RR（95％CI）分别为-1．09（-5．35,3．16）,-0．27（-2．85,2．31）和-0．06（-0．49,0．38）。而两组ADHD—RS注意缺陷分量表分值差异有统计学意义[RR-1．79,95％CI（-2．22,-1．35）],表明哌甲酯在注意缺陷评定分量表上优于阿托莫西汀。两组副反应也无差异。结论阿托莫西汀与哌甲酯比较,尚不能确定何者疗效更明显。由于纳入RCT太少,且测量指标为终点替代指标,故其长期疗效、对不同亚组患者作用的差别及其安全性等尚不明确,仍需开展更多高质量的RCT进一步验证。     

托莫西汀与哌甲酯缓释片治疗注意缺陷多动障碍对照研究

目的：探讨托莫西汀与哌甲酯缓释片治疗注意缺陷多动障碍患儿的临床疗效和安全性。方法将48例注意缺陷多动障碍患儿随机分为两组,每组24例,研究组口服托莫西汀治疗,对照组口服哌甲酯缓释片治疗,观察8周。治疗前后采用Conners儿童行为问卷,数字划销测验评定临床疗效,随时记录治疗过程中出现的不良反应。结果治疗后两组Conners儿童行为问卷评分学习问题、冲动‐多动、多动指数3个因子分及数字划销测验失误率较治疗前显著下降（P＜0.05或0.01）,治疗第4周、8周末两组有效率比较差异无显著性（P＞0.05）。两组不良反应均较轻微,研究组主要表现为食欲下降、头晕、日间困倦、体质量下降等,对照组主要表现为食欲下降、体质量下降、头痛及入睡困难等。结论托莫西汀与哌甲酯缓释片治疗注意缺陷多动障碍患儿疗效显著,总体疗效相当,安全性高,依从性好。     

IVA-CPT法对哌甲酯缓释片治疗儿童注意缺陷多动障碍的疗效评估

目的通过对56例患注意缺陷多动障碍(ADHD)儿童进行哌甲酯缓释片治疗前后整合视听连续执行测试(IVA-CPT)数值的对比,探讨其治疗效果及疗效评估。方法所有入选患儿均在治疗前给予IVA-CPT测试,然后给予盐酸哌甲酯缓释片18 mg口服,1次/d,2⁴周随访一次,用药34周随访一次,用药3⁵个月再进行IVA-CPT测试。结果反应控制商数(视听)和注意商数(视听)治疗前后经配对t检验,差异均有统计学意义(P<0.01)。结论哌甲酯缓释片对ADHD患儿注意缺陷、控制力差,多动冲动等核心症状的改善有明显效果,而IVA-CPT检测对ADHD患儿的疗效具有直观、综合的评估作用。     

注意缺陷多动障碍的家系研究

目的 探讨遗传因素在注意缺陷多动障碍(ADHD)发生中的地位和作用。方法 采用家系调查简表(儿童用和成人用),分析54个ADHD患者家系各级亲属ADHD检出率及相关精神障碍的患病情况。结果 ADHD患者一级亲属的ADHD检出率(29．63％)明显高于二级(3．25％)、三级(4．42％)亲属检出率;男性亲属患病数明显多于女性亲属(x^2=9．709,P=0．002);父亲患病数明显多于母亲(x^2=8．704,P=0．003)。各级亲属ADHD的检出率随着与先证者的亲属关系级数递增而剧减。结论 ADHD具有家族聚集性,一级亲属患病风险明显增高,并存在性别差异。遗传因素在决定疾病易患性变异上可能有重要作用。     

成人注意缺陷多动障碍

注意缺陷多动障碍 (Ａｔｔｅｎｔｉｏｎ ｄｅｆｉｃｉｔ/ｈｙｐｅｒ ａｃｔｉｖｉｔｙｄｉｓｏｒｄｅｒ,ＡＤＨＤ)是常见于儿童期的一种精神疾病 ,以前认为该病是一种年龄自限性疾病 ,随着年龄的增长而逐渐缓解 ,但近年来大量研究提示ＡＤＨＤ的部分症状将持续至成年 ,并依此提出成人ＡＤＨＤ的诊断。虽然它已日益引起人们的重视 ,但在临床工作中却很少诊断 ,这可能与疾病的合并现象及精神兴奋药的使用尤其是在有物质滥用或反社会人格的患者中的使用有关。在ＤＳＭ -Ⅲ、ＤＳＭ -Ⅲ -Ｒ及ＤＳＭ -Ⅳ中均有相关描述 ,而在我国最新精神疾病分…     

天麻钩藤饮治疗高血压病的临床研究

目的:探究天麻钩藤饮对高血压病的治疗效果.方法:选择本院2018年10月至2019年4月收治的高血压病患者104例,基于随机数字法将其分为对照组和研究组,其中对照组患者51例,研究组患者53例.对照组使用西药治疗,口服卡托普利;研究组在对照组基础上添加天麻钩藤饮进行治疗,治疗后观察患者的收缩压,舒张压及临床疗效(P＜0...     

Methylphenidate Hydrochloride Modified-Release in Adults with Attention Deficit Hyperactivity Disorder: A Randomized Double-Blind Placebo-Controlled Trial

Introduction

Treatment options for adults with attention deficit hyperactivity disorder (ADHD) are limited. The study was conducted to confirm the clinically effective and safe dose of methylphenidate hydrochloride modified-release (MPH-LA) in adults with ADHD and evaluate the maintenance of effect of MPH-LA.

Methods

The study consisted of three treatment phases. The double-blind dose-confirmation phase: 9-week double-blind period (3-week titration period, 6-week fixed dose) with randomization to MPH-LA 40, 60, or 80 mg/day or placebo. The real-life dose-optimization phase: a 5-week re-titration period to optimal dose; and the double-blind maintenance of effect phase, a 6-month double-blind randomized placebo-controlled maintenance of effect phase. The three co-primary endpoints were change in Diagnostic and Statistical Manual of Mental Disorders-IV ADHD Rating Scale (DSM-IV ADHD RS) and Sheehan Disability Scale (SDS) total scores from baseline to end of 9-week confirmation phase and the percentage of treatment failures during the 6-month maintenance of effect phase.

Results

725 of 863 screened patients were randomized to 40 (N = 181), 60 (N = 182), or 80 mg (N = 181) MPH-LA or placebo (N = 181), and 584 (80.6%) completed. 489 (83.7%) of completers were re-randomized to the double-blinded maintenance of effect phase and 235 (48.1%) of them completed. Improvement from baseline in DSM-IV ADHD RS (P < 0.0001 for all comparisons) and SDS (40 mg, P = 0.0003; 60 mg, P = 0.0176; 80 mg, P < 0.0001) total scores was significantly greater vs. placebo for all MPH-LA doses. Treatment failure rate was significantly lower with MPH-LA (21.3%) versus placebo (49.6%) during the 6-month maintenance of effect phase. Safety profile was consistent with the profile for MPH-LA in children; percentage of serious adverse events was comparable between all MPH-LA arms (1.3%) and placebo (1.5%), while percentage of adverse events was higher in MPH-LA arms.

Conclusion

MPH-LA provided and maintained significant symptomatic and functional improvement in adult ADHD patients.     

“N of 1” Trials of Methylphenidate in Two Children with Williams Syndrome and Attention Deficit Hyperactivity Disorder

Poor attention and motor restlessness are common in Williams syndrome (WS) children, and attention deficit hyperactivity disorder (ADHD) is at least as prevalent in WS as in other mentally handicapped groups. We determined the effectiveness of methylphenidate in two children with WS and ADHD. Each child underwent a double-blind dose-determining assessment to select the optimum dose for “N of 1” trials, which consisted of single subject, placebo-controlled randomized controlled trials with multiple crossovers. A regimen of 5 mg in the morning and 2.5 mg at noon was determined by consensus for both trials. Response to MPH was assessed using parent and teacher Conners ratings, and analyzed separately for each child, using mixed model ANOVA. No significant differences in behavioral ratings between medication and placebo weeks were found during the “N of 1 trials.” We conclude that methylphenidate was not superior to placebo in decreasing ADHD symptoms in these two children with Williams syndrome.     

Inhibition and Mental Effort in Attention Deficit Hyperactivity Disorder

The efficiency of cognitive inhibition was contrasted in children diagnosed with ADHD and a control group of age- and IQ-matched average children. Two tasks were used to measure inhibitory ability: the negative-prime Stroop task and a directed-forgetting memory task. Based on contemporary theoretical perspectives that postulate deficits in inhibitory function in the ADHD population, it was predicted that ADHD children would be significantly less efficient inhibitors than the average children. Contrary to predictions, however, ADHD children showed no deficits in inhibitory abilities compared to controls. Average children were faster on the second administration of the Stroop task, whereas ADHD children were slower. These results were interpreted within the framework of the inhibition models. It was proposed that differences in inhibitory abilities, such as the ones tapped here, may appear earlier than age 8, and that the engaging aspects of tasks may have optimized the ADHD children's performance. The slower performance of the ADHD group on the second administration of the Stroop task is consistent with the hypothesis that although ADHD children can inhibit, they find it more effortful to do so than do average children.     

注意力缺陷多动障碍儿童的智力和行为特点

目的：探讨注意力缺陷多动障碍（ADHD）儿童的智力水平、智力结构及行为特点。方法：对ADHD儿童组及正常儿童组用韦氏儿童智力量表（WISC-CR）及Achenbach儿童行为量表（CBCL）进行智力和行为测定,并对智力和行为测定的结果进行比较分析。结果：ADHD儿童的智力水平、总智商（FIQ）、言语智商（VIQ）及操作智商（PIQ）均明显低于正常儿童组,两组比较差异有统计学意义。在各项分测验中,除译码外,其他9项分测验差异均有统计学意义。两组儿童VIQ〈PIQ1个标准差（15分）所占人数比较,差异具有显著性。提示ADHD儿童存在智力结构发展的不平衡。两组儿童行为测试结果比较分析,显示ADHD儿童内向分、外向分及行为总分均明显高于正常儿童组,两组比较差异均有统计学意义。在各项分测验中,除体诉外,其他8项分测验差异均有统计学意义。结论：ADHD儿童同正常儿童相比智力水平较低,智力结构发展不平衡,还具有许多行为和情绪问题。     

脑电生物反馈治疗注意缺陷多动障碍儿童的临床效果分析

目的 探讨脑电生物反馈治疗注意缺陷多动障碍儿童的临床效果。方法 采用VBFB3000脑电反馈系统，以抑制4～8Hz慢波活动，同时增加12～16Hz感觉运动节律波为训练目标，通过该装置采集患儿的脑电波并以各种图像的方式进行实时反馈。每次训练包括5级游戏，2次／周，每次训练45min左右。结果 注意力缺陷为主型训练40次后转为正常占84．6％；多动-冲动为主型训练40次后转为正常100G；混合型训练40次后转为正常占91．6％。结论 脑电生物反馈训练对不同亚型的注意缺陷多动障碍患儿均有明显疗效。