可乐定透皮贴治疗中重度抽动障碍共患注意缺陷多动障碍儿童的近期疗效

目的 探讨可乐定透皮贴治疗中重度抽动障碍(tic disorder, TD)共患注意缺陷多动障碍(attention deficit hyperactivity disorder, ADHD)儿童的近期疗效。方法 将36例中重度TD共患ADHD儿童作为研究对象,在药物治疗前和治疗后12周,采用耶鲁抽动障碍整体严重程度量表(YGTSS)和Conners父母症状问卷(PSQ),对治疗前后的各量表变化值进行疗效评价。结果 治疗后儿童YGTSS、PSQ各因子评分和YGTSS总分均低于治疗前(P<0.05)。结论 可乐定透皮贴治疗可以缓解TD儿童的抽动症状和ADHD的核心症状,可作为推荐治疗药物。     

抽动障碍共患注意缺陷多动障碍的治疗研究

目的探讨抽动障碍(TD)共患注意缺陷多动障碍(ADHD)应用精神兴奋剂治疗的疗效。方法选择2004年1月至2006年8月在本院多动症专科门诊就诊的确诊为TD共患ADHD患儿69例(DSM-IV诊断标准、Conners量表和YGTSS量表),采用哌甲酯,泰必利或(和)氟哌啶醇联合治疗,随访2月观察疗效和安全性(血压、心律、肝功能等)。结果治疗2个月后Conners量表学习问题、多动指数2个因子,YGTSS量表运动抽动、发声抽动2个因子积分均较治疗前显著减低,差异达到显著统计学意义(P<0.01),结论兴奋剂对抽动症影响不大,小剂量兴奋剂(如哌甲酯)与常规多巴胺受体阻滞剂(泰必利)合用对TD共患ADHD具有较好疗效。     

滋肾调肝法治疗注意缺陷多动障碍共患抽动障碍46例临床观察

目的:观察滋肾调肝方治疗注意缺陷多动障碍(ADHD)共患抽动障碍(TD)的临床疗效.方法:将66例ADHD共患TD患儿随机分为试验组和对照组进行治疗,试验组服用滋肾调肝方,对照组服用静灵口服液,2组均治疗12周.通过对治疗前后ADHD观察表和耶鲁综合抽动严重程度量表中核心症状项目的减分率来评价疗效.结果:试验组总有效率为87.0%,对照组总有效率为80.0%,2组总有效率比较,差异无统计意义(P>0.05).2组抽动疗效比较,试验组总有效率为91.3%,对照组总有效率为80.0%,2组间差异有统计意义(P<0.05).2组注意缺陷、多动、冲动疗效比较,差异无统计意义(P>0.05).结论:滋肾调肝方治疗ADHD共患TD具有确切的疗效,且在改善抽动症状方面优于静灵口服液.     

沙盘游戏治疗注意缺陷多动障碍儿童的临床价值研究

目的探讨沙盘游戏对注意缺陷多动障碍(ADHD)儿童的治疗价值及临床意义。方法68例ADHD患儿,根据治疗意愿不同分为研究组与对照组,各34例。研究组进行为期12周的沙盘游戏治疗,对照组不接受沙盘游戏治疗。比较两组治疗前后Conners父母症状问卷(PSQ)评分、Achenbach儿童行为量表(CBCL)评分。结果治疗后,对照组品行问题、学习问题、心身障碍、冲动-多动、焦虑、多动指数评分与治疗前比较差异无统计学意义(P>0.05);研究组冲动-多动、焦虑、多动指数评分均低于治疗前,差异有统计学意义(P<0.05);研究组冲动-多动、多动指数评分低于对照组,差异有统计学意义(P<0.05)。治疗后,研究组CBCL总粗分(44.18±8.97)分、社交退缩(2.18±0.88)分、攻击(9.53±8.15)分、违纪(2.24±2.76)分均低于治疗前,且均低于对照组的(50.19±6.53)、(3.13±0.98)、(14.24±8.82)、(4.41±2.93)分,差异有统计学意义(P<0.05)。结论沙盘游戏治疗能改善ADHD儿童的焦虑情绪及注意缺陷、多动冲动等行为,可作为ADHD儿童综合治疗方案的非药物治疗措施。     

托莫西汀治疗儿童注意缺陷多动障碍疗效观察

目的:探讨托莫西汀(ATX)对门诊符合DSM-IV诊断标准的注意缺陷多动障碍(ADHD)患儿的有效性及安全性。方法:采用开放性研究方法,对温州市第七人民医院儿童青少年心理门诊诊断为ADHD的患儿共48例口服托莫西汀0.8 mg/(kg·d)治疗8周,采用ADHDRS-IV-Parent:Inv、CGI-ADHD-S、Conners多动指数量表进行临床疗效评定,采用TESS量表对药物不良反应进行临床监测。结果:ADHDRS-IV-Parent:Inv总体有效率77.08%(37/48);治疗前CGI-ADHD-S(5.19±0.71)分、Conners多动总分(26.2±3.1)分、行为总分(39.1±5.2)分,治疗8周后CGI-ADHD-S(2.98±0.89)分、Conners多动总分(12.3±2.9)分、行为总分(18.2±4.6)分,治疗前后比较差异均有统计学意义(P<0.01);其主要的不良反应为食欲下降、上腹痛、恶心呕吐、头晕、心悸等。结论:ATX对ADHD患儿的注意缺陷、多动、冲动症状均有较好的疗效,而且安全性好。     

托莫西汀治疗儿童注意缺陷多动障碍的疗效与安全性的系统评价

目的：探讨盐酸托莫西汀治疗儿童注意缺陷多动障碍(ADHD)的疗效和安全性。方法：采用Meta分析对7项盐酸托莫西汀与安慰剂对比治疗ADHD对照研究的文献进行分析。结果：本研究纳入7篇文献,均为国外文献(Jadad评分≧3分);样本含量为1304例;Meta分析结果显示,治疗后托莫西汀组的注意缺陷／多动评定量表(ADHD—RS)总分值[MD=-5.86,95﹪CI(-7.73,-3.99)P＜0.00001］、ADHD-RS多动/冲动分量表分值[MD=-2.64,95﹪CI(-3.75,-1.52)P＜0.00001］、ADHD-RS注意缺陷分量表分值[MD=-2.35,95﹪CI(-3.87,-0.83)P＜0.00001］改善均显著优于对照组,两组比较有显著性差异;托莫西汀组患儿比对照组更容易发生腹痛、恶心、呕吐、嗜睡和食欲减退等不良反应(P<0.05)。结论：托莫西汀治疗儿童ADHD具有良好的疗效,可显著改善儿童ADHD的多动／冲动以及注意缺陷,但应注意其不良反应。     

托吡酯联合静灵口服液治疗抽动障碍患儿效果分析

目的：探讨托吡酯联合静灵口服液治疗抽动障碍患儿的效果。方法选取2011年1月至2012年12月温州医科大学附属慈溪医院抽动障碍患儿90例,按照入院顺序将其分为对照组和治疗组,各45例。对照组采用托吡酯进行治疗,治疗组在对照组的基础上加用静灵口服液。采用耶鲁评分表（ YGTSS）和注意力缺陷多动障碍量表（ ADHD）评价2组治疗效果。结果治疗组患儿治疗后运动抽动、发声抽动、功能受损程度、抽动总分评分均低于对照组,组间差异均有统计学意义[（8．6±2．8）分比（11．4±3．6）分、（3．0±1．3）分比（4．6±2．9）分、（8±3）分比（11±5）分、（10±4）分比（13±4）分,均P＜0．01];注意力缺陷、多动冲动、ADHD总分评分均低于对照组[（9±3）分比（12±5）分、（4．2±1．9）分比（6．8±2．7）分、（14±5）分比（18±7）分,均P＜0．01];治疗组总有效率为88．9％（40/45）,明显高于对照组的66．7％（30/45）,组间差异有统计学意义（P＜0．05）。结论托吡酯联合静灵口服液治疗抽动障碍患儿可明显降低YGTSS和ADHD评分,疗效优于单用托吡酯。     

托莫西汀治疗儿童注意缺陷多动障碍的疗效与安全性的系统评价

目的:系统评价托莫西汀治疗儿童注意缺陷多动障碍(ADHD)的疗性与安全性。方法:计算机检索Cochrane library、Medline、EMbase、中国生物医学文献数据库,查找托莫西汀治疗儿童ADHD的随机对照试验(RCT),采用Rev Man 5.1统计软件进行Meta分析。结果:共纳入17项RCT,包括2 548例患儿。Meta分析结果显示,治疗后托莫西汀组的注意缺陷/多动评定量表(ADHD-RS)总分值[MD=-7.53,95%CI(-9.56,-5.51),P<0.01]、ADHD-RS多动/冲动分量表分值[MD=-4.15,95%CI(-5.25,-3.06),P<0.01]、ADHD-RS注意缺陷分量表分值[MD=-3.80,95%C(I-5.08,-2.51),P<0.01]及临床总体印象-总体严重度量表(CGI-S)分值[MD=-0.74,95%C(I-1.23,-0.26),P<0.01]改善均显著优于对照组,两组比较差异有统计学意义;两组患儿治疗过程中脱落失访例数比较,差异无统计学意义[RR=1.00,95%C(I0.85,1.18),P=0.99];托莫西汀组患儿比对照组更容易发生恶心、呕吐、食欲减退、腹痛、头痛、头晕、倦怠、易激惹、疲劳、体质量下降等不良反应(P<0.05)。结论:托莫西汀治疗儿童ADHD具有良好的疗效,可显著改善儿童ADHD的多动/冲动以及注意缺陷,其耐受性与对照组无显著性差异,但应注意其不良反应。     

儿童注意缺陷、多动障碍的药物治疗

注意缺陷、多动障碍 (ADHD)是儿童期最为常见的一种心理行为疾病 ,药物治疗是ADHD主要的治疗方法之一。中枢兴奋药是治疗ADHD最常用的药物 ,作用快、疗效好 ,且不良反应较少。可乐定和抗抑郁剂也有较好的治疗效果 ,可乐定主要适用于伴抽动或情绪异常的ADHD病儿 ,而抗抑郁剂多用于伴抑郁或焦虑的ADHD病儿 ,但不良反应较明显。本文还介绍了近年来出现的一些治疗AD HD的新药     

哌甲酯治疗汉族儿童注意缺陷多动障碍疗效与GRIN2B基因多态性的关系

目的:探讨N-甲基-D-天冬氨酸受体2B亚单位基因(GRIN2B)rs1806201位点和rs1805247位点多态性与哌甲酯治疗汉族注意缺陷多动障碍(ADHD)患儿疗效的关系。方法:2017年1月至2019年1月驻马店市中心医院收治的100例ADHD患儿作为研究对象,进行2~4周的哌甲酯开放剂量治疗,获得最佳治疗反应。采用注意缺陷多动障碍诊断量表父母版(ADHDDS-P)评估ADHD症状。根据治疗前后量表评分,将疗效分为缓解、有效和无效。用TaqMan SNP基因分型技术检测GRIN2B基因rs1806201位点和rs1805247位点多态性。结果:100例患儿治疗后缓解40例,有效25例,无效35例。GRIN2B基因rs1806201位点TT型和CT型患儿治疗效果优于CC型患儿(P<0.05)。而rs1805247位点不同基因型患儿治疗效果的比较差异无统计学意义(P>0.05)。rs1806201位点TT和CT基因型患儿治疗后ADHDDS-P量表注意力缺陷评分、多动冲动评分和总分的减分值均高于CC型患儿(P<0.05),而rs1805247位点不同基因型患儿ADHDDS-P量表减分值比较差异无统计学意义(P>0.05)。结论:GRIN2B基因rs1806201位点多态性与哌甲酯治疗效果有关,而GRIN2B基因rs1805247位点多态性与哌甲酯治疗效果无关。GRIN2B基因rs1806201位点TT型和CT型ADHD患儿对哌甲酯的药物反应优于CC基因型患儿。     

托莫西汀与哌甲酯治疗注意缺陷多动障碍患儿的疗效和安全性比较

目的:比较托莫西汀与哌甲酯治疗注意缺陷多动障碍患儿的疗效和安全性。方法:选择我院收治的注意缺陷多动障碍患儿共52例,随机分为托莫西汀组与哌甲酯组各26例,治疗结束后观察两组患儿的治疗有效率、ADHDRS-IV-Parent:Inv评分以及CPRS-R:S评分。结果:托莫西汀组与哌甲酯组的治疗有效率相近。治疗后托莫西汀组与哌甲酯组的ADHDRS-IV-Parent:Inv各项评分均明显下降,与治疗前比较差异均有统计学意义(P<0.05)。治疗后托莫西汀组与哌甲酯组CPRS-R:S评分的分数均明显下降,与治疗前比较差异均有统计学意义(P<0.05)。托莫西汀组的多动分变化值大于哌甲酯组,差异有统计学意义(P<0.05),两组患儿在治疗过程中均未发现严重的药物不良反应。结论:托莫西汀的疗效与哌甲酯相近,都具有良好的安全性,值得临床推广。     

小儿黄龙颗粒对注意缺陷多动障碍亚型的疗效分析

目的:探讨小儿黄龙颗粒对注意缺陷多动障碍(ADHD)不同亚型的治疗效果。方法:回顾性分析2018年12月至2020年10月江西省儿童医院诊治的90例注意缺陷多动障碍患儿临床资料,根据注意缺陷多动障碍亚型不同进行分类,将注意力障碍为主型的患儿纳入A组(n=30)、将多动/冲动型患儿纳入B组(n=30)、将混合型患儿纳入C组(n=30)。比较三组治疗前、治疗8周后症状(采用SNAP-Ⅳ评定量表)、临床疗效[采用Conners简明症状问卷(ASQ)]及中医证候主症积分。结果:治疗后,三组SNAP-Ⅳ症状评分、ASQ评分均较治疗前降低,差异有统计学意义(P<0.05);三组神思涣散、多动不宁、性急易怒、多言多语评分均较治疗前降低,差异有统计学意义(P<0.05)。结论:小儿黄龙颗粒对各分型ADHD患儿均有一定疗效,可显著改善患儿临床症状,降低中医证候主症积分。     

Substance Use Disorder Characteristics and Externalizing Problems Among Inpatient Adolescent Smokers

Abstract

Attention deficit hyperactivity disorder (ADHD) and/or conduct disorder (CD) have been found to be associated with substance use disorders and cigarette smoking among adolescents. However, studies have often failed to explore these relationships among females from a dimensional perspective, taking into account comorbidity between ADHD and CD symptomatology, and examining ADHD symptom subtypes (i.e., inattention and hyperactivity/impulsivity) separately as they relate to substance involvement and smoking characteristics. This study takes each of the above into consideration when examining the relationship between externalizing symptomatology and substance involvement characteristics in a sample of 191 (62.3% female, meanage = 15.4 years) inpatient adolescent smokers. The results of this study suggest that ADHD and CD symptoms may be related to different types of substance use characteristics. CD symptoms were associated with early onset of substance involvement and ADHD symptoms were related to alcohol and marijuana frequency. ADHD inattention symptoms, but not hyperactivity/impulsivity symptoms, were associated with marijuana and nicotine dependence. Lastly, significant interactions suggested that ADHD symptoms among boys and CD symptoms among girls were related to frequency of any type of substance use prior to inpatient hospitalization. The results of this study point to potentially important clinical implications such as tailoring prevention and intervention efforts according to type of externalizing symptomatology and gender.     

Pharmacotherapy of attention-deficit hyperactivity disorder in adolescents

Attention-deficit hyperactivity disorder (ADHD) is a common neurobehavioural disorder in children and adolescents, consisting of developmentally inappropriate levels of inattention and/or hyperactivity and impulsivity. The majority of children with ADHD will continue to experience significant ADHD symptoms as teens. ADHD in adolescents can result in significant functional impairment and poorer quality of life. Children and adolescents with ADHD are at higher risk of developing other psychiatric illnesses such as mood, conduct and substance abuse disorders. Stimulants (amphetamines and methylphenidates) and nonstimulants (atomoxetine, guanfacine extended-release (XR) and clonidine XR) have been found to be effective and are approved by the US FDA for the treatment of ADHD in adolescents in the US. Of the agents approved in the US, only guanfacine XR and clonidine XR are not approved in any other countries. There is growing evidence that treatment of ADHD with stimulants reduces the risk of development of other psychiatric co-morbidities, including substance abuse disorders. To date, all FDA-approved stimulants and nonstimulants that have been adequately studied have been demonstrated to be safe and effective in treating ADHD in both children and adolescents. Therefore, clinical decisions used in selecting pharmacotherapy to treat ADHD in children aged 6-12 years can be applied in the adolescent population.     

Psychiatric comorbidities in children with attention deficit hyperactivity disorder: implications for management

Attention deficit hyperactivity disorder (ADHD) is frequently comorbid with a variety of psychiatric disorders. These include oppositional defiant disorder and conduct disorder (CD), as well as affective, anxiety, and tic disorders. ADHD and ADHD with comorbid CD appear to be distinct subtypes; children with ADHD/CD are at higher risk of antisocial personality and substance abuse as adults. Stimulants are often effective treatments for aggressive or antisocial behavior in patients with ADHD, but mood stabilizers or atypical antipsychotics may be used to treat explosive aggressive outbursts. Response to stimulants is not affected by comorbid anxiety, but children with ADHD/anxiety disorder may show greater benefit from psychosocial interventions than those with ADHD alone. The degree of prevalence of major depressive disorder (MDD) and bipolar disorder among children with ADHD is controversial, but a subgroup of severely emotionally labile ADHD children who present serious management issues for the clinician clearly exists. Antidepressants may be used in conjunction with stimulants to treat MDD, while mood stabilizers and atypical antipsychotics are often required to treat manic symptoms or aggression. After resolution of the manic episode, stimulant treatment of the comorbid ADHD may be safely undertaken. Recent research suggests that stimulants can be safely used in children with comorbid ADHD and tic disorders, but the addition of anti-tic agents to stimulants is often necessary. Clinicians who work with patients with ADHD should be prepared to deal with a wide range of emotional and behavioral problems beyond the core symptoms of inattention and impulsivity/hyperactivity.     

Clonidine treatment of hyperactive and impulsive children with autistic disorder.

Many autistic children have associated problems of inattention, impulsivity, and hyperactivity that limit the effectiveness of educational and behavioral interventions. Few controlled psychopharmacologic trials have been conducted in autistic children to determine which agents may be effective for these associated features. Eight male children (8.1 +/- 2.8 years) with autistic disorder, diagnosed by DSM-III-R criteria, completed a placebo-controlled, double-blind crossover trial of clonidine. Subjects were included in the study if they had inattention, impulsivity, and hyperactivity that was excessive for their developmental level. Subjects had not tolerated or responded to other psychopharmacologic treatments (neuroleptics, methylphenidate, or desipramine). Teacher ratings on the Aberrant Behavior Checklist irritability, stereotypy, hyperactivity, and inappropriate speech factors were lower during treatment with clonidine than during treatment with placebo. Attention deficit disorder with hyperactivity: Comprehensive Teacher's Rating Scale ratings were not significantly improved during the study, except for oppositional behavior. Parent Conners Abbreviated Parent-Teacher Questionnaire ratings significantly improved during clonidine treatment. Clonidine led to increased ratings of the side effects of drowsiness and decreased activity. Clinician ratings (Children's Psychiatric Rating Scale Autism, Hyperactivity, Anger and Speech Deviance factors; Children's Global Assessment Scale; Clinical Global Impressions efficacy) of videotaped sessions were not significantly different between clonidine and placebo. Clonidine was modestly effective in the short-term treatment of irritability and hyperactivity in some children with autistic disorder.     

Pharmacological options for the treatment of Tourette's disorder.

Tourette's disorder is a neuropsychiatric disorder characterised clinically by motor and vocal tics, which may be associated to conductual disorders such as obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD). Although the neurochemistry of Tourette's disorder is not well known, there are some effective therapies for tics, OCD and ADHD. However, these are not devoid of adverse effects. Tics only require treatment when they interfere with the functioning of the patient. If therapy is needed, monotherapy at the minimal effective dose is desirable, but some patients may require two or more drugs. The most frequently used drugs for tics are antipsychotics (mainly pimozide and haloperidol) and clonidine. The potential usefulness of atypical antipsychotic drugs (risperidone, olanzapine, clozapine, ziprasidone) and other dopaminergic drugs (fluphenazine, sulpiride, tiapride, metoclopramide, piquindone, tetrabenazine), clonazepam, calcium channel antagonists, botulinum toxin, dopamine agonists, selegiline, and other drugs is discussed. The drugs of choice for OCD in patients with Tourette's disorder are the selective serotonin reuptake inhibitors (SSRIs), although the tricyclic antidepressant clomiplamine, which inhibits both serotonin and noradrenaline uptake, has also been found to be useful. ADHD can be treated with some psychostimulants, mainly methylphenidate, although these drugs must be used with caution. Other potentially useful drugs for the treatment of ADHD in patients with Tourette's disorder are clonidine, guanfacine, selegiline, some tricyclic antidepressants, sertraline, pimozide and clonazepam. Finally, the potential value of some nonpharmacological therapies (hypnotherapy, biofeedback, conductual therapies, electroconvulsive therapy, acupuncture and surgery) is briefly reviewed.