Donnelly Craig L, Amaya-Jackson Lisa
Section of Child and Adolescent Psychiatry, Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
Paediatr Drugs. 2002;4(3):159-70. doi: 10.2165/00128072-200204030-00003.
Post-traumatic stress disorder (PTSD) is a common psychiatric condition in childhood and adolescence. Rates vary widely depending upon the type of trauma exposure. Interpersonal traumas, such as rape or physical abuse, are more likely to result in PTSD than exposure to natural or technological disaster. Clinical presentations are exceedingly complex and children with PTSD are at increased risk of having comorbid psychiatric diagnoses. Because of its complexity and frequent occurrence with other disorders, assessment of PTSD necessitates a broad-based evaluation utilizing multiple informations and structured instruments specific to the symptoms of PTSD in youth. Cognitive-behavioral therapy (CBT) is the treatment of first choice. Pharmacological agents for PTSD treatment have received little empirical investigation in childhood. Pharmacological treatment is used to target disabling symptoms of the disorder, which limit psychotherapy or life functioning, by helping children to tolerate working through distressful material in therapy and life. Pharmacological treatment should be based on a stepwise approach utilizing broad spectrum medications such as the selective serotonin reuptake inhibitors as first-line agents. Comorbid conditions should be identified and treated with appropriate medication or psychosocial interventions. Treatment algorithms are provided to guide rational medication strategies for children and adolescents with PTSD, subsyndromal PTSD, and in PTSD that is comorbid with other psychiatric conditions of childhood. Reduction in even one debilitating symptom of PTSD can improve a child's overall functioning across multiple domains.
创伤后应激障碍（PTSD）是儿童和青少年期常见的精神疾病。发病率因创伤暴露类型的不同而有很大差异。人际创伤，如强奸或身体虐待，比暴露于自然或技术灾难更易导致PTSD。临床表现极为复杂，PTSD儿童合并其他精神疾病诊断的风险增加。由于其复杂性以及常与其他疾病并发，PTSD的评估需要利用多种信息和针对青少年PTSD症状的结构化工具进行广泛评估。认知行为疗法（CBT）是首选治疗方法。用于治疗儿童PTSD的药物很少得到实证研究。药物治疗旨在针对该疾病导致功能障碍的症状，通过帮助儿童耐受在治疗和生活中处理痛苦材料的过程，来限制心理治疗或生活功能。药物治疗应采用逐步治疗方法，使用如选择性5-羟色胺再摄取抑制剂等广谱药物作为一线用药。应识别合并症，并使用适当的药物或心理社会干预措施进行治疗。提供了治疗算法，以指导针对患有PTSD、亚综合征PTSD以及与儿童期其他精神疾病并发的PTSD的儿童和青少年的合理用药策略。即使PTSD的一种致残症状减轻，也可改善儿童在多个领域的整体功能。
