Mrazek D A
Department of Psychiatry, Children's National Medical Center, Washington, DC.
Ann Allergy. 1992 Oct;69(4):285-90.
Asthma is the most common chronic illness of childhood. An increased prevalence of psychopathology has been shown repeatedly to occur in severely asthmatic children, but little evidence exists to suggest that this is true for children with mild asthma. A major problem in interpreting the psychological literature addressing asthma has been the absence of studies of children with specified subtypes of the disease and the analysis of heterogeneous samples including children with a wide range of ages and poorly defined disease characteristics. Depression and anxiety disorders occur at a greater prevalence in severely asthmatic children and may be exacerbated by antiasthmatic medications. Vocal cord dysfunction may be misdiagnosed as asthma and is suggested to be associated with an increased risk of psychiatric disturbance. The presence of depressive illness in very severe asthmatic patients is associated with greater asthma mortality and requires intervention. Treatment considerations include the need for a high level of suspicion for noncompliance in patients who are nonresponsive to antiasthmatic medications, judicious use of antidepressant medication, referral of children with co-occurring psychiatric symptoms for psychiatric assessment and management, and consideration of early intervention strategies to minimize the initial expression of asthmatic symptoms.
哮喘是儿童期最常见的慢性疾病。反复研究表明，重度哮喘患儿精神病理学患病率有所增加，但几乎没有证据表明轻度哮喘患儿也是如此。解读有关哮喘的心理学文献的一个主要问题是，缺乏对特定疾病亚型儿童的研究，以及对包括不同年龄段和疾病特征定义不明确的儿童在内的异质性样本的分析。抑郁和焦虑症在重度哮喘患儿中更为普遍，并且可能会因抗哮喘药物而加重。声带功能障碍可能被误诊为哮喘，并且被认为与精神障碍风险增加有关。极重度哮喘患者中抑郁症的存在与更高的哮喘死亡率相关，需要进行干预。治疗方面的考虑包括，对于对抗哮喘药物无反应的患者，需要高度怀疑其存在不依从性；谨慎使用抗抑郁药物；将伴有精神症状的儿童转诊进行精神评估和管理；以及考虑早期干预策略，以尽量减少哮喘症状的初始表现。
