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[精神科及心理治疗干预对患有精神疾病的儿童和青少年的疗效——荟萃分析与综述的系统评价。第二部分:注意缺陷多动障碍与品行障碍]

[Efficacy of psychiatric and psychotherapeutic interventions in children and adolescents with psychiatric disorders--a systematic evaluation of meta-analyses and reviews. Part II: ADHD and conduct disorders].

作者信息

Bachmann Mareile, Bachmann Christian, Rief Winfried, Mattejat Fritz

机构信息

1 Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Hans-Sachs-Strasse 4-6, Marburg.

出版信息

Z Kinder Jugendpsychiatr Psychother. 2008 Sep;36(5):321-33. doi: 10.1024/1422-4917.36.5.321.

Abstract

OBJECTIVE

In recent years, a large and growing body of research on the effectiveness of treatments for psychiatric disorders in childhood and adolescence has been published; however the large number makes it difficult to get an overview on the current status of research. The aim of this article is to systematically review the existing meta-analyses and reviews disorders on the four most frequent childhood and adolescent psychiatric disorders (anxiety disorder, depression, ADHD, conduct disorder) and to present an up-to-date summary on the effects of treatment for those disorders.

METHODS

This article is based on a systematic literature search, which produced 112 meta-analyses and reviews on the efficacy of psychological and psychiatric interventions in childhood and adolescence published between 2000 and 2007. The articles resulting from the literature search were evaluated according to clearly defined criteria. Presentation of the results follows a dichotomous classification (internalizing vs. externalizing disorders), with Part II of this article reporting the results on ADHD and conduct disorders.

RESULTS

The majority of reviews published between 2000 and 2007 focuses on the treatment of depressive disorders and ADHD. Only for ADHD is the use of medication (stimulants) considered to be the most efficacious treatment option available. For the remaining three disorders, psychotherapy is recommended as the most effective treatment of choice. A combination of psychological and pharmacological treatments is an important option in ADHD and depressive disorders. Considering the efficacy, treatments for ADHD and anxiety disorders produce higher effect-sizes than do interventions for depressive and conduct disorders. For all disorders, there are several desiderata (content and methodological aspects) to be incorporated into future research.

CONCLUSIONS

Empirically supported treatment recommendations can be derived for anxiety disorders, depressive disorders, ADHD and conduct disorders. Finally, important implications for research and practice are discussed.

摘要

目的

近年来,关于儿童和青少年精神疾病治疗效果的研究成果大量涌现且不断增加;然而数量众多使得难以全面了解研究现状。本文旨在系统回顾现有的荟萃分析,并综述四种最常见的儿童和青少年精神疾病(焦虑症、抑郁症、注意力缺陷多动障碍、品行障碍),并就这些疾病的治疗效果给出最新总结。

方法

本文基于系统的文献检索,检索出2000年至2007年间发表的112项关于儿童和青少年心理及精神干预疗效的荟萃分析和综述。根据明确界定的标准对文献检索所得的文章进行评估。结果呈现采用二分法分类(内化性障碍与外化性障碍),本文第二部分报告注意力缺陷多动障碍和品行障碍的结果。

结果

2000年至2007年间发表的大多数综述聚焦于抑郁症和注意力缺陷多动障碍的治疗。仅对于注意力缺陷多动障碍而言,使用药物(兴奋剂)被认为是最有效的治疗选择。对于其余三种疾病,推荐心理治疗作为最有效的首选治疗方法。心理治疗和药物治疗相结合是治疗注意力缺陷多动障碍和抑郁症的重要选择。考虑到疗效,注意力缺陷多动障碍和焦虑症的治疗产生的效应量高于抑郁症和品行障碍的干预措施。对于所有疾病,未来研究都有若干需要改进之处(内容和方法学方面)。

结论

可以得出关于焦虑症、抑郁症、注意力缺陷多动障碍和品行障碍的循证治疗建议。最后,讨论了对研究和实践的重要启示。

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