Bouvard M P, Mouren-Siméoni M C
Service de Psychopathologie de l'Enfant et de l'Adolescent, Hôpital Robert Debré, Paris.
Encephale. 1990 Sep-Oct;16(5):389-98.
The discovery of neuroleptics has certainly not had the same impact in child psychiatry as it has had in adult psychiatry. Yet, these substances are widely used with children. Prescription is generally based on a few simple rules: treatment is started with low doses which are progressively increased, so as to reach an optimal posology which establishes a balance between clinical efficiency and side effects; plasmatic levels may be monitored on a regular basis. The emergence of adverse effects continues to remain the essential preoccupation of the clinical practitioner; it is the reason why so many treatment plans are discontinued (on a short term basis, acute dyskinesia, sedation, hypotension, weight gain; on a long-term basis, passiveness, tardive dyskinesia, but this is seldom observed in children). As a result, one must be careful in prescribing neuroleptics to youngsters and consider other drugs whenever possible. Following a brief review of the kinetic specificities of neuroleptics in children, we describe the general modalities of prescription for this age group and give some personal results as illustrative examples. We then discuss the issue of tolerance and side effects.
抗精神病药物的发现对儿童精神病学的影响肯定不如对成人精神病学的影响大。然而，这些药物在儿童中被广泛使用。处方通常基于一些简单的规则：治疗从低剂量开始，逐渐增加剂量，以达到最佳剂量，从而在临床疗效和副作用之间建立平衡；可以定期监测血浆水平。不良反应的出现仍然是临床医生的主要关注点；这就是为什么许多治疗方案被中断的原因（短期来看，有急性运动障碍、镇静、低血压、体重增加；长期来看，有被动性、迟发性运动障碍，但这种情况在儿童中很少见）。因此，在给青少年开抗精神病药物时必须谨慎，并尽可能考虑使用其他药物。在简要回顾了抗精神病药物在儿童中的药代动力学特性之后，我们描述了该年龄组的一般处方方式，并给出一些个人结果作为示例。然后我们讨论耐受性和副作用问题。
