Potter Mona P, Liu Howard Y, Monuteaux Michael C, Henderson Carly S, Wozniak Janet, Wilens Timothy E, Biederman Joseph
Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Department of Psychiatry, Massachusetts General Hospital , Boston, Massachusetts, USA.
J Child Adolesc Psychopharmacol. 2009 Oct;19(5):529-38. doi: 10.1089/cap.2008.0142.
The aim of this study was to describe prescribing practices in the treatment of pediatric bipolar disorder in a university practice setting.
A retrospective chart review was performed on 53 youths diagnosed using Diagnostic and Statistical Manual of Mental Disorders, 4(th) edition (DSM-IV), criteria with bipolar spectrum disorder under the active care of child psychiatrists practicing in a pediatric psychopharmacology specialty clinic. Current medications, doses, and related adverse events were recorded. Clinicians were asked to provide a target disorder (bipolar mania/mixed state, depression, attention deficit hyperactivity disorder [ADHD], or anxiety) for each medication to the best of their ability. The Clinical Global Impressions-Severity (CGI-S) scale was used to measure severity of each disorder before treatment and the Clinical Global Impressions-Improvement (CGI-I) was used to quantify the magnitude of improvement with treatment. Meaningful improvement of the disorder was defined by CGI-I score of 1 or 2.
The mean number of psychotropic medications per patient was 3.0 +/- 1.6. A total of 68% of patients were treated for co-morbid disorders; 23% of patients were treated with monotherapy, primarily with second-generation antipsychotics. Mania improved in 80% of cases, mixed state improved in 57% of cases, ADHD improved in 56% of cases, anxiety improved in 61% of cases, and depression improved in 90% of cases.
The management of pediatric bipolar disorder often requires multiple medications. For the treatment of mania/mixed states, clinicians prescribed second-generation antipsychotics more frequently than mood stabilizers, especially in the context of monotherapy. Co-morbidity was a frequent problem with moderate success obtained with combined pharmacotherapy approaches. Further psychosocial strategies to augment pharmacotherapy may improve outcome while reducing the medication burden in pediatric bipolar disorder.
本研究旨在描述在大学医疗环境中治疗儿童双相情感障碍的处方用药情况。
对在儿童精神药理学专科诊所执业的儿童精神科医生积极治疗下，依据《精神疾病诊断与统计手册》第4版（DSM-IV）标准诊断为双相谱系障碍的53名青少年进行回顾性病历审查。记录当前用药、剂量及相关不良事件。要求临床医生尽可能为每种药物确定一个目标疾病（双相躁狂/混合状态、抑郁、注意力缺陷多动障碍[ADHD]或焦虑）。使用临床总体印象-严重程度（CGI-S）量表测量治疗前各疾病的严重程度，使用临床总体印象-改善（CGI-I）量表量化治疗后的改善程度。疾病有意义的改善定义为CGI-I评分为1或2。
每位患者使用精神药物的平均数量为3.0±1.6。共有68%的患者因共病接受治疗；23%的患者接受单一疗法治疗，主要使用第二代抗精神病药物。80%的躁狂病例、57%的混合状态病例、56%的ADHD病例、61%的焦虑病例以及90%的抑郁病例病情得到改善。
儿童双相情感障碍的治疗通常需要多种药物。在治疗躁狂/混合状态时，临床医生更频繁地开具第二代抗精神病药物而非心境稳定剂，尤其是在单一疗法的情况下。共病是一个常见问题，联合药物治疗方法取得了一定成效。进一步的心理社会策略辅助药物治疗可能会改善治疗效果，同时减轻儿童双相情感障碍患者的药物负担。
