Division of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY 11004, USA,
J Clin Psychiatry. 2011 May;72(5):655-70. doi: 10.4088/JCP.11r07064.
Most major psychiatric disorders have an onset in childhood or adolescence in a sizeable proportion of patients, and earlier onset disorders often have a severe and chronic course that can seriously disrupt sensitive developmental periods, with lifelong adverse consequences. Accordingly, psychopharmacologic treatments have been increasingly utilized in severely ill youth. However, the increased use of psychopharmacologic treatments in pediatric patients has also raised concerns regarding a potential overdiagnosis and overtreatment of youth, without adequate data regarding the pediatric efficacy and safety of psychotropic agents. Over the past decade, a remarkable number of pediatric randomized controlled trials have been completed, especially with psychostimulants, antidepressants, and antipsychotics. For these frequently used agents, effect sizes against placebo have typically been at least moderate, with most numbers-needed-to-treat well below 10 for response, indicating clinical significance as well. Nevertheless, data also point to a greater and/or different profile of susceptibility to adverse effects in pediatric compared to adult patients, as well as to a role for nonpharmacologic treatments, given alone or combined with pharmacotherapy, for many of the youth. Taken together, these results highlight the need for a careful assessment of the risk-benefit relationship of psychopharmacologic treatments in patients who cannot be managed sufficiently with nonpharmacologic interventions and for routine, proactive adverse effect monitoring and management. Although considerable progress has been made, there is still enormous need for additional data and funding of pediatric psychopharmacology trials. It is hoped that the field will acquire the necessary resources to propel pediatric clinical psychopharmacology to new levels of insight by linking it with, but not replacing it by, pharmacoepidemiologic and biomarker approaches and advances.
大多数主要的精神障碍在相当一部分患者中都在儿童期或青少年期开始出现，且早期发病的障碍通常具有严重和慢性的病程，可能严重扰乱敏感的发育时期，导致终身不良后果。因此，精神药理学治疗在严重患病的青少年中越来越多地被应用。然而，精神药理学治疗在儿科患者中的应用增加也引起了对青少年潜在过度诊断和过度治疗的关注，而对于精神药物在儿科的疗效和安全性，缺乏足够的数据。在过去的十年中，已经完成了大量的儿科随机对照试验，尤其是针对精神兴奋剂、抗抑郁药和抗精神病药。对于这些常用药物，与安慰剂相比，其疗效通常至少为中度，大多数反应的需要治疗数（NNT）都远低于 10，表明了其临床意义。然而，数据也表明，与成人患者相比，儿科患者对不良反应的敏感性更高和/或不同，并且对于许多青少年来说，非药物治疗，单独或与药物治疗联合使用，也具有一定的作用。总的来说，这些结果强调了需要对不能通过非药物干预充分治疗的患者进行精神药理学治疗的风险效益评估，并需要常规、积极地监测和管理不良反应。尽管已经取得了相当大的进展，但仍需要更多的数据和儿科精神药理学试验的资金。人们希望该领域能够获得必要的资源，通过与药物流行病学和生物标志物方法和进展相结合，但不替代它们，将儿科临床精神药理学推向新的认识水平。
