Staton Dennis
Lakeland Mental Health Center, Moorhead, MN, USA.
Adolesc Health Med Ther. 2010 Aug 4;1:73-85. doi: 10.2147/AHMT.S8791. eCollection 2010.
When treatments are ordered for adolescent major depression, or for other adolescent medical illnesses, adherence and clinical outcomes are likely to be unsatisfactory, unless 4 basic principles of the medical treatment of adolescent illness are implemented. These comprise providing effective patient and parent/caregiver education, establishing effective patient and caregiver therapeutic alliances, providing effective treatment, and managing other factors associated with treatment adherence as indicated. The goals of treatment are to achieve the earliest possible response and remission. Failure to treat adolescent major depression successfully has potentially serious consequences, including worsened adherence, long-term morbidity, and suicide attempt. Accordingly, prescribed treatment must be aggressively managed. Doses of an antidepressant medication should be increased as rapidly as can be tolerated, preferably every 1-2 weeks, until full remission is achieved or such dosing is limited by the emergence of unacceptable adverse effects. A full range of medication treatment options must be employed if necessary. Treatment adherence, occurrence of problematic adverse effects, clinical progress, and safety must be systematically monitored. Adolescents with major depression must be assessed for risk of harm to self or others. When this risk appears significant, likelihood of successful outcomes will be enhanced by use of treatment plans that comprehensively address factors associated with treatment nonadherence. Abbreviated and comprehensive plans for the treatment of potentially fatal adolescent illnesses are outlined in this review.
当为青少年重度抑郁症或其他青少年疾病安排治疗时，除非实施青少年疾病医学治疗的4项基本原则，否则依从性和临床结果可能不尽人意。这些原则包括为患者及家长/照顾者提供有效的教育，建立有效的患者与照顾者治疗联盟，提供有效的治疗，并根据需要处理与治疗依从性相关的其他因素。治疗的目标是尽早实现反应和缓解。未能成功治疗青少年重度抑郁症可能会产生潜在的严重后果，包括依从性变差、长期发病和自杀企图。因此，必须积极管理规定的治疗。抗抑郁药物的剂量应尽快增加至可耐受的程度，最好每1-2周增加一次，直至完全缓解或因出现不可接受的不良反应而限制剂量增加。如有必要，必须采用全面的药物治疗方案。必须系统地监测治疗依从性、出现问题的不良反应、临床进展和安全性。必须评估患有重度抑郁症的青少年对自身或他人造成伤害的风险。当这种风险似乎很大时，通过使用全面解决与治疗不依从相关因素的治疗计划，成功治疗的可能性将得到提高。本综述概述了针对潜在致命性青少年疾病的简短而全面的治疗计划。
