Javelot H, Glay-Ribau C, Ligier F, Weiner L, Didelot N, Messaoudi M, Socha M, Body-Lawson F, Kabuth B
Centre psychothérapeutique de Nancy-Laxou, 54520 Laxou, France; Service de psychiatrie de l'enfant et de l'adolescent, hôpital d'enfants, 54500 Vandœuvre-lès-Nancy, France; ETAP - neuropsychopharmacology department, 54500 Vandœuvre-lès-Nancy, France; Psychiatry II and Inserm unit 1114, university hospital of Strasbourg, 67000 Strasbourg, France; Clinical pharmacy service, établissement public de santé Alsace Nord, 67170 Brumath, France.
Centre psychothérapeutique de Nancy-Laxou, 54520 Laxou, France.
Ann Pharm Fr. 2014 May;72(3):164-77. doi: 10.1016/j.pharma.2013.12.009. Epub 2014 Jan 30.
Psychotimulant-antipyschotic combinations are frequently used in child psychiatry, but have been rarely described in the literature.
We propose here a retrospective study of 44 children who received the combination methylphenidate (MPH)-risperidone (RIS). The sample is composed of children who received either MPH (n=28) or RIS (n=16) as primary treatment. A vast majority of the children had a comorbid attention deficit hyperactivity disorder (ADHD) diagnosis.
For over 60% of patients, regardless of their initial monotherapy, bitherapy decreased the symptoms of ADHD and conduct disorder, sleep disorders and anxiety. Concerning the safety of the bitherapy, a compensation effect on weight gain and appetite was respectively observed in 70% and 50% of patients. Even though iatrogenic tachycardia can be encountered with both drugs, it has never been reported when they are associated and we have reported a total of 3 cases in our study. We have also observed a case of dyskinesia resolved with the discontinuation of the treatment.
DISCUSSION/CONCLUSION: MPH-RIS bitherapy appears to be particularly effective in ADHD with conduct disorder symptoms. Although tolerance may limit its use, the benefit/risk ratio seems favourable for a number of children.
精神振奋药与抗精神病药联合使用在儿童精神病学中经常出现，但在文献中鲜有描述。
我们在此提出一项对44名接受哌甲酯（MPH）-利培酮（RIS）联合治疗的儿童的回顾性研究。样本由接受MPH（n = 28）或RIS（n = 16）作为主要治疗的儿童组成。绝大多数儿童被诊断患有共病注意缺陷多动障碍（ADHD）。
超过60%的患者，无论其初始单一疗法如何，联合治疗均减轻了ADHD、品行障碍、睡眠障碍和焦虑的症状。关于联合治疗的安全性，分别在70%和50%的患者中观察到对体重增加和食欲的代偿作用。尽管两种药物都可能出现医源性心动过速，但联合使用时从未有过相关报告，且我们的研究中共报告了3例。我们还观察到1例运动障碍在停药后得到缓解。
讨论/结论：MPH-RIS联合治疗在伴有品行障碍症状的ADHD中似乎特别有效。尽管耐受性可能限制其使用，但对于许多儿童来说，获益/风险比似乎是有利的。
