Persico Antonio M, Arango Celso, Buitelaar Jan K, Correll Christoph U, Glennon Jeffrey C, Hoekstra Pieter J, Moreno Carmen, Vitiello Benedetto, Vorstman Jacob, Zuddas Alessandro
Child & Adolescent NeuroPsychiatry Unit, University Campus Bio-Medico, Rome, Italy; Mafalda Luce Center for Pervasive Developmental Disorders, Milan, Italy.
Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain.
Eur Neuropsychopharmacol. 2015 Oct;25(10):1513-31. doi: 10.1016/j.euroneuro.2015.06.009. Epub 2015 Jun 20.
Paediatric psychopharmacology holds great promise in two equally important areas of enormous biomedical and social impact, namely the treatment of behavioural abnormalities in children and adolescents, and the prevention of psychiatric disorders with adolescent- or adult-onset. Yet, in striking contrast, pharmacological treatment options presently available in child and adolescent psychiatry are dramatically limited. The most important currently unmet needs in paediatric psychopharmacology are: the frequent off-label prescription of medications to children and adolescents based exclusively on data from randomized controlled studies involving adult patients; the frequent lack of age-specific dose, long-term efficacy and tolerability/safety data; the lack of effective medications for many paediatric psychiatric disorders, most critically autism spectrum disorder; the scarcity and limitations of randomized placebo-controlled trials in paediatric psychopharmacology; the unexplored potential for the prevention of psychiatric disorders with adolescent- and adult-onset; the current lack of biomarkers to predict treatment response and severe adverse effects; the need for better preclinical data to foster the successful development of novel drug therapies; and the effective dissemination of evidence-based treatments to the general public, to better inform patients and families of the benefits and risks of pharmacological interventions during development. Priorities and strategies are proposed to overcome some of these limitations, including the European Child and Adolescent Clinical Psychopharmacology Network, as an overarching Pan-European infrastructure aimed at reliably carrying out much needed psychopharmacological trials in children and adolescents, in order to fill the identified gaps and improve overall outcomes.
儿童精神药理学在两个具有同等重要意义、对生物医学和社会产生巨大影响的领域有着巨大前景，即治疗儿童和青少年的行为异常，以及预防青少年或成人期发病的精神障碍。然而，形成鲜明对比的是，目前儿童和青少年精神病学中可用的药物治疗选择极为有限。儿童精神药理学目前最重要的未满足需求包括：仅基于涉及成年患者的随机对照研究数据，频繁地对儿童和青少年进行药物的超说明书处方；经常缺乏针对特定年龄的剂量、长期疗效以及耐受性/安全性数据；对于许多儿童精神障碍，尤其是自闭症谱系障碍，缺乏有效的药物；儿童精神药理学中随机安慰剂对照试验的稀缺和局限性；预防青少年和成人期发病的精神障碍的潜在可能性尚未得到探索；目前缺乏预测治疗反应和严重不良反应的生物标志物；需要更好的临床前数据以促进新型药物疗法的成功开发；以及向公众有效传播循证治疗方法，以便在开发过程中更好地让患者和家庭了解药物干预的益处和风险。文中提出了一些优先事项和策略来克服其中一些限制，包括欧洲儿童和青少年临床精神药理学网络，作为一个总体的泛欧基础设施，旨在可靠地开展儿童和青少年急需的精神药理学试验，以填补已确定的空白并改善总体结果。
