Kölch M, Plener P L
Department for Child and Adolescent Psychiatry and Psychotherapy, Medical School Brandenburg, Neuruppin.
Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm.
Pharmacopsychiatry. 2016 Nov;49(6):219-225. doi: 10.1055/s-0042-117644. Epub 2016 Oct 13.
Pharmacotherapeutic interventions are available for most psychiatric disorders in children. Evidence for these interventions varies, depending on the targeted disorders. For attention-deficit/hyperactivity disorder, a sound database on efficacy and safety of medication exists. For other common disorders or psychopathological phenomena like disruptive behavior, anxiety disorders, depressive disorders, or autism, data on efficacy and safety are much scarcer. This selective review aims to provide an overview about current psychopharmacological interventions in child and adolescent psychiatry. The literature indicates either a lower efficacy than other interventions or less beneficial effects compared to possible adverse events in these cases. Most guidelines recommend psychopharmacotherapy in children to be embedded in a psychosocial or therapeutic intervention plan. Decision for medication depends on the severity of symptoms, chronicity, and, most important, impairment of the child in academic performance, family relationships, and everyday life. The high rates of off-label use in the age group of children are often due to a lack of market authorization studies less indicative of low efficacy. As adverse events need to be monitored closely, pharmacotherapy should mainly be restricted to experienced mental health care providers.
药物治疗干预可用于儿童的大多数精神障碍。这些干预措施的证据因目标障碍而异。对于注意力缺陷多动障碍，存在关于药物疗效和安全性的可靠数据库。对于其他常见障碍或心理病理现象，如破坏性行为、焦虑症、抑郁症或自闭症，疗效和安全性的数据则少得多。这篇选择性综述旨在概述儿童和青少年精神病学中当前的心理药物治疗干预措施。文献表明，在这些情况下，与其他干预措施相比，药物疗效较低，或者与可能的不良事件相比，益处较少。大多数指南建议，儿童的心理药物治疗应纳入心理社会或治疗干预计划。是否用药取决于症状的严重程度、慢性病程，以及最重要的是对儿童学业成绩、家庭关系和日常生活的影响。儿童年龄组中高比例的超说明书用药往往是由于缺乏上市许可研究，而不是疗效低的表现。由于需要密切监测不良事件，药物治疗应主要限于经验丰富的精神卫生保健提供者。
