儿童情绪失调的优化预防和治疗：ADOPT 研究中三个随机对照试验的方案。
Affective dysregulation in childhood - optimizing prevention and treatment: protocol of three randomized controlled trials in the ADOPT study.
机构信息
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Cologne, Germany.
School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty of the University of Cologne, Pohligstraße 9, 50969, Cologne, Germany.
出版信息
BMC Psychiatry. 2019 Sep 2;19(1):264. doi: 10.1186/s12888-019-2239-8.
BACKGROUND
The terms affective dysregulation (AD) and irritability describe transdiagnostic dimensions and are characterized by an excessive reactivity to negative emotional stimuli with an affective (anger) and a behavioral component (aggression). Due to early onset, high prevalence and persistence, as well as developmental comorbidity, AD in childhood is one of the most psychosocially impairing and cost-intensive mental health conditions. AD is especially prevalent in children in the youth welfare service. Despite continuous research, there remains a substantial need for diagnostic approaches and optimization of individualized treatment strategies in order to improve outcomes and reduce the subjective and economic burden.
METHODS
The ADOPT (Affective Dysregulation - Optimizing Prevention and Treatment) Consortium integrates internationally established, highly experienced and interdisciplinary research groups. The work program encompasses (a) epidemiology, including prevalence of symptoms and disorders, (b) development and evaluation of screening and assessment tools, (c) stepped care approaches for clinically useful personalized medicine, (d) evaluation of an easily accessible and cost-effective online intervention as indicated prevention (treatment effects, moderation/mediation analysis), and (e) evaluation of an intensive personalized modular outpatient treatment in a cohort of children with AD who live with their parents and in a cohort of children with AD who live in out-of-home care (treatment effects, moderation/mediation analysis).
DISCUSSION
The results will lead to significant recommendations for improving treatment within routine clinical care in two cohorts of children with AD and coexisting conditions, especially oppositional-defiant disorder, conduct disorder and disruptive mood dysregulation disorder.
TRIAL REGISTRATION
Trial registration ADOPT Online: German Clinical Trials Register (DRKS) DRKS00014963 . Registered 27 June 2018. Trial registration ADOPT Treatment: German Clinical Trials Register (DRKS) DRKS00013317 . Registered 27 September 2018. Trial registration ADOPT Institution: German Clinical Trials Register (DRKS) DRKS00014581 . Registered 04 July 2018.
背景
情感失调（AD）和易怒这两个术语描述了跨诊断维度，其特征是对负面情绪刺激表现出过度的反应性，具有情感（愤怒）和行为成分（攻击）。由于发病早、患病率和持续性高，以及发育共病，儿童时期的 AD 是最具心理社会损害和成本密集型的心理健康状况之一。AD 在青年福利服务中的儿童中尤为普遍。尽管不断进行研究，但仍需要诊断方法和优化个体化治疗策略，以改善结果并减轻主观和经济负担。
方法
ADOPT（情感失调 - 优化预防和治疗）联盟整合了国际上成熟的、经验丰富的跨学科研究团队。该工作计划包括：（a）流行病学，包括症状和疾病的患病率；（b）发展和评估筛查和评估工具；（c）用于临床有用的个性化医学的阶梯式护理方法；（d）评估易于获得且具有成本效益的在线干预措施作为指示性预防（治疗效果、调节/中介分析）；（e）对与父母同住的 AD 儿童和居住在家庭外护理中的 AD 儿童的密集个性化模块门诊治疗进行评估（治疗效果、调节/中介分析）。
讨论
研究结果将为改善有 AD 和共存疾病（特别是对立违抗性障碍、品行障碍和情绪障碍）的两组儿童的常规临床护理中的治疗提供重要建议。
试验注册
ADOPT Online 试验注册：德国临床试验注册处（DRKS）DRKS00014963。2018 年 6 月 27 日注册。ADOPT 治疗试验注册：德国临床试验注册处（DRKS）DRKS00013317。2018 年 9 月 27 日注册。ADOPT 机构试验注册：德国临床试验注册处（DRKS）DRKS00014581。2018 年 7 月 4 日注册。
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