Tan Daniel, King Thomas R
Spectrum Psychiatric Services, Houston, TX, USA.
Tris Pharma, Inc., 2031 US-130, Monmouth Junction, Monmouth Junction, NJ, 08852, USA.
Ann Gen Psychiatry. 2022 May 27;21(1):14. doi: 10.1186/s12991-022-00394-2.
Stimulants are often prescribed as first-line therapy for attention-deficit/hyperactivity disorder. Currently, there are many therapeutic options available for clinicians and families to consider when making the decision to use a medication. In practice, selection of a stimulant medication for ADHD is highly personalized and can be narrowed down to two major factors: finding the optimal duration of the medication effect, and then estimating a starting dose and subsequently "fine-tuning" the medication to the optimal dosage of the medication. With the possibility of titrating to an optimal stimulant dosage within one prescription of a liquid stimulant, prescribers can recruit the parent/caregiver to actively participate in managing the transition to medication, allowing for greater ownership and a sense of shared control over the process.
The short case series offers a communication method by which clinicians can apply the principles of shared decision-making in helping the parent or caregiver of a newly diagnosed patient with ADHD make informed decisions about medication selection, and to obtain a greater sense of comfort with the new medication regimen.
Much has been published on the importance of clinicians and their patients fostering an environment of clear and unrestricted information-sharing. This short case series illustrates the effectiveness of this approach. Once parents are comfortable with the decision to start drug treatment for ADHD, it is incumbent upon the healthcare provider to ensure that an open channel of communication is maintained, and that parent/caregivers are encouraged to raise concerns as soon as possible.
兴奋剂常被作为注意力缺陷多动障碍的一线治疗药物。目前，临床医生和患者家属在决定用药时有多种治疗选择可供考虑。在实际操作中，选择治疗多动症的兴奋剂药物极具个性化，可归结为两个主要因素：确定药物效果的最佳持续时间，然后估算起始剂量，随后将药物“微调”至最佳剂量。由于在一剂液体兴奋剂处方内有可能滴定至最佳兴奋剂剂量，开处方者可让家长/照顾者积极参与管理用药过渡，从而使他们对这一过程有更强的主人翁意识和共同掌控感。
这个简短的病例系列提供了一种沟通方式，临床医生可借此运用共同决策原则，帮助新诊断的多动症患者的家长或照顾者就药物选择做出明智决策，并对新的药物治疗方案更放心。
关于临床医生及其患者营造清晰且无限制的信息共享环境的重要性，已有大量相关文献发表。这个简短的病例系列说明了这种方法的有效性。一旦家长对开始药物治疗多动症的决定感到放心，医疗服务提供者就有责任确保保持开放的沟通渠道，并鼓励家长/照顾者尽快提出担忧。
