Allen A J, Leonard H, Swedo S E
Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892, USA.
J Am Acad Child Adolesc Psychiatry. 1995 Aug;34(8):976-86. doi: 10.1097/00004583-199508000-00007.
This report will review the costs, risks, and benefits of potentially useful medications for the treatment of children and adolescents with anxiety disorders and will identify areas where data are limited and additional research is needed.
A Medline-assisted review of the literature was performed. Attention was given to dosage, response, and side effects of medications. Wherever possible, blinded, controlled medication trials in children with anxiety disorders (diagnosed by structured criteria) were targeted for use as the primary references. Relatively few systematic studies were found, so information from open trials and case reports also was included, as were controlled trials in adult populations.
The largest body of work supporting the use of medications for childhood anxiety came from studies of obsessive-compulsive disorder, where clomipramine and fluoxetine have been found effective in systematic studies. In other childhood anxiety disorders, there are conflicting data about the efficacy of medications, such as tricyclic antidepressants, benzodiazepines, serotonin reuptake inhibitors, beta-blockers, and monoamine oxidase inhibitors.
This review of the systematic pharmacological trials for childhood anxiety disorders revealed only 13 controlled studies: 5 for obsessive-compulsive disorder, 4 for school refusal/separation anxiety disorder, and 4 for avoidant/overanxious disorder or mixed diagnostic groups. Medications appear to be helpful for childhood anxiety disorders, although definitive pharmacotherapeutic data are lacking for many conditions. A systematic study of these medications is required to establish safety and efficacy in the pediatric age group. Evolving diagnostic criteria and terminology, the presence of comorbid diagnoses (especially affective disorders), and inadequate medication dosages may be factors hindering research in this field. Until additional research is done, clinicians must carefully consider the relative risk-to-benefit ratio when prescribing these medications.
本报告将回顾用于治疗儿童和青少年焦虑症的潜在有用药物的成本、风险和益处，并确定数据有限且需要进一步研究的领域。
进行了一项由医学文献数据库辅助的文献综述。关注了药物的剂量、反应和副作用。只要有可能，就将针对焦虑症儿童（根据结构化标准诊断）的双盲、对照药物试验作为主要参考文献。发现相对较少的系统研究，因此也纳入了开放试验和病例报告的信息，以及成人人群的对照试验。
支持将药物用于儿童焦虑症治疗的最大量研究工作来自强迫症研究，在系统研究中发现氯米帕明和氟西汀有效。在其他儿童焦虑症中，关于三环类抗抑郁药、苯二氮䓬类药物、5-羟色胺再摄取抑制剂、β受体阻滞剂和单胺氧化酶抑制剂等药物疗效的数据相互矛盾。
对儿童焦虑症系统药理学试验的这项综述仅揭示了13项对照研究：5项针对强迫症，4项针对学校恐惧症/分离焦虑症，4项针对回避型/过度焦虑症或混合诊断组。药物似乎对儿童焦虑症有帮助，尽管许多情况下缺乏明确的药物治疗数据。需要对这些药物进行系统研究，以确定其在儿科年龄组中的安全性和疗效。不断演变的诊断标准和术语、共病诊断（尤其是情感障碍）的存在以及药物剂量不足可能是阻碍该领域研究的因素。在完成更多研究之前，临床医生在开这些药物时必须仔细考虑相对风险效益比。
