Sylvester C
Department of Psychiatry, University of Illinois at Chicago.
Psychiatr Clin North Am. 1993 Dec;16(4):779-91.
Several features of pediatric pharmacology applied to psychiatry were mentioned throughout this review. The use of medications in young children requires attention to nuances of informed consent because of limited data and many potentially beneficial, possibly safer medications that are not approved for children. Children more rapidly metabolize and eliminate medications. They differ in sensitivity to main effects and side effects of a variety of medications. Therefore, it is important to start low and aim for the lowest effective dose. Ultimate doses may be higher, split and frequent doses may be necessary, and both clinical and laboratory follow-up may need to be more frequent. Finally, childhood onset of psychiatric disorders, similar to pediatric experience with diabetes or rheumatoid arthritis, frequently confers devastating stress and chronicity. The child's physician shares the frustration of poor treatment response or responses that cannot be sustained in a developing, dependent organism with a more aggressive variant of a disorder and an inevitably longer course. Despite a heartening increase in pediatric psychopharmacology interest and knowledge, much remains to be learned.
在本综述中提及了儿科药理学应用于精神病学的几个特点。由于数据有限以及许多潜在有益、可能更安全但未获儿童用药批准的药物,在幼儿中使用药物需要关注知情同意的细微差别。儿童代谢和消除药物的速度更快。他们对各种药物的主要作用和副作用的敏感性有所不同。因此,重要的是从小剂量开始,目标是最低有效剂量。最终剂量可能更高,可能需要分多次给药,并且临床和实验室随访可能都需要更频繁。最后,精神疾病在儿童期发病,类似于儿童患糖尿病或类风湿性关节炎的经历,常常带来毁灭性的压力和慢性病程。患儿的医生与患儿一样感到沮丧,因为在一个不断发育、依赖他人的机体中,对于病情更严重的变体和不可避免更长的病程,治疗反应不佳或无法持续。尽管儿科精神药理学的关注度和知识有了令人鼓舞的增长,但仍有许多有待学习的地方。