对情绪失调的儿童和青少年进行兴奋剂治疗会产生不良后果吗?

Hannah O'Connor, Joseph Biederman, M. DiSalvo, G. Joshi, S. Faraone, Janet Wozniak
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摘要

本文旨在研究精神科门诊中情绪失调程度较高的儿童和青少年接受兴奋剂治疗的效果。研究对象是在 2016 年 9 月至 2021 年 11 月期间到儿童精神科门诊就诊并获得兴奋剂药物处方的 6-17 岁转诊儿童和青少年。根据儿童行为检查表(CBCL;CBCL-AAA)的注意力问题、攻击行为和焦虑/抑郁综合分量表的总T分<180或≥210,儿童被分为情绪失调程度低和情绪失调程度高的两类。我们对从电子病历中提取的患者处方、诊断和医院就诊数据进行了分析,时间跨度为转诊前的任何时间到转诊后的三个月。与得分较低的患者相比,入院时 CBCL-AAA 得分较高的患者在用药和诊断方面有显著差异,而且更有可能服用较多剂量的兴奋剂。这些患者也更有可能在随访期间接受额外的药物治疗,其中主要是第二代抗精神病药物(SGAs)。急诊室就诊和精神病住院的情况很少见,但只有在CBCL-AA评分较高的组别中才会出现。这些结果表明,刺激剂治疗对情绪失调程度较高和较低的青少年都会产生不利影响,因此需要加大刺激剂剂量并使用 SGAs 进行强化治疗。CBCL可能是识别兴奋剂治疗不良后果的有用工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is Stimulant Treatment in Children and Adolescents with Mood Dysregulation Associated with Adverse Outcomes?
The aim of this paper is to examine effects of stimulant treatment in children and adolescents with high levels of emotional dysregulation in a psychiatric outpatient clinic. Subjects were referred children and adolescents 6-17 years of age who presented to a child psychiatric outpatient clinic between September 2016-November 2021 and received a prescription for a stimulant medication. Children were stratified into those with low and high levels of emotional dysregulation as defined by an aggregate T-score of <180 or ≥210 on the combined Attention Problems, Aggressive Behavior, and Anxious/Depressed subscales of the Child Behavior Checklist (CBCL; CBCL-AAA). We analyzed patient prescription, diagnosis, and hospital visit data extracted from the electronic medical record from any time prior to referral through three months after referral. Patients with higher CBCL-AAA scores at clinic intake had a significantly different medication and diagnosis profile and were more likely to have a higher dosage of stimulants than patients with lower scores. These patients also were more likely to receive an additional medication class during follow-up, which was driven by second-generation antipsychotics (SGAs). Emergency room visits and inpatient psychiatric admissions were rare but present only in the group with higher CBCL-AA scores. These results suggest that stimulant treatment affects youth with high versus low levels of emotional dysregulation adversely with a need for higher stimulant doses and treatment augmentation with SGAs. The CBCL may be a useful tool for identifying poor outcomes with stimulant treatment.
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