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Preschoolers and Psychopharmacological Interventions 学龄前儿童和心理药理学干预
Pub Date : 2008-10-13 DOI: 10.1521/CAPN.2008.13.2.1
M. Gleason, W. Froehlich
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引用次数: 1
Medicating Children: The Enduring Controversy over ADHD and Pediatric Stimulant Pharmacotherapy 儿童用药:ADHD和儿童兴奋剂药物治疗的持久争议
Pub Date : 2008-10-01 DOI: 10.1521/CAPN.2008.13.5.1
R. Mayes, Catherine L. Bagwell, Jennifer L. Erkulwater
Attention Deficit Hyperactivity Disorder (ADHD) holds the distinction of being both the most extensively studied pediatric mental disorder and one of the most controversial. This is partly due to the fact that it is also the most commonly diagnosed mental disorder among minors. On average, one in every ten to 15 children in the U.S. has been diagnosed with the disorder and one in every 20 to 25 uses a stimulant medication—often Ritalin, Adderall, or Concerta—as treatment. The biggest increase in youth diagnosed with ADHD and prescribed a stimulant drug occurred during the 1990s, when the prevalence of physician visits for stimulant pharmacotherapy increased five-fold. This unprecedented increase in U.S. children using psychotropic medication triggered an intense public debate.
注意缺陷多动障碍(ADHD)既是研究最广泛的儿童精神障碍,也是最具争议的儿童精神障碍之一。这在一定程度上是因为它也是未成年人中最常见的精神障碍。在美国,平均每10到15个孩子中就有一个被诊断出患有这种疾病,每20到25个孩子中就有一个使用兴奋剂——通常是利他林、阿得拉或concerta——来治疗。在20世纪90年代,被诊断为多动症并服用兴奋剂药物的青少年人数增幅最大,当时接受兴奋剂药物治疗的医生访问量增加了5倍。美国儿童使用精神药物的史无前例的增长引发了激烈的公众辩论。
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引用次数: 4
Prescriptions Into Practice: Bupropion 实用处方:安非他酮
Pub Date : 2008-10-01 DOI: 10.1521/CAPN.2008.13.5.6
N. Akhtar, A. Khan
Pharmacokinetics Bupropion is a racemic mixture. The pharmacologic activity and pharmacokinetics of the individual enantiomers have not been studied. Bupropion follows biphasic pharmacokinetics best described by a 2-compartment model. The terminal phase has a mean half-life of about 21 hours, while the distribution phase has a mean half-life of three to four hours. Absorption: Bupropion has not been administered intravenously to humans; therefore, the absolute bioavailability in humans has not been determined. Following oral administration of bupropion to healthy volunteers, peak plasma concentrations of bupropion are achieved within three hours. At steady state, the mean peak concentration (Cmax) following a 150mg dose every 12 hours is 136ng/ml. In a single-dose study, food increased the Cmax of bupropion by 11% and the extent of absorption as defined by area under the plasma concentration (AUC) by 17%. Distribution: Bupropion is 84% bound to plasma proteins at concentrations up to 200mcg/ml. The extent of protein binding of the hydoxybupropion metabolite is similar to that for bupropion, whereas the extent of protein binding of the threohydrobupropion metabolite is about half that seen with bupropion. The volume of distribution (Vss/F) estimated from a single 150mg dose given to 17 subjects is 1,950L (20% CV). Metabolism: Bupropion is metabolized by CYP 2B and CYP 3A4 systems into three active metabolites, hydroxybupropion, threohydrobupropion and erythohydrobupropion. The potency and toxicity of the metabolites relative to bupropion have not been fully characterized. However, it has been demonstrated in an antidepressant screening test in mice that hydroxybupropion is one half as potent as bupropion, while threohydrobupropion and erythohydrobupropion are 5-fold less potent than bupropion. Excretion: The mean apparent clearance (Cl/F) estimated from 2 single-dose (150mg) studies are 135 (+/-20%) and 209L/hr (+/-21%). Following chronic dosing of 150mg of bupropion every 12 hours for 14 days (n=34), the mean Cl/F at steady state was 160L/hr (+/-23%). The mean elimination half-life of bupropion estimated from a series of studies is approximately 21 hours. Estimates of half-lives of metablites determined from a multiple-dose study were 20 hours for hydroxybupropion, 37 hours for threohydrobupropion and 33 hours for erythrobupropion. Following oral administration of 200mg of 14C-bupropion in humans, 87% and 10% of a radioactive dose was recovered in the urine and feces, respectively. The fraction of the oral dose of bupropion excreted unchanged was only 0.5%.
安非他酮是外消旋混合物。个别对映体的药理活性和药代动力学尚未研究。安非他酮遵循双相药代动力学,最好用2室模型来描述。终末相的平均半衰期约为21小时,而分布相的平均半衰期为3至4小时。吸收:安非他酮尚未静脉注射给人;因此,人类的绝对生物利用度尚未确定。健康志愿者口服安非他酮后,安非他酮血药浓度在3小时内达到峰值。在稳定状态下,每12小时给药150mg后的平均峰值浓度(Cmax)为136ng/ml。在一项单剂量研究中,食物使安非他酮的Cmax增加11%,血浆浓度下面积(AUC)定义的吸收范围增加17%。分布:安非他酮84%与血浆蛋白结合,浓度高达200mcg/ml。羟基安非他酮代谢物的蛋白质结合程度与安非他酮相似,而三氢安非他酮代谢物的蛋白质结合程度约为安非他酮的一半。17名受试者单次150mg剂量的分布体积(Vss/F)估计为1,950L (20% CV)。代谢:安非他酮经CYP 2B和CYP 3A4系统代谢为三种活性代谢物:羟基安非他酮、三氢安非他酮和红氢安非他酮。相对于安非他酮的代谢物的效力和毒性尚未完全表征。然而,在小鼠抗抑郁药筛选试验中已经证明,羟基安非他酮的效力是安非他酮的一半,而三氢安非他酮和红氢安非他酮的效力比安非他酮低5倍。排泄:2个单剂量(150mg)研究估计的平均表观清除率(Cl/F)为135(+/-20%)和209L/hr(+/-21%)。长期每12小时给药150mg安非他酮,连续14天(n=34),稳态时平均Cl/F为160L/hr(+/-23%)。一系列研究估计安非他酮的平均消除半衰期约为21小时。多剂量研究确定的代谢物半衰期估计为羟基安非他酮20小时,三氢安非他酮37小时,红安非他酮33小时。口服200mg 14c -安非他酮后,尿液和粪便中分别回收了87%和10%的放射性剂量。口服安非他酮的排泄比例不变,仅为0.5%。
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引用次数: 0
Pharmacogenetics—A Useful Tool in Antidepressant Pharmacotherapy? 药物遗传学——抗抑郁药物治疗的有用工具?
Pub Date : 2008-08-01 DOI: 10.1521/CAPN.2008.13.4.1
K. Domschke
Major Depressive Disorder (MDD) is a highly disabling disease characterized by a lifetime prevalence of 5%–25%, with women being affected approximately twice as often as men. Family and twin studies indicate a strong genetic contribution to the pathogenesis of MDD with an estimated heritability of 40%–50%. Antidepressive pharmacotherapeutic agents such as tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI), norepinephrine and serotonin reuptake inhibitors (SNRI) or noradrenergic and specific serotonergic antidepressants (NaSSA) have proven to be highly effective for a large proportion of patients in the treatment of major depression. However, two major issues need to be addressed in the pharmacotherapy of MDD, treatment resistance and treatment intolerance. Treatment Resistance A full 30%–40% of all patients fail to respond sufficiently to initial pharmacotherapy treatment. Since it can take several weeks after treatment initiation for these agents to exert antidepressant effects, patients might have to endure this period of time without symptom relief before the antidepressant is known to be ineffective. Thus, it would be highly beneficial for providers to be able to identify non–responders to a
重度抑郁症(MDD)是一种高度致残的疾病,其特点是终生患病率为5%-25%,女性的发病率约为男性的两倍。家庭和双胞胎研究表明,重度抑郁症的发病机制有很强的遗传作用,估计遗传率为40%-50%。抗抑郁药物治疗药物,如三环抗抑郁药(TCA),选择性5 -羟色胺再摄取抑制剂(SSRI),去甲肾上腺素和5 -羟色胺再摄取抑制剂(SNRI)或去甲肾上腺素和特异性5 -羟色胺能抗抑郁药(NaSSA)已被证明对很大一部分患者治疗重度抑郁症非常有效。然而,在MDD的药物治疗中,有两个主要问题需要解决,即治疗耐药性和治疗不耐受。30%-40%的患者对最初的药物治疗没有充分的反应。由于这些药物在治疗开始后可能需要几周的时间才能发挥抗抑郁作用,患者可能必须忍受这段时间症状没有缓解,然后才知道抗抑郁药无效。因此,对于提供者来说,能够识别对
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引用次数: 0
Stimulant Medication Adherence—Theoretical Perspectives 兴奋剂药物依从性-理论观点
Pub Date : 2008-07-23 DOI: 10.1521/CAPN.2008.13.1.1
A. Charach
After 12 months of use, children with ADHD take their medication only 50% to 75% of the time, a proportion that decreases to less than 50% after three years of use. The Multimodal Treatment Study of ADHD documented that poor adherence to medication contributed to symptom recurrence. Over two years of use, children with ADHD who discontinued medication treatment deteriorated in comparison to those who continued use. Likewise, clinical treatment guidelines recommend that physicians pay close attention to medication adherence, noting that poor treatment adherence may contribute to treatment non–response. Though clinicians have developed strategies to address the problem of adherence among children with ADHD, few studies have investigated what contributes to early discontinuation of medications among children and adolescents with ADHD. In order to better understand the problem of treatment non–compliance, this article will apply four empirically based theoretical models of health behavior to the treatment adherence literature for children who take stimulants for ADHD. It is expected that clinicians can use the application of various models to better appreciate the complexities of treatment adherence in the care of children with ADHD.
在使用12个月后,患有多动症的儿童只有50%到75%的时间服用药物,在使用三年后,这一比例下降到不到50%。ADHD的多模式治疗研究表明,服药依从性差会导致症状复发。在两年的使用中,与继续使用药物的儿童相比,停止药物治疗的ADHD儿童病情恶化。同样,临床治疗指南建议医生密切关注药物依从性,指出治疗依从性差可能导致治疗无反应。尽管临床医生已经制定了解决ADHD儿童坚持服药问题的策略,但很少有研究调查了导致ADHD儿童和青少年早期停药的原因。为了更好地理解治疗不依从性的问题,本文将运用四种基于经验的健康行为理论模型来研究服用兴奋剂治疗ADHD儿童的治疗依从性文献。期望临床医生能够运用各种模型来更好地理解ADHD儿童治疗依从性的复杂性。
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引用次数: 1
Promoting Adherence with Children and Adolescents with Psychosis 促进儿童和青少年精神病患者的依从性
Pub Date : 2008-07-23 DOI: 10.1521/CAPN.2008.13.1.5
R. Gearing, Irfan A Mian, A. Charach
ness–career model specifically focuses on these factors and the ways in which they affect seeking and accepting help in health care. These theoretical models offer concepts that can help practitioners understand family and child medication adherence behavior. Overall, practitioners need to keep in mind that parental beliefs and attitudes can strongly influence the treatment decisions that they make on their child’s behalf, that these attitudes and beliefs may change over time, and that they are shaped by a variety of social, cultural and environmental factors.
职业模式特别关注这些因素以及它们影响寻求和接受医疗保健帮助的方式。这些理论模型提供的概念,可以帮助从业者了解家庭和儿童药物依从行为。总的来说,从业者需要记住,父母的信念和态度可以强烈地影响他们代表孩子做出的治疗决定,这些态度和信念可能会随着时间的推移而改变,并且受到各种社会、文化和环境因素的影响。
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引用次数: 2
1H MRS: What the Practicing Clinician Needs to Know 1H MRS:执业临床医生需要知道什么
Pub Date : 2008-06-01 DOI: 10.1521/CAPN.2008.13.3.1
V. Gabbay, Lev Gottlieb, D. Shungu
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引用次数: 0
Prescriptions Into Practice: Guanfacine 实用处方:胍法辛
Pub Date : 2007-12-01 DOI: 10.1521/CAPN.2007.12.6.8
N. Akhtar
Guanfacine is an oral, centrally acting, alpha2–adrenergic receptor agonist used alone or in combination with other drugs for the treatment of essential hypertension. This medication works by producing a decrease in sympathetic outflow, resulting in a reduction of peripheral vascular resistance, renal vascular resistance, heart rate and blood pressure. Intuniv(Guanfacine), a non–stimulant selective alpha–2A–receptor agonist has been studied in children and adolescents with ADHD and has been considered for approval by FDA in June 2007. It binds selectively to alpha 2A adrenergic cell receptors located in the prefrontal cortex. The prefrontal cortex is an area of the brain associated with executive functioning, that is, working memory, behavioral inhibition, regulation of attention, distractibility, impulsivity, frustration tolerance, etc. The selective alpha–2A agonist strengthens working memory and prefrontal cortex neuronal firing. This research supports the use of guafacine for the treatment of ADHD.
胍法辛是一种口服中枢作用的α 2 -肾上腺素受体激动剂,用于单独或与其他药物联合治疗原发性高血压。这种药物的作用是使交感神经流出减少,从而降低周围血管阻力、肾血管阻力、心率和血压。inuniv (Guanfacine)是一种非兴奋剂选择性α - 2a受体激动剂,已在儿童和青少年多动症患者中进行了研究,并于2007年6月被FDA考虑批准。它选择性地与位于前额皮质的α 2A肾上腺素能细胞受体结合。前额叶皮层是大脑中与执行功能相关的区域,即工作记忆、行为抑制、注意力调节、注意力分散、冲动、挫折容忍等。选择性α - 2a激动剂增强工作记忆和前额皮质神经元放电。这项研究支持使用guafacine治疗ADHD。
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引用次数: 0
ADHD By Night: Sleep Problems and ADHD Medications 夜间多动症:睡眠问题和多动症药物
Pub Date : 2007-12-01 DOI: 10.1521/CAPN.2007.12.6.1
M. Stein, M. Weiss, B. Leventhal
It is now well established that impairments associated with ADHD often extend beyond the school day. As a result, new treatments have been developed to improve attention and reduce overactivity and impulsivity for increasingly longer periods of time. These longer–acting methylphenidate and amphetamine–based stimulants have become the most common ADHD medications. However, in addition to their salutary effects, ADHD medications can lead to less desirable effects in other functional domains, such as sleep. This review will describe the relationship between ADHD, stimulant medication, and sleep while highlighting clinical implications. A wide variety of sleep problems often co–occur with ADHD and often may antedate treatment. In fact, treatment of some sleep disorders (e.g., Sleep Disordered Breathing Disorder, Delayed Sleep Phase Disorder) may, in and of themselves, lead to improved attention or behavior. As a result, a sleep history and baseline measure of sleep functioning are an essential component of a proper evaluation of individuals presenting with symptoms of ADHD. If a primary sleep disorder is suspected, further sleep evaluation should be conducted by appropriately trained professionals. More commonly, however, sleep problems coexist with ADHD and psychiatric comorbidity, or may result from, or are exacerbated by, stimulant medication.
现在已经确定,与注意力缺陷多动障碍相关的损害通常会延伸到学校以外的日子。因此,新的治疗方法已经被开发出来,以提高注意力,减少越来越长时间的过度活动和冲动。这些长效的哌醋甲酯和安非他明类兴奋剂已经成为治疗多动症最常见的药物。然而,除了这些有益的作用外,多动症药物也会对其他功能领域产生不良影响,比如睡眠。这篇综述将描述ADHD、兴奋剂药物和睡眠之间的关系,同时强调临床意义。各种各样的睡眠问题往往与多动症同时发生,而且往往可能在治疗前出现。事实上,治疗一些睡眠障碍(例如,睡眠障碍呼吸障碍,延迟睡眠阶段障碍)本身可能会导致注意力或行为的改善。因此,睡眠史和睡眠功能的基线测量是对出现ADHD症状的个体进行适当评估的重要组成部分。如果怀疑有原发性睡眠障碍,应由受过适当训练的专业人员进行进一步的睡眠评估。然而,更常见的是,睡眠问题与多动症和精神疾病并存,或者可能是由兴奋剂药物引起的,或者是由兴奋剂药物加剧的。
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引用次数: 6
The Influence of Cannabis on the Developing Brain 大麻对大脑发育的影响
Pub Date : 2007-10-29 DOI: 10.1521/CAPN.2007.12.3.6
S. Sundram
M., Clevenger, W., Wu, M., Arnold, L. et al. (2001). Impairment and Deportment Responses to Different Methylphenidate Doses in Children With ADHD: The MTA Titration Trial. Journal of the American Academy of Child and Adolescent Psychiatry, 40(2), 180–187. Kollins, S., Greenhill, L., Swanson, J., Wigal, S., Abikoff, H., McCracken, J., Riddle, M., et al. (2006). Rationale, Design, and Methods of the Preschool ADHD Treatment Study (PATS). Journal of the American Academy of Child and Adolescent Psychiatry, 45(11), 1275–1283. McGough, J., McCracken, J., Swanson, J., Riddle, M., Kollins, S., Greenhill, L., Abikoff, H., et al. (2006). Pharmacogenetics of Methylphenidate Response in Preschoolers with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 45(11), 1314–1322. Swanson, J., Greenhill, L., Wigal, T., Kollins, S., Stehli, A., Davies, M., Chuang, S. et al. (2006). Stimulant–Related Reductions of Growth Rates in the PATS. Journal of the American Academy of Child and Adolescent Psychiatry, 45(11), 1304–1313. Wigal, T., Greenhill, L., Chuang, S., McGough, J., Vitiello, B., Skrobala, A., Swanson, J. et al. (2006). Safety and Tolerability of Methylphenidate in Preschool Children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 45(11), 1294–1303.
M., Clevenger, W., Wu, M., Arnold, L.等(2001)。多动症儿童对不同剂量哌甲酯的损害和行为反应:MTA滴定试验。美国儿童与青少年精神病学学会杂志,40(2),180-187。科林斯,s.s,格林希尔,路易斯安那州,斯旺森,J.,维加尔,S.,阿比科夫,H.,麦克拉肯,J.,里德尔,M.等(2006)。学龄前ADHD治疗研究(PATS)的基本原理、设计和方法。美国儿童与青少年精神病学学会杂志,45(11),1275-1283。麦高夫,J.,麦克拉肯,J.,斯旺森,J.,里德尔,M.,科林斯,S.,格林希尔,L.,阿比科夫,H.等(2006)。学龄前ADHD儿童哌甲酯反应的药物遗传学研究。美国儿童与青少年精神病学学会杂志,45(11),1314-1322。Swanson, J., Greenhill, L., Wigal, T., Kollins, S., Stehli, A., Davies, M., Chuang, S.等(2006)。与兴奋剂有关的减缓太平洋太平洋地区的生长速率。美国儿童与青少年精神病学学会杂志,45(11),1304-1313。Wigal, T., Greenhill, L., Chuang, S., McGough, J., Vitiello, B., Skrobala, A., Swanson, J.等(2006)。哌甲酯治疗学龄前ADHD儿童的安全性和耐受性。美国儿童与青少年精神病学学会杂志,45(11),1294-1303。
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引用次数: 0
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Child & adolescent psychopharmacology news
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