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首页> 外文期刊>The journal of clinical psychiatry >Developments in pediatric psychopharmacology: focus on stimulants, antidepressants, and antipsychotics.
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Developments in pediatric psychopharmacology: focus on stimulants, antidepressants, and antipsychotics.

机译：儿科心理药理学的发展：专注于兴奋剂，抗抑郁药和抗精神病药。

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Most major psychiatric disorders have an onset in childhood or adolescence in a sizeable proportion of patients, and earlier onset disorders often have a severe and chronic course that can seriously disrupt sensitive developmental periods, with lifelong adverse consequences. Accordingly, psychopharmacologic treatments have been increasingly utilized in severely ill youth. However, the increased use of psychopharmacologic treatments in pediatric patients has also raised concerns regarding a potential overdiagnosis and overtreatment of youth, without adequate data regarding the pediatric efficacy and safety of psychotropic agents. Over the past decade, a remarkable number of pediatric randomized controlled trials have been completed, especially with psychostimulants, antidepressants, and antipsychotics. For these frequently used agents, effect sizes against placebo have typically been at least moderate, with most numbers-needed-to-treat well below 10 for response, indicating clinical significance as well. Nevertheless, data also point to a greater and/or different profile of susceptibility to adverse effects in pediatric compared to adult patients, as well as to a role for nonpharmacologic treatments, given alone or combined with pharmacotherapy, for many of the youth. Taken together, these results highlight the need for a careful assessment of the risk-benefit relationship of psychopharmacologic treatments in patients who cannot be managed sufficiently with nonpharmacologic interventions and for routine, proactive adverse effect monitoring and management. Although considerable progress has been made, there is still enormous need for additional data and funding of pediatric psychopharmacology trials. It is hoped that the field will acquire the necessary resources to propel pediatric clinical psychopharmacology to new levels of insight by linking it with, but not replacing it by, pharmacoepidemiologic and biomarker approaches and advances.
机译：大多数主要的精神疾病在相当大比例的患者中会在儿童期或青春期发作，而较早的发作性疾病通常具有严重和慢性的病程，会严重破坏敏感的发育时期，并带来终生的不良后果。因此，在重病青年中越来越多地使用心理药物治疗。然而，在没有足够的有关精神药物的儿科疗效和安全性的数据的情况下，在儿科患者中越来越多地使用心理药物治疗也引起了人们对潜在的过度诊断和过度治疗的担忧。在过去的十年中，已经完成了大量的儿科随机对照试验，尤其是对精神刺激药，抗抑郁药和抗精神病药进行的试验。对于这些经常使用的药物，针对安慰剂的作用大小通常至少为中等，大多数需要治疗的数字远低于10才能产生反应，这也表明了临床意义。然而，数据还表明，与成年患者相比，儿科对不良反应的易感性更大和/或不同，并且对于许多年轻人而言，单独或联合药物治疗进行非药物治疗具有重要作用。综上所述，这些结果强调了需要仔细评估无法通过非药物干预得到充分管理的患者中心理药物治疗的风险-收益关系，以及常规，主动的不良反应监测和管理。尽管已经取得了相当大的进步，但是仍然非常需要儿童心理药理学试验的其他数据和资金。希望该领域将通过与药物流行病学和生物标志物的研究方法和进展相联系而不是代替它来推动儿科临床心理药理学发展到新的见识水平，从而获得必要的资源。

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