按一下以編輯母片標題樣式,*,按一下以編輯母片,第二層,第三層,第四層,第五層,情緒障礙兒童的藥物治療,台北市立療養院,兒童精神科,林亮吟,為什麼要使用藥物,藥物是兒童青少年精神疾病情緒問題的有效方法之一。,情緒障礙的治療不能只有藥物。,藥物治療應該是完整治療的其中一部份。,使用藥物前應該有完整的生理心理評估。,對於情緒障礙兒童可能需要的治療還包括行為治療、心理治療、家庭治療、親職指導、社交技巧的教導與特殊教育等等,需合格的兒童精神科醫師開與處方。,使用藥物前的注意事項,藥物名稱？,藥物對兒童的可能幫助？,其他有幫助的方法是什麼？,藥物需要服用多久？,什麼時候會發揮作用產生療效？,常見的副作用有哪些,?,有沒有較少見的嚴重副作用？,服用藥物後會成癮嗎？會不會被濫用？,建議劑量與使用頻率,服藥前後需要做什麼生化檢查？,誰來追蹤藥物的進展？,飲食有無禁忌,?,藥物與其他藥物的交互作用為何？,服藥後需要特別的活動嗎？還是做什麼活動需要小心？,什麼時候可以停藥？,假如有副作用該怎麼辦？,藥價？,校護需要知道兒童的服藥狀況嗎?,藥物的基本種類,Stimulant Medications,興奮劑,Antidepressant Medications,抗憂鬱劑,Antipsychotic,Medications,抗精神病藥物,Mood Stabilizers and Anticonvulsant Medication,情緒穩定劑與抗癲癇藥物,Anti-anxiety Medications,抗焦慮劑,Sleep Medications,助眠劑,Miscellaneous Medications,其他,各類情緒障礙的適用藥物,Antidepressant Medications,抗憂鬱劑,經常使用在,憂鬱症,Depression,懼學症,School phobias,恐慌症,Panic attacks,其他焦慮性疾患,Other anxiety disorders,尿床,Bedwetting,飲食疾患,Eating disorders,強迫症,Obsessive-compulsive disorder,人格障礙,Personality disorders,創傷後壓力症(候群),Posttraumatic stress disorder,注意力缺陷過動症,ADHD,各類情緒障礙的適用藥物,Antidepressant Medications,抗憂鬱劑,抗憂鬱劑的種類,Tricyclics,(TCA),三環抗鬱劑,Serotonin,reuptake inhibitors(SSRI),血清素吸收抑制劑,Monoamine,oxidase,inhibitors(MAOI),單胺氧化抑制劑,Atypical antidepressants,非典型抗鬱劑,各類情緒障礙的適用藥物,Antidepressant Medications,抗憂鬱劑,常用的抗憂鬱劑,Tricyclic,antidepressants,(TCAs),Amitriptyline,(Trypotanol,Elavil,),Clomipramine(,Anafranil,),Imipramine(,Tofranil,),Nortriptyline(,Avatyl,Pamelor,),Imipramine(,Tofranil,),各類情緒障礙的適用藥物,Antidepressant Medications,抗憂鬱劑,常用的抗憂鬱劑,Serotonin,reuptake inhibitors,(SSRIs),Fluoxetine,(,Prozac,),:for OCD in school age,Sertraline,(,Zoloft,):for OCD,in school age,Paroxetine,(Seroxat,Paxil,),Fluvoxamine(Luvox,),Venlafaxine(,Effexor,),Citalopram,(Cipram,Celexa,),各類情緒障礙的適用藥物,Antidepressant Medications,抗憂鬱劑,常用的抗憂鬱劑,Monoamine,oxidase,inhibitors,(,MAOIs,),Phenelzine(,Nardil,),Tranylcypromine(Parnate,),Atypical Antidepressants,Bupropion(,Wellbutrin,),Nefazodone(,Serzone,),Trazodone(,Mesyrel,Desyrel,),Mirtazapine(,Remeron,),各類情緒障礙的適用藥物,Antipsychotic,Medications,抗精神病藥物,經常使用在,精神病症狀,Psychotic symptoms,妄念,Delusions,幻覺,Hallucination,失序的思考,Disorganized thinking,抽搐症,Tics:verbal&motor,吐雷氏症候群,Tourette,s Syndrome,偶而使用在,嚴重的焦慮,Severe anxiety,攻擊行為,Aggressive behavior,各類情緒障礙的適用藥物,Antipsychotic,Medications,抗精神病藥物,經常使用的傳統抗精神病藥物,Chlorpromazine,(,Thorazine,),Thioridazine(,Mellaril,),Fluphenazine(,Prolixin,),Trifluoperazine(,Stelazine,),Thiothixene(,Navane,),Haloperidol(,Haldol,),新的非典型抗精神病藥物,Clozapine(,Clozaril,),Risperidone(,Risperdal,),Quetiapine(,Seroquel,),Olanzapine(,Zyprexa,),Ziprasidone(,Zeldox,),各類情緒障礙的適用藥物,Mood Stabilizers and Anticonvulsant Medication,情緒穩定劑與抗癲癇藥物,經常使用在,躁鬱症,Manic-depressive episodes,情緒變動,Excessive mood swings,攻擊行為,Aggressive behavior,衝動控制障礙,Impulse control disorders,下列兩種疾病出現嚴重的情緒症狀,Severe mood symptoms in,a.,Schizoaffectivedisorder,情感性精神分裂症,b.Schizophrenia,精神分裂症,各類情緒障礙的適用藥物,Anti-anxiety Medications,抗焦慮劑,經常用在,嚴重焦慮症,Severe anxiety,常用的藥物種類有,Benzodiazepines,Antihistamines,Atypicals,各類情緒障礙的適用藥物,Anti-anxiety Medications,抗焦慮劑,常用的藥物種類有,Benzodiazepines,Alprazolam(,Xanax,),Lorazepam(,Ativan,),Diazepam(,Valium,),Clonazepam,(Rivotril,Klonopin,),Antihistamines,Diphenhydramine,(,Benadryl,),Hydroxizine(,Vistaril,),Atypicals,Buspirone(,Rrelac,BuSpar,),Zolpidem(,Stilnox,Ambien,),各類情緒障礙的適用藥物,Sleep Medications,助眠劑,經常用在,常用的藥物種類有,SSRI Anti-depressants,Trazodone,(Mesyrel,Desyrel,),Zolpidem,(,Ambien,),Diphenhydramine,(,Benadryl,),各類情緒障礙的適用藥物,Miscellaneous Medications,其他,ADHD severe impulsiveness,Clonidine(,Catapres,),Flashbacks of,PTSD,Guanfacine(,Tenex,),各類情緒障礙的適用藥物,Stimulant Medications,興奮劑,經常使用在,注意力缺陷過動症,ADHD,常用藥物有,Dextroamphetamine,(,Dexedrine,Adderal,)(DEX),Methylphenidate(,Ritalin,),利他能 (,MPH),Pemoline(,Cylert,),M,ixed-salts amphetamine(AMP),研究與專家的共識意見,NIMH&FDA,美國國家精神研究院&美國食品藥物管理局,2000年10月會議討論結果,Investigate the effects of psychotropic medications in young children,Examine current obstacles to research in this area,Identify possible approaches to future activities,Researchers and clinicians involved in the diagnosis and treatment of young children with behavioral and emotional disturbances,研究與專家的共識意見,NIMH&FDA,美國國家精神研究院&美國食品藥物管理局,2000年10月會議討論結果,0.51%,to 1.23%of preschoolers received,stimulant,medications,0.07%to 0.32%,antidepressants,0.19%to 0.23%,clonidine,0.02%to 0.09%,neuroleptics,in 1995,From 1991 to 1995,with stimulants showing a,two-to threefold,increase,Most of these medications are prescribed by,pediatricians,and other,primary care physicians,Low use rate is in contrast with the use of psychosocial services,研究與專家的共識意見,NIMH&FDA,美國國家精神研究院&美國食品藥物管理局,2000年10月會議討論結果,Autism,other pervasive disorders,and ADHD,have onset typically in preschool years,Psychotropics,Attempt to treat associated symptoms,such as,stereotypies,compulsions,aggression,and self-injurious behavior,Stimulant Medications,興奮劑,By 1996,161 randomized controlled trials,had been published,Encompassing 5 preschool,150 school-age,7 adolescent,9 adult studies,Improvement occurred in 65%to 75%of the 5,899 patients randomized to stimulants,only 5%to 30%of improvement