心境稳定剂在治疗儿童精神障碍中的应用.docVIP

心境稳定剂在治疗儿童精神障碍中的应用 　　摘 要 心境稳定剂在儿童和青少年心理和行为障碍治疗中的应用广泛，适用于治疗双相情感障碍、破坏性行为障碍和注意力缺陷-多动障碍等行为障碍患者出现的冲动和攻击行为以及情绪不稳定和易激惹等表现，同时对发育迟缓儿童如精神发育迟滞和孤独症等患者出现的伤害他人或自伤行为治疗也有效果。在经典的心境稳定剂中，锂盐是唯一获准可一线用于儿童和青少年双相情感障碍患者躁狂发作和维持治疗的药物，而丙戊酸盐、卡马西平、奥卡西平和拉莫三嗪在治疗儿童攻击性或破坏性行为中也有一定的临床应用。选用心境稳定剂治疗儿童精神障碍时应考虑药物的疗效证据、安全性和不良反应以及患者的靶症状、疾病史、用药史和家族史等，以确保儿童用药安全、有效。 　　关键词 心境稳定剂 精神障碍 儿童 　　中图分类号：R971.4； R749.94 文献标识码：A 文章编号：1006-1533（2014）19-0005-05 　　The application of mood stabilizers in children’s mental disorders 　　HAN Jingjing*， GAO Hongyun** 　　（Department of Psychology， Children’s Hospital， Fudan University， Shanghai 201102， China） 　　ABSTRACT Mood stabilizers have been widely used in psychological and behavioral disorders in children and adolescents， including bipolar disorder， disruptive behavior disorders， attention deficit hyperactivity disorder and other behavioral disorders that appear in aggressive behavior， and emotional instability， irritability and other symptoms and they can be applied in the treatment of the delay of development such as mental retardation， and autism appeared to harm others or have the self-injurious behavior in children. Among classic mood stabilizers， lithium is the only approved first-line therapy for the treatment of manic episodes and maintenance in children and adolescents with bipolar disorder， and valproate and carbamazepine， oxcarbazepine and lamotrigine can also be applied in the certain treatment of children with aggressive or disruptive behavior. The evidence of drug efficacy， safety and adverse reactions， target symptoms， disease， medication and even family history should be considered when a mood stabilizer is going to use so as to ensure the safe and effective medication in children and adolescents. 　　KEY WORDS mood stabilizers； mental disorders； children 　　心境稳定剂是几类具有相同治疗作用的药物的统称，能够抗躁狂发作、抗抑郁发作、预防自杀和稳定情绪，包括以锂盐、丙戊酸盐和卡马西平等抗惊厥药物为代表的传统心境稳定剂，同时第二代抗精神病药物如奥氮平、喹硫平和利培酮等也因具有不同程度的抗躁狂发作、抗抑郁发作和稳定心境的作用而被认为是新一代的心境稳定剂。尽管心境稳定剂这一术语已在精神科领域得到广泛应用，但对其标准定义迄今尚未达成一致共识[1]。就临床应用