ADHD注意缺陷多动障碍诊断治疗.ppt

治疗的主要方法 药物治疗 行为治疗 药物联合行为治疗 父母/患者健康教育 教育支持服务 药物是治疗ADHD的最有效的手段 MTA研究：不同治疗模式的效果 药物治疗和药物联合行为治疗显著优于行为治疗和常规社区护理 在改善核心症状方面，药物治疗与药物联合行为治疗无显著差异 行为治疗可能有助于改善某些非ADHD症状或巩固药物疗效 The MTA Cooperative Group. Arch Gen Psychiatry. 1999;56:1073-1086. The MTA Cooperative Group。Arch Gen Psychiatry 1999;56:1088-1096 ADHD不伴焦虑者 ADHD伴焦虑者 Wilens T, et al. ADHD, In Annual Review of Medicine, 2002: 53. Greenhill L. Childhood attention deficit hyperactivity disorder: pharmacological treatments. In: Nathan PE, Gorman J, eds. Treatments that Work. Philadelphia, PA: Saunders; 1998:42-64. * 当时尚未上市 ADHD治疗用药 中枢兴奋剂 (一线治疗药物) 哌甲酯：首选 速释－利他林 控释－专注达? （ *托莫西丁 ） 苯丙胺类化合物 右旋苯丙胺 匹莫林 抗抑郁药 三环类抗抑郁药 安非他酮 抗高血压药 可乐定 胍法辛 ADHD诊断概述与治疗原则 概况：定义，发病情况，危害 临床表现：核心症状 诊断：诊断与分类标准 治疗原则：综合干预（药物、心理、教育） 早期识别和正确诊断是及时采取恰当治疗的前提 综合应用以药物和心理行为干预为核心的多种治疗方法，是ADHD儿童获得满意预后的关键环节 总 结 * The prevalence of ADHD is fairly consistent across diverse geographic, racial, and socioeconomic populations. Differences in reported prevalence rates between countries are largely a result of the definitions used and not from geographical differences. In studies using ICD (International Classification of Diseases) criteria, rates are generally lower because of more restrictive criteria. Estimates based on DSM-III-R criteria may be understating current prevalence rates. The evolution of criteria from DSM-III to DSM-IV has broadened the case definition so that more children appear to be affected. Earlier DSM diagnostic criteria had a narrower focus—largely based on hyperactivity. Current criteria, which include hyperactive-impulsive and inattentive subtypes, have resulted in higher rates of diagnosis. Elia et al. N Engl J Med 1999;340:780. Wolraich et al. JAACAP 1996;35:319. Baumgaertel et al. JAACAP 1995;34:629. * * There are obvious additional stresses placed on family members of individuals with ADHD. Mothers of children with ADHD have reported significantly lower levels of self-esteem in parenting and higher levels of depression, self-blame,