唐氏综合征的药物治疗
Pharmacotherapy of Down syndrome.
摘要(中文译文)
共病精神障碍在唐氏综合征（DS）中较为常见。关于唐氏综合征精神共病的药物治疗证据有限。本文综述了与唐氏综合征共存的精神疾病的药物治疗文献，包括重性抑郁障碍（MDD）、双相障碍、焦虑障碍、强迫症（OCD）、注意缺陷/多动障碍（ADHD）、孤独症谱系障碍（ASD）、精神病性障碍及紧张症。文中还纳入了关于退行现象的一节。对于重性抑郁障碍，我们通常以选择性5-羟色胺再摄取抑制剂（SSRIs）开始治疗。对于双相障碍，我们常使用卡马西平。对于精神病性症状，我们从利培酮或阿立哌唑开始。我们使用丁螺环酮治疗焦虑。对于强迫性迟缓/强迫症，我们从SSRI开始。对于刻板重复行为，我们倾向于使用丁螺环酮。对于注意缺陷/多动障碍，我们从胍法辛开始。对于共病孤独症谱系障碍的易激惹，我们使用利培酮或阿立哌唑。对于唐氏综合征中的痴呆，我们将患者转诊至神经科医生进行医学检查和药物管理。我们用劳拉西泮治疗类紧张症性“退行”。如果无效，我们使用美金刚或氯氮平。如果药物治疗无效，则考虑电休克治疗。对于伴有重性抑郁障碍±精神病性症状的“退行”，我们使用抗抑郁药，必要时联用抗精神病药。有必要开展针对唐氏综合征共病精神障碍药物治疗的随机对照试验。
Abstract
: Comorbid psychiatric disorders are common in Down syndrome (DS). Evidence for pharmacotherapy of psychiatric co-morbidity in DS is limited. : This article reviews the literature on the pharmacotherapy of psychiatric conditions co-occurring with DS, including major depressive disorder (MDD), bipolar disorder, anxiety disorders, obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), psychosis, and catatonia. A section on the phenomenon of regression is included. : For MDD, we typically begin with selective serotonin reuptake inhibitors (SSRIs). For bipolar disorder, we often use carbamazepine. For psychotic symptoms, we begin with risperidone or aripiprazole. We use buspirone to treat anxiety. For obsessional slowness/OCD, we begin with an SSRI. For stereotypical repetitive behavior, we tend to use buspirone. For ADHD, we begin with guanfacine. For irritability of comorbid ASD, we use risperidone or aripiprazole. For dementia in DS, we refer to a neurologist for medical work-up and medication management. We treat catatonia-like 'regression' with lorazepam. If ineffective, we use memantine or clozapine. Electroconvulsive therapy is considered if pharmacotherapy is ineffective. We treat 'regression' with symptoms of MDD ± psychosis, with an antidepressant and an antipsychotic if needed. Randomized controlled trials of medications for comorbid psychiatric disorders in DS are warranted.
如何引用
AMA
Michelle L Palumbo, Christopher J McDougle. Pharmacotherapy of Down syndrome.. Expert opinion on pharmacotherapy. 2018; doi:10.1080/14656566.2018.1529167.
APA
Michelle L Palumbo, Christopher J McDougle (2018). Pharmacotherapy of Down syndrome.. Expert opinion on pharmacotherapy. https://doi.org/10.1080/14656566.2018.1529167
GB/T 7714
Michelle L Palumbo, Christopher J McDougle. Pharmacotherapy of Down syndrome.[J]. Expert opinion on pharmacotherapy, 2018 doi:10.1080/14656566.2018.1529167.
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