（新整理）儿童青少年精神分裂症的药物治疗ppt课件.ppt

1、Page 21. 中华医学会精神病学分会. 精神分裂症防治指南（第二版）.2015.(140).2. 精神病学（第五版）3. American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry. 2013 Sep;52(9):976-90.4. Howes OD, et al. Treatm

2、ent-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology. Am J Psychiatry. 2016 Dec 6:appiajp201616050503.5. Hiemke C, Baumann P, Bergemann N,等. AGNP精神科治疗药物监测共识指南:2011J. 实用药物与临床, 2016, 19(10).6. Correll C U, M

3、anu P, Olshanskiy V, et al. Cardiometabolic Risk of Second-Generation Antipsychotics During First-Time Use in Children and AdolescentsJ. Jama the Journal of the American Medical Association, 2009, 302(16):1765-1773.Page 3u儿童青少年精神分裂：起病年龄儿童青少年精神分裂：起病年龄1818岁的一种病因岁的一种病因未明，临床上以基本个性改变、特征性思维障碍、未明，临床上以基本个性改

4、变、特征性思维障碍、感知觉异常、情感与环境不协调、孤独性表现为主感知觉异常、情感与环境不协调、孤独性表现为主要特征的精神障碍。要特征的精神障碍。u儿童青少年精神分裂症分为：儿童青少年精神分裂症分为：起病年龄起病年龄13131818岁的早发性精神分裂症岁的早发性精神分裂症起病年龄起病年龄1313岁的儿童期发病的精神分裂。岁的儿童期发病的精神分裂。儿童青少年精神分裂症的诊断，与成人相同，不考儿童青少年精神分裂症的诊断，与成人相同，不考虑发病年龄。虑发病年龄。American Academy of Child and Adolescent Psychiatry. Practice parameter

5、 for the assessment and treatment of children and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry. 2013 Sep;52(9):976-90.Page 4中华医学会精神病学分会. 精神分裂症防治指南（第二版）.2015.(140).American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and treatment of childre

6、n and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry. 2013 Sep;52(9):976-90.Page 5中华医学会精神病学分会. 精神分裂症防治指南（第二版）.2015.(140).American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. J Am A

7、cad Child Adolesc Psychiatry. 2013 Sep;52(9):976-90.Page 6Howes OD, et al. Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology. Am J Psychiatry. 2016 Dec 6:appiajp201616050503.Page 7抗精神病药抗精神病药代谢酶代谢酶

8、典型药典型药1A2、2D6阿立哌唑阿立哌唑2D6、3A4利培酮利培酮2D6、3A4喹硫平喹硫平2D6、3A4氯氮平氯氮平1A2、2C19、3A4奥氮平奥氮平N-葡萄糖醛酸转移酶、1A2、2D6帕利哌酮帕利哌酮1A2抑制剂：抑制剂：诺氟沙星、氟伏沙明、环丙沙星、诱导剂：诱导剂：卡马西平、吸烟2D6抑制剂：抑制剂：帕罗西汀、奋乃静、美托洛尔、氟西汀、度洛西汀、胺碘酮诱导剂：3A4抑制剂：抑制剂：氟伏沙明、红霉素、胺碘酮诱导剂：诱导剂：卡马西平、苯巴比妥、苯妥英2C19抑制剂：抑制剂：奥美拉唑、氟伏沙明、氟西汀、埃索美拉唑诱导剂：诱导剂：卡马西平、银杏叶、苯巴比妥、苯妥英Hiemke C, Baum

9、ann P, Bergemann N,等. AGNP精神科治疗药物监测共识指南:2011J. 实用药物与临床, 2016, 19(10).Page 8ADR代谢EPS心血管其他中华医学会精神病学分会. 精神分裂症防治指南（第二版）.2015.(140).American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. J Am Acad Child Adol

10、esc Psychiatry. 2013 Sep;52(9):976-90.Page 9Correll C U, Manu P, Olshanskiy V, et al. Cardiometabolic Risk of Second-Generation Antipsychotics During First-Time Use in Children and AdolescentsJ. Jama the Journal of the American Medical Association, 2009, 302(16):1765-1773.Page 10Correll C U, Manu P,

11、 Olshanskiy V, et al. Cardiometabolic Risk of Second-Generation Antipsychotics During First-Time Use in Children and AdolescentsJ. Jama the Journal of the American Medical Association, 2009, 302(16):1765-1773.Page 11American Academy of Child and Adolescent Psychiatry. Practice parameter for the asse

12、ssment and treatment of children and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry. 2013 Sep;52(9):976-90.Page 12中华医学会精神病学分会. 精神分裂症防治指南（第二版）.2015.(140).American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and treatment of children and adoles

13、cents with schizophrenia. J Am Acad Child Adolesc Psychiatry. 2013 Sep;52(9):976-90.Page 13其他其他ADRADR催乳素升高催乳素升高血液系统血液系统抽搐抽搐肝毒性肝毒性镇静、体位镇静、体位低血压等低血压等中华医学会精神病学分会. 精神分裂症防治指南（第二版）.2015.(140).American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and treatment of childr

14、en and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry. 2013 Sep;52(9):976-90.Page 141.1. 首选指南推荐的非典型抗精神病药，急性发作可以考虑首选指南推荐的非典型抗精神病药，急性发作可以考虑短期使用氟哌啶醇，需谨慎（短期使用氟哌啶醇，需谨慎（EPSEPS和认知功能）和认知功能）2.2. 多种药物联合使用可按照不同药理作用、不良反应、多种药物联合使用可按照不同药理作用、不良反应、P450P450酶的相互作用选择药物。酶的相互作用选择药物。3.3. ADRADRa)a) 儿童青少年代谢紊乱的影响尤为突出，奥氮平最好不作为首选儿童青少年代谢紊乱的影响尤为突出，奥氮平最好不作为首选b)b) EPSEPS和催乳素的和催乳素的ADRADR比成人高，可能与比成人高，可能与D D2 2受体密度低有关，急性受体密度低有关，急性期可预防使用抗帕金森的药物。期可预防使用抗帕金森的药物。Page 15