Genetic factors n Brain damage n Neurochemical factors
病 因 遺傳因素 Genetic factors n 腦部損傷 Brain damage n 神經傳導物質 Neurochemical factors n 神經生理因素 Neurophysiological factors n n 心理社會因素 Psychosocial factors 影片一、二
過動症的原因: 神經影像 Frontal Lobe 額葉功能異常 專心時 服藥後 MPH 休息時 (SPEC, ant. cingulate and hippcampus)
注意力不足過動症的神經化學生理 Noradrenaline Dopamine Nerve Impulse Transporter Synapse Receptors
MTA: Multimodal Treatment Study of children with ADHD n 美國心理衛生研究院(the National Institute of Mental Health)及教育部( Department of Education)進行的一項公 正大型的權威性研究 n The MTA Cooperative Group. A 14 -month randomized clinical trial of treatment strategies for attention-deficit hyperactivity disorder (ADHD). Archives of General Psychiatry, 1999; 56: 1073 -1086.
中樞神經興奮劑 Methylphenidate n 持續釋放型 Sustained-Released – Ritalin SR n 延長釋放型 Extended-Released – Concerta® 專司達 ®
延長釋放劑型 Extended-Released n Concerta – Once daily – Duration: 12 hours n Ritalin LA, Metadate CD (Available only in USA) – Once daily – Duration: 8~10 hours n Adderall XR (Available only in USA) – Once daily – D-amphetamine and L-amphetamine – Efficay, similar to MPH bid
OROS system - Concerta Laser-Drilled Hole MPH Compartment #1 MPH Overcoat MPH Compartment #2 Tablet Shell Push Compartment
主要參考文獻 n n n Pliszka S, AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2007 Jul; 46(7): 894 -921. University of Michigan Health System. Attention-deficit hyperactivity disorder. Ann Arbor (MI): University of Michigan Health System; 2005 Oct. 35 p. National Institute for Health and Clinical Excellence (NICE). Methylphenidate atomoxetine and dexamfetamine for attention deficit hyperactivity disorder (ADHD) in children and adolescents. London (UK): National Institute for Health and Clinical Excellence (NICE); 2006 Mar. 34 p.
Grades of Recommendation n n [MS] Minimal Standard is applied to recommendations that are based on rigorous empirical evidence (e. g. , randomized, controlled trials) and/or overwhelming clinical consensus. Minimal standards apply more than 95% of the time (i. e. , in almost all cases). [CG] Clinical Guideline is applied to recommendations that are based on strong empirical evidence (e. g. , nonrandomized, controlled trials) and/or strong clinical consensus. Clinical guidelines apply approximately 75% of the time (i. e. , in most cases). [OP] Option is applied to recommendations that are acceptable based on emerging empirical evidence (e. g. , uncontrolled trials or case series/reports) or clinical opinion, but lack strong empirical evidence and/or strong clinical consensus. [NE] Not Endorsed is applied to practices that are known to be ineffective or contraindicated.
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