兒童青少年精神分裂癥的藥物治療病區(qū)學(xué)習(xí)教案

1、會(huì)計(jì)學(xué)1兒童兒童(r tng)青少年精神分裂癥的藥物治療青少年精神分裂癥的藥物治療病區(qū)病區(qū)第一頁，共16頁。n中華醫(yī)學(xué)會(huì)精神病學(xué)分會(huì). 精神分裂癥防治指南（第二版）.2015.(140).n精神病學(xué)（第五版）nAmerican 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 S

2、ep;52(9):976-90.nHowes 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.nHiemke C, Baumann P, Bergemann N,等. AGNP精神科治療(zhlio)藥物監(jiān)測(cè)共識(shí)指南:2

3、011J. 實(shí)用藥物與臨床, 2016, 19(10).nCorrell 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.第1頁/共15頁第二頁，共16頁。u兒童青少年精神分裂：起病年齡兒童青少年精神分裂：

4、起病年齡1818歲的一種病因未歲的一種病因未明，臨床上以基本個(gè)性改變、特征性思維障礙、感明，臨床上以基本個(gè)性改變、特征性思維障礙、感知覺知覺(zhju)(zhju)異常、情感與環(huán)境不協(xié)調(diào)、孤獨(dú)性異常、情感與環(huán)境不協(xié)調(diào)、孤獨(dú)性表現(xiàn)為主要特征的精神障礙。表現(xiàn)為主要特征的精神障礙。u兒童青少年精神分裂癥分為：兒童青少年精神分裂癥分為：u起病年齡起病年齡13131818歲的早發(fā)性精神分裂癥歲的早發(fā)性精神分裂癥u起病年齡起病年齡1313歲的兒童期發(fā)病的精神分裂。歲的兒童期發(fā)病的精神分裂。u兒童青少年精神分裂癥的診斷，與成人相同，不考兒童青少年精神分裂癥的診斷，與成人相同，不考慮發(fā)病年齡。慮發(fā)病年齡。Am

5、erican 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.第2頁/共15頁第三頁，共16頁。中華醫(yī)學(xué)會(huì)精神病學(xué)分會(huì)(fn hu). 精神分裂癥防治指南（第二版）.2015.(140).American Academy of Child an

6、d 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.第3頁/共15頁第四頁，共16頁。中華醫(yī)學(xué)會(huì)精神病學(xué)分會(huì)(fn hu). 精神分裂癥防治指南（第二版）.2015.(140).American Academy of Child and Adolescent Psychiatry. P

7、ractice parameter for the assessment and treatment of children and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry. 2013 Sep;52(9):976-90.第4頁/共15頁第五頁，共16頁。Howes OD, et al. Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Conse

8、nsus Guidelines on Diagnosis and Terminology. Am J Psychiatry. 2016 Dec 6:appiajp201616050503.第5頁/共15頁第六頁，共16頁?？咕癫∷幋x酶典型藥典型藥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奧氮平奧氮平N-葡萄糖醛酸轉(zhuǎn)移酶、1A2、2D6帕利哌酮帕利哌酮1A2抑制劑：抑制劑：諾氟沙星、氟伏沙明、環(huán)丙沙星、誘導(dǎo)劑：誘導(dǎo)劑：卡馬西平、吸煙2D6抑制劑：抑制劑：帕羅西汀、奮乃靜、美托洛爾、氟西汀、度洛西汀、胺碘

9、酮誘導(dǎo)劑：3A4抑制劑：抑制劑：氟伏沙明、紅霉素、胺碘酮誘導(dǎo)劑：誘導(dǎo)劑：卡馬西平、苯巴比妥、苯妥英2C19抑制劑：抑制劑：奧美拉唑、氟伏沙明、氟西汀、埃索美拉唑誘導(dǎo)劑：誘導(dǎo)劑：卡馬西平、銀杏葉、苯巴比妥、苯妥英Hiemke C, Baumann P, Bergemann N,等. AGNP精神科治療藥物(yow)監(jiān)測(cè)共識(shí)指南:2011J. 實(shí)用藥物(yow)與臨床, 2016, 19(10).第6頁/共15頁第七頁，共16頁。中華醫(yī)學(xué)會(huì)精神病學(xué)分會(huì)(fn hu). 精神分裂癥防治指南（第二版）.2015.(140).American Academy of Child and Adolescen

10、t 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.第7頁/共15頁第八頁，共16頁。Correll C U, Manu P, Olshanskiy V, et al. Cardiometabolic Risk of Second-Generation Antipsychotics During First

11、-Time Use in Children and AdolescentsJ. Jama the Journal of the American Medical Association, 2009, 302(16):1765-1773.第8頁/共15頁第九頁，共16頁。Correll C U, Manu P, Olshanskiy V, et al. Cardiometabolic Risk of Second-Generation Antipsychotics During First-Time Use in Children and AdolescentsJ. Jama the Journ

12、al of the American Medical Association, 2009, 302(16):1765-1773.第9頁/共15頁第十頁，共16頁。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.第10頁/共15

13、頁第十一頁，共16頁。中華醫(yī)學(xué)會(huì)精神病學(xué)分會(huì)(fn hu). 精神分裂癥防治指南（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 Adolesc Psychiatry. 2013 Sep;52(9):976-90.第11頁/共15頁第十二頁，共16頁。中華醫(yī)學(xué)會(huì)精神病學(xué)分會(huì)(f

14、n hu). 精神分裂癥防治指南（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 Adolesc Psychiatry. 2013 Sep;52(9):976-90.第12頁/共15頁第十三頁，共16頁。nEPSEPS和催乳素的和催乳素的ADRADR比成人高，可能與比成人高，可能與D2D2受受體密度低有關(guān)，急性期可預(yù)防使用抗帕金體密度低有關(guān)，急性期可預(yù)防使用抗帕金森的藥物。森的藥物。第13頁/共15頁第