上海精神医学
上海精神醫學
상해정신의학
SHANGHAI ARCHIVES OF PSYCHIATRY
2013年
4期
236-243
,共8页
姜凌霄%李焱%张喜燕%江文庆%杨曹骅%郝楠%郝丽丽%李梦瑶%刘文文%张林娜%杜亚松
薑凌霄%李焱%張喜燕%江文慶%楊曹驊%郝楠%郝麗麗%李夢瑤%劉文文%張林娜%杜亞鬆
강릉소%리염%장희연%강문경%양조화%학남%학려려%리몽요%류문문%장림나%두아송
背景：注意缺陷多动障碍（Attention Deficit/Hyperactivity Disorder, ADHD）是中国精神科门诊儿童患者中最常见的诊断，最高比例约占所有患儿的50%。目的：了解中国精神科儿童门诊ADHD患儿特征和治疗情况的变迁。方法：随机抽取2000年至2011年间在上海市精神卫生中心儿少心理咨询门诊初诊患儿的病历，每年抽取250份。在所抽取的3000例患儿中，998例（33%）诊断为ADHD。结果：约80%的ADHD患儿为男性，大多数在7岁之前患病。确诊患儿初诊时平均（标准差）年龄为10.0（2.6）岁，初诊时平均病程为2.9（1.2）年，近年趋势为初诊年龄变小，初诊时病程变短。约20%的患儿为非上海户籍，约11%合并其他精神疾病诊断（主要是抑郁症和抽动障碍），近年来上述比例呈上升趋势。576例（58%）有复诊记录的患儿中，77%接受中枢兴奋剂，但是，行为治疗（单用或合并药物）的比例近年来明显增加。结论：ADHD仍然是中国精神科门诊儿童患者中最常见的诊断，但由于非专科治疗服务的扩大以及其他疾病诊断的增加，门诊ADHD患儿的比例在下降。令人欣慰的是ADHD呈现早诊断和早治疗的趋势以及非药物干预的应用有所增加。尽管如此，多数ADHD患儿确诊前至少已有2年病程，因此需要进一步研究来确定更好的方法以便更早地识别和治疗这一障碍。
揹景：註意缺陷多動障礙（Attention Deficit/Hyperactivity Disorder, ADHD）是中國精神科門診兒童患者中最常見的診斷，最高比例約佔所有患兒的50%。目的：瞭解中國精神科兒童門診ADHD患兒特徵和治療情況的變遷。方法：隨機抽取2000年至2011年間在上海市精神衛生中心兒少心理咨詢門診初診患兒的病歷，每年抽取250份。在所抽取的3000例患兒中，998例（33%）診斷為ADHD。結果：約80%的ADHD患兒為男性，大多數在7歲之前患病。確診患兒初診時平均（標準差）年齡為10.0（2.6）歲，初診時平均病程為2.9（1.2）年，近年趨勢為初診年齡變小，初診時病程變短。約20%的患兒為非上海戶籍，約11%閤併其他精神疾病診斷（主要是抑鬱癥和抽動障礙），近年來上述比例呈上升趨勢。576例（58%）有複診記錄的患兒中，77%接受中樞興奮劑，但是，行為治療（單用或閤併藥物）的比例近年來明顯增加。結論：ADHD仍然是中國精神科門診兒童患者中最常見的診斷，但由于非專科治療服務的擴大以及其他疾病診斷的增加，門診ADHD患兒的比例在下降。令人訢慰的是ADHD呈現早診斷和早治療的趨勢以及非藥物榦預的應用有所增加。儘管如此，多數ADHD患兒確診前至少已有2年病程，因此需要進一步研究來確定更好的方法以便更早地識彆和治療這一障礙。
배경：주의결함다동장애（Attention Deficit/Hyperactivity Disorder, ADHD）시중국정신과문진인동환자중최상견적진단，최고비례약점소유환인적50%。목적：료해중국정신과인동문진ADHD환인특정화치료정황적변천。방법：수궤추취2000년지2011년간재상해시정신위생중심인소심리자순문진초진환인적병력，매년추취250빈。재소추취적3000례환인중，998례（33%）진단위ADHD。결과：약80%적ADHD환인위남성，대다수재7세지전환병。학진환인초진시평균（표준차）년령위10.0（2.6）세，초진시평균병정위2.9（1.2）년，근년추세위초진년령변소，초진시병정변단。약20%적환인위비상해호적，약11%합병기타정신질병진단（주요시억욱증화추동장애），근년래상술비례정상승추세。576례（58%）유복진기록적환인중，77%접수중추흥강제，단시，행위치료（단용혹합병약물）적비례근년래명현증가。결론：ADHD잉연시중국정신과문진인동환자중최상견적진단，단유우비전과치료복무적확대이급기타질병진단적증가，문진ADHD환인적비례재하강。령인흔위적시ADHD정현조진단화조치료적추세이급비약물간예적응용유소증가。진관여차，다수ADHD환인학진전지소이유2년병정，인차수요진일보연구래학정경호적방법이편경조지식별화치료저일장애。
Background:Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common diagnosis among children treated in outpatient psychiatric clinics in China, accounting for up to 50%of all patients. Objective:Understand changes over time in the characteristics and treatment of children with ADHD seen at specialty psychiatric clinics in China. Methods:For each year from 2000 through 2011, 250 charts of patients who made their initial visit to the Child and Adolescent Psychological Counseling Clinic of the Shanghai Mental Health Center were randomly selected. Among the 3000 selected patients, 998 (33%) had a diagnosis of ADHD. Results:About 80%of the ADHD patients were male and the majority of them fell ill prior to the age of seven. The mean (sd) age at the time of first attendance at the clinic was 10.0 (2.6) years and the mean duration of illness at the time of the initial visit was 2.9 (1.2) years;both of these values decreased significantly over time. About 20%of them were non-residents of Shanghai and about 11%had comorbid psychiatric diagnoses (primarily depression and tic disorder);both of these proportions increased significantly over time. Among the 576 (58%) who visited the clinic more than once, 77%were treated with central nervous system stimulants, but the proportion administered behavioral treatments (either solely on in combination with medications) increased significantly over time. Conclusion:ADHD remains the most common diagnosis of children seen in specialty psychiatric clinics in China but the proportion of clinic attendees with ADHD is gradually declining as non-specialty treatment services expand and other diagnoses become more prominent. There are encouraging trends of earlier identification and treatment of ADHD and of increasing use of non-pharmacological interventions. Nevertheless, most children with ADHD have been ill for at least two years at the time of the initial diagnosis, so continued research efforts are needed to identify the best ways to speed up the recognition and treatment of this disabling condition.
