Thuốc kích thích

European Child & Adolescent Psychiatry - Tập 9 - Trang S27-S43 - 2000
Paramala Janardhanan Santosh1, Eric Taylor2
1Department of Child & Adolescent Psychiatry Institute of Psychiatry, Clinical Lecturer in Child & Adolescent Psychiatry, London, UK
2Department of Child & Adolescent Psychiatry, Institute of Psychiatry, London, UK

Tóm tắt

Các loại thuốc kích thích là yếu tố quan trọng trong điều trị ADHD (Rối loạn tăng động - giảm chú ý). Các thử nghiệm được thiết kế cẩn thận về thuốc kích thích đã phát hiện thấy sự cải thiện đáng kể trong hành vi cốt lõi của ADHD ở 65–75% đối tượng mắc ADHD. Hầu hết các loại thuốc kích thích tiêu chuẩn được hấp thu nhanh, với các tác động hành vi xuất hiện trong vòng 30 phút, đạt đỉnh trong khoảng một đến ba giờ và biến mất trong vòng năm giờ. Liều dùng ở trường học thường là cần thiết, bất chấp nguy cơ bị bạn bè chế giễu và các yêu cầu giám sát thêm từ người lớn. Cơ chế mà thuốc kích thích hoạt động để giảm hoạt động thái quá vẫn chưa được hiểu rõ hoàn toàn, nhưng chúng cải thiện tính bốc đồng và mức độ hoạt động. Một số đánh giá có kiểm soát được thực hiện trong thời gian dài hơn một năm cho thấy tác dụng của thuốc rõ ràng vẫn tồn tại theo thời gian. Một chương trình điều trị được thiết kế cẩn thận với methylphenidate hiệu quả hơn trong việc giảm triệu chứng tăng động so với một chương trình can thiệp hành vi và nhận thức cường độ cao. Sự kết hợp giữa thuốc kích thích với các can thiệp tâm lý xã hội trong ADHD mang lại rất ít lợi thế hơn so với việc chỉ sử dụng thuốc. Rất khó để đề xuất các hướng dẫn thực hành không thể tranh cãi mà phù hợp ở mọi nơi. Việc các bác sĩ lâm sàng kê đơn thuốc kích thích cần phải theo dõi việc sử dụng thuốc một cách chặt chẽ, đảm bảo rằng nó không bị lạm dụng bởi gia đình, bạn bè của trẻ hoặc những người phát thuốc ở trường. Việc sử dụng đa thuốc chỉ nên được tiến hành bởi dịch vụ chuyên khoa và sự kết hợp giữa methylphenidate và clonidine cần được sử dụng một cách thận trọng. Ngoài ADHD, thuốc kích thích cũng hữu ích trong điều trị chứng ngủ rũ, trầm cảm kháng trị và các hội chứng chú ý và tăng động một phần. Vẫn còn nhiều khoảng trống trong kiến thức; dược động học, dược lực học và dược di truyền của các tác động của thuốc kích thích cần được nghiên cứu thêm. Các chi tiết về các chế độ dùng thuốc kích thích dường như có tác động lớn đến phản ứng đạt được. Cần có thêm nghiên cứu, tốt nhất là trong các bối cảnh thực hành thực tế, so sánh các hình thức kết hợp khác nhau với các can thiệp tâm lý, nghiên cứu các tác động ở nhóm trẻ em bên ngoài nhóm trẻ em đang đi học với ADHD điển hình: trẻ em ở độ tuổi mẫu giáo, người lớn, những người có hội chứng một phần (như tính không chú ý) và những người có rối loạn đồng mắc.

Từ khóa

#Thuốc kích thích #ADHD #methylphenidate #clonidine #can thiệp tâm lý xã hội #dược động học #dược lực học #rối loạn đồng mắc.

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