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1、儿童和青少年中的强迫症和社交焦虑障碍第1页，共22页，编辑于2022年，星期四Financial Disclosure Statement John T.Walkup,MDnConsultantnJanssen Pharmaceutica Inc,Solvay PharmaceuticalsnGrants/Research SupportnGlaxoSmithKline,Lilly Research Laboratories,Pfizer Inc,Solvay Pharmaceuticals,Wyeth-Ayerst Laboratories第2页，共22页，编辑于2022年，星期四Intro
2、ductionnReviewn -OCDn -social anxiety disordernReview recently published RUPP anxiety treatment study forn -separation anxiety disordern -social anxiety disordern -generalized anxiety disorder第3页，共22页，编辑于2022年，星期四Obsessive-Compulsive Disorder Controlled TrialsnClomipramine-DeVeaugh-Geiss et al,1992n
3、Fluoxetine-Riddle et al,1992nSertraline-March et al,1998nFluvoxamine-Riddle et al,2001nParoxetine-data analysisnFluoxetine-data analysisnParoxetine ii-study under waynFoa and March-study under way第4页，共22页，编辑于2022年，星期四Sertraline In Childhood OCDnDouble-blind,placebo-controlled,12-week,multisite trial
4、nN=187;age=6-7 year;sertraline200mg/dnSertralineplacebonMild side effectsnSimilar profile of response as clomipraminenMarch et al.JAMA,1998;280:1752.第5页，共22页，编辑于2022年，星期四Fluvoxamine In Childhood OCDnDouble-blind,placebo-controlled,multisite trial nN=120;age=8-17 years;fluvoxamine 50-200mg/dnFluvoxam
5、ineplacebonMild side effectsnRiddle et al.J Am Acad Child Adolesc Psychiatry.2001;40:222.第6页，共22页，编辑于2022年，星期四Paroxetine In Childhood OCDnDouble-blind,placebo-controlled,multisite trialn16 weeks open-label treatment and 16 weeks double-blind treatmentnN=375;mean age=12 years;paroxetine 10-60mg/dnMil
6、d side effectsnEmsile et al.presented at the American Psychiatric Association Meeting.Chicago.IL.2000.第7页，共22页，编辑于2022年，星期四Long-Term Treatment Of OCD In Children And AdolescentsnLeonard et al,1991nDeVeaugh-Geiss et al,1992nWalkup et al,1999nWagner et al,1999第8页，共22页，编辑于2022年，星期四Desipramine Substitut
7、ion During Long-Term Treatment With ClomipraminenDouble-blind desipramine substitution(8 months)nN=26 on long-term clomipramine for OCDnResultsnLeonard et al.Arch Gen Psychiatry.1991;48:922.第9页，共22页，编辑于2022年，星期四Fluvoxamine In Childhood CD:long-Term TreatmentnMultisite,long-tterm,open-label trialnN=9
8、8,ages 8-17 years;fluvoxamine200 mg/dnAdverse events:hyperactivityin children;somnolenceadolescencenWalkup et al.Presented at the Annual Meeting of the American Academy of Child and Adolescent Psychiatry.1999.第10页，共22页，编辑于2022年，星期四Sertraline In Childnood OCD:Long-Term TrialnMulticenter,long-term,ope
9、n-label,extension trialnN=137;sertraline-120mg/dnSignificant reduction in mean CY-BOCS from beginning of extension(17.0)to end(10.8)nAdverse vents:hyperkinesia,headache,insomnia,GI distressnWagner et al.Presented at NCDEU 39th Annual Meeting Boca Raton.Florida;June 1-4,1999.第11页，共22页，编辑于2022年，星期四Whe
10、n To Discontinue Therapy For OCD?nPlan discontinuation trialnAfter a stable responsenAfter a trial of CBTnIt may be sooner than you thinknDuring a nonstressful periodnNever in winter?nIs summer camp better?第12页，共22页，编辑于2022年，星期四Social Anxiety DisorderControlled TrialsnParoxetine-study under waynBeid
11、el and Sallee第13页，共22页，编辑于2022年，星期四Controlled Trials:Sparation Anxiety Disorder,Social AnxietyDisorder,Generalized Anxiety DisordernResearch units of pediatric psychopharmacologyn -Columbia/Johns Hopkins site-fluvoxaminen -Pittsburgh site-fluoxetine第14页，共22页，编辑于2022年，星期四Pharmacology Of Pediatric Anx
12、ietyDiagnostic IssuesnHigh degree of comorbidity(Biederman et al.1995;Gurley et al.1996)n -social phobia,generalized anxiety disorder,separation anxiety disordern -but not panic disorder,PTSD or OCDnPrior studies target disorders as a group(Birmaher et at.1994;Barrett et al.1996;Fairbanks et al.1996
13、;Kendall et al.1995)第15页，共22页，编辑于2022年，星期四The Research Units Of Pediatric Psychopharmacology Anxiety GroupnJohns Hopkins University:John Walkup,MD;Mark Riddle,MD;Michael Labellarte,MDnColumbia University at NYSPI:Daniel Pine,MD;Laurence Greenhill,MD;Rachel Klein,PhD;Mark Davies,MPH;Michael Sweeney,P
14、hDnNew york University:Howard Abikoff,PhD;Sabine Hack,MD;Pbrian Klee,MDnUniversity of California,Los Angeles:James McCracken,MD;Lindsay Bergman,PhD;John Piacentini,PhDnDuke University:John March,MD MPH;Scott Compton,PhDnNathan Kline Institute:James Robinson,Med;Thomas OHara;Sheryll Baker,PhDnNationa
15、l Institute Mental Health:Benedetto Vitiello.MD;Louise Ritz,MBA;Margaret Roper,MPH第16页，共22页，编辑于2022年，星期四Study Methodology:Subject CriterianDiagnosis and other inclusion criterian -SAD,SoAD,GAD;ages 6-17 yn -PARSmoderate severityn -CGAS69nExclusion criterian -Other serious psychiatric disordersn -Con
16、ditions know to be responsive to SSRIsn -Past SSRI failuren -Need for stimulantsnPARS=Pediatric anxiety rating scale.nRUPP.In press.第17页，共22页，编辑于2022年，星期四Study Methodology:MeasuresnPrimary outcome measures:n -continuous:PARSn development and reliability testingn -categorical:CGI-In definition of res
17、ponder Secondary outcome measures:-MASC,SCARED(parent,child)-CGAS,HAM-A,CGI-SRUPP,In pressn 第18页，共22页，编辑于2022年，星期四Study Methodology:Proceduresn3-week open psychoeducational phase:-exclude responders to interventionn8-week parallel-group study:n -randomization at NIMH(50/50)n -continue psychosocial i
18、nterventionn -dosing:start at 25mg,increase to 250 mg(6-12years old)or 300mg(13-18 years old)by week 6n -weekly:PARS,CGI-S&I,adverse effects,side effectsnRUPP,In press.第19页，共22页，编辑于2022年，星期四SSRIs:Complications Of TreatmentnActivationnBipolar switchingnCelebrationnDimensional issues and comorbidities
19、nDisordersnEvolving psychopathologynFrontal-lobe symptoms-apathynGastrointestinal symptomsnHey!第20页，共22页，编辑于2022年，星期四SSRIs:Dosing In Children And AdolescentsnFluoxetine 10-20mg/daynParoxetine 20-30mg/daynSertraline 25-125mg/daynFluvoxamine 50-150mg/daynCitalopram 20-40mg/day第21页，共22页，编辑于2022年，星期四OCD And Social Anxiety Disorder In Children And Adolescents:SummarynDo not minimize anxiety symptom severitynData from numerous controlled trialsnSSRIs are likely to be very helpful第22页，共22页，编辑于2022年，星期四