Clonidine for posttraumatic stress disorder in preschool children
Clonidine for posttraumatic stress disorder in preschool children
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DOI：
10.1097/00004583-199609000-00022
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发表时间：
1996-09-01
影响因子：
13.3
通讯作者：
Riggs, PD
中科院分区：
文献类型：
--
作者：
Harmon, RJ;Riggs, PD
严重和长期虐待和忽视的学龄前儿童的创伤后应激障碍（PTSD）通常会导致极端和致残的症状，这些症状无法在高度结构化的计划之外进行管理，例如，精神病日间医院即使环境治疗辅以个人、团体、行为管理和家庭治疗，有些儿童在治疗计划和家中仍然难以管理，如果不使用精神药物。尽管人们对这个年龄段的儿童使用药物犹豫不决，但这些儿童的症状的严重性和行为管理的困难，甚至在精神科日间治疗期间，使我们有必要考虑这种治疗的益处可能超过与精神药物干预相关的风险。可用于治疗成人PTSD（Friedman，1988; Rosenberg等，1994）并且一些临床医生也使用它来治疗儿童PTSD（Marmar等人，1993年），我们开始了一项有限的开放式临床试验，使用可乐定与3至6岁的学龄前儿童进入我们的计划。我们认为可乐定只适用于那些符合DSM-IV创伤后应激障碍标准（美国精神病学协会，1994）的儿童，当他们的创伤后应激障碍症状过度觉醒，冲动和攻击性仍然严重，并且在治疗至少1个月后，通过个人，家庭和结构/行为治疗方法没有减轻。
Posttraumatic stress disorder (PTSD) in severely and chronically abused and neglected preschool children often results in extreme and disabling symptoms that cannot be managed outside of a highly structured program, e.g., in a psychiatric day hospital. Even when the milieu treatment is supplemented with individual, group, behavioral management, and family therapies, some children remain difficult to manage, both in the therapeutic program and at home, without the use of psychotropic medication. Although one hesitates to use medication with this age group, the severity of the symptoms and the difficulties in managing the behavior of these children, even during psychiatric day treatment, necessitated our considering that the benefits of such treatment might outweigh the risks associated with psychopharmacological intervention.Given the recent suggestion that clonidine, a presynaptic alpha(2)-adrenergic agonist, is useful in the treatment of adult PTSD (Friedman, 1988; Rosenberg et al., 1994) and that some clinicians are also using it to treat childhood PTSD (Marmar et al., 1993), we initiated a limited open clinical trial using clonidine with the 3- to 6-year-old preschool children entering our program. We considered clonidine only in those children who met DSM-IV criteria for PTSD (American Psychiatric Association, 1994), when their PTSD symptoms of hyperarousal, impulsivity, and aggression remained severe and had not abated with individual, family, and structural/behavioral treatment approaches after at least 1 month in treatment.