Pediatric generalized anxiety disorder: epidemiology, diagnosis, and management.
Pediatric generalized anxiety disorder: epidemiology, diagnosis, and management.
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DOI：
10.2165/00148581-200911030-00003
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发表时间：
2009-01-01
期刊：
影响因子：
--
通讯作者：
Walkup, John T
中科院分区：
文献类型：
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作者：
Keeton, Courtney Pierce;Kolos, Amie C;Walkup, John T
儿童广泛性焦虑症（GAD）的特征是对各种事件过度和无法控制的担忧，并伴有身体症状，如头痛，紧张，不安，胃肠道不适和心悸。症状造成明显的痛苦，并干扰社会，情感和教育功能。GAD发生在超过10%的儿童和青少年中，平均发病年龄为8.5岁，并且更经常报告女孩。常见的并发症包括分离焦虑症和社交恐惧症。评估涉及多信息，多方法的方法，涉及儿童，家长和学校教师。应进行临床访谈，以评估焦虑的三种主要表现方式：行为，思想和躯体症状。有几种半结构化的诊断访谈，焦虑症访谈时间表的使用越来越多。由患者、护理人员和教师完成的评定量表为诊断和症状监测提供了有用的信息。有几个量表可用于评估患者的精神疾病诊断和统计手册（第4版）GAD诊断;然而，工具通常无法区分患有GAD的儿童与患有类似焦虑症的儿童。认知行为疗法（CBT）和选择性5-羟色胺再摄取抑制剂（SSRIs）已被证明对治疗包括GAD在内的儿童焦虑症有效。有证据表明，CBT加舍曲林的组合提供了额外的好处相比，单独治疗。对于药物治疗，系统跟踪治疗后出现的不良事件（如头痛、胃痛、行为激活、症状恶化和出现自杀念头）非常重要。推荐的起始剂量为氟伏沙明25 mg/天，氟西汀10 mg/天，舍曲林25 mg/天，但也可以降低起始剂量。剂量可以每周调整一次，目的是实现高质量的反应，同时最大限度地减少副作用。长期药物治疗尚未得到很好的研究;然而，为了达到最佳的长期结果，可能需要延长药物的使用。建议在症状缓解后继续用药约1年，停止用药时选择一年中无压力的时间。如果症状复发，应认真考虑重新开始用药。
Pediatric generalized anxiety disorder (GAD) is characterized by excessive and uncontrollable worry about a variety of events and is accompanied by physical symptoms such as headaches, tension, restlessness, gastrointestinal distress, and heart palpitations. Symptoms impose marked distress and interfere with social, emotional, and educational functioning. GAD occurs in over 10% of children and adolescents, has an average age of onset of 8.5 years, and is more often reported in girls. Common co-occurring conditions include separation anxiety disorder and social phobia. Assessment involves a multi-informant, multi-method approach involving the child, parents, and school teachers. A clinical interview should be conducted to assess for the three primary ways anxiety presents: behaviors, thoughts, and somatic symptoms. Several semi-structured diagnostic interviews are available, and the Anxiety Disorders Interview Schedule is increasingly used. Rating scales completed by the patient, caregivers, and teachers provide useful information for diagnosis and symptom monitoring. Several scales are available to assess patients for the Diagnostic and Statistical Manual of Mental Disorders (4th Edition) GAD diagnosis; however, instruments generally cannot distinguish children with GAD from children with similar anxiety disorders. Both cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) have demonstrated efficacy for the treatment of pediatric anxiety disorders including GAD. Evidence suggests that the combination of CBT plus sertraline offers additional benefit compared with either treatment alone. With pharmacotherapy, systematic tracking of treatment-emergent adverse events such as headaches, stomach aches, behavioral activation, worsening symptoms, and emerging suicidal thoughts is important. Recommended starting doses are fluvoxamine 25 mg/day, fluoxetine 10 mg/day, and sertraline 25 mg/day, though lower starting doses are possible. Dosing can be adjusted as often as weekly with the goal of achieving a high-quality response, while minimizing side effects. Long-term treatment with medication has not been well studied; however, to achieve optimal long-term outcome extended use of medication may be required. It is recommended to continue medication for approximately 1 year following remission in symptoms, and when discontinuing medication to choose a stress-free time of the year. If symptoms return, medication re-initiation should be considered seriously.