Læknablaðið - 15.05.2000, Blaðsíða 13

FRÆÐIGREINAR / BARNAGEÐLÆKNINGAR
Greiningar og meðferðarúrræði 102 barna og unglinga
sem komu til barna- og unglingageðdeildar
Landspítalans vegna ofvirknieinkenna
frá 1. júní 1998 til 31. maí 1999
Gísli Baldursson,
Páll Magnússon,
Ólafur Ó.
Guðmundsson
Frá göngudeild barna- og ung-
lingageðdeildar Landspítalans.
Fyrirspumir, bréfaskipti: Gísli
Baldursson, göngudeild
barna-og unglingageðdeildar
Landspítalans, Dalbraut 12,
105 Reykjavík. Sími: 560 2500,
netfang: gislib@rsp.is
Lykilorð: ofvirkniröskun, fylgi-
raskanir, lyfjameðhöndlun.
Ágrip
Tilgangur: Greining og meðferð við ofvirkniröskun
hefur aukist mjög á undanförnum árum. Lítið er vit-
að um meðferðarhefðir hér á landi. Rannsóknin lýsir
lyfja- og sálfélagslegri meðferð hjá hópi barna sem
vísað var til ofvirknimóttöku við göngudeild barna-
og unglingageðdeildar Landspítalans (BUGL). Jafn-
framt voru greiningar og fylgiraskanir skoðaðar.
Efniviður og aðferðir: Rannsóknin er afturskyggn og
tekur til 102 barna og unglinga á aldrinum 3-15 ára
sem komu til athugunar vegna ofvirkni eða gruns um
ofvirkni á göngudeild BUGL á tímabilinu 1. júní
1998 til 31. maí 1999. Greiningarviðtal við foreldra
var byggt á ICD-10 (International Statistical Classifi-
cation of Diseases and Related Health Problems, 10"1
revision) greiningarskilmerkjum, stuðst var við staðl-
aða hegðunarmatskvarða sem útfylltir voru af for-
eldrum og kennurum, vitsmunaþroski barnsins var
metinn og læknisskoðun gerð með tilliti til líkamlegs
og andlegs ástands.
Niðurstöður: Alls greindust 72 börn með ofvirkni-
röskun. Algengasta fylgiröskunin var mótþróa-
þrjóskuröskun bæði í þeim hópi bama sem greindist
með ofvirkniröskun og þeim sem fengu aðra fyrstu
greiningu. Hjá umtalsverðum hluta hópsins greindust
einnig tilfinningaraskanir. Algengast var að lyfjameð-
ferð væri hafin milli fjögurra og átta ára aldurs. Ami-
triptýlín og metýlfenýdat voru oftast valin sem fyrsta
meðferð en önnur lyf voru mun sjaldnar notuð og hjá
35% barnanna hafði lyfjameðferð ekki verið reynd.
Við komu voru 56 börn á lyfjameðferð og 11 þeirra
fengu fleiri en eitt lyf. Algengasta sálfélagslega með-
ferðarúrræðið var að bjóða foreldrum upp á sérstök
ráðgjafarviðtöl. Næst algengast var meðferðartilboð
um þjálfunarnámskeið og fræðslunámskeið.
ENGLISH SÖMMARY
Baldursson G, Magnússon P, Guðmundsson ÓG
Medication use and treatment characteristics of
children referred to the outpatient ADHD-clinic at
the Department of Child and Adolescent
Psychiatry, the National University Hospital
Læknablaðið 2000; 86: 337-42
Objective: The diagnosis and treatment of hyperkinetic
disorder has increased considerably in recent years.
Despite a growing interest in the use of psychotropics to
treat hyperkinetic disorder, knowledge about medication
patterns in lceland is limited. The aim of the study was to
gather information about clinical characteristics and treat-
ment practice in children referred for hyperactive behaviour
to the outpatient childpsychiatric service at the National
University Hospital, lceland.
Material and methods: Data was accumulated by retro-
spectively looking at the records of 102 children of both
sexes between 3 and 15 years of age, referred to the
ADHD outpatient clinic during the period June 1,1998 -
May 31,1999. A semi-structured diagnostic parent inter-
view was used to assess childhood psychiatric disorders
according to ICD-10. The ADHD Rating Scale- IV, the
Home Situations Questionnaire and the Child Behavior
Checklist were completed by the parents. Teachers filled
out the ADHD Rating Scale and the Teacher Report Form
as well as a form evaluating the child’s academic progress.
To assess intellectual functioning, WISC-III or WPPSI-R
were administered. Medical evaluation was performed and
drug treatment recorded.
Results: Seventy-two children fulfilled ICD-10 diagnostic
criteria of hyperkinetic disorder. High rates of other behavi-
oural disorders, especially oppositional defiant disorder
and a significant frequency of emotional disorders were
recorded. Nearly two-thirds of the children had been
started on medication prior to referral, most often amytryp-
tiline and methylphenidate. Eleven children received
combined pharmacotherapy but 35% had not received any
drug treatment. Psychopharmacotherapy for most of the
children was started between the age of four and eight
years. Behaviour management counselling and parent
training was recommended in most cases.
Conclusions: Thirty children did not meet full hyperkinetic
disorder diagnostic criteria, but these children may none-
theiess have manifested high levels of symptoms. Most of
the children were started on tricyclic antidepressants
rather than stimulants which is unusual compared with
international research and practice. The reason is unclear
but may reflect the high rate of comorbidity but also doc-
tors’ preferences.
Keywords: hyperkinetic disorder, psychotropic drugs,
therapeutic use, icetand.
Correspondence: Gísli Baldursson. E-mail:gislib@rsp.is
Læknablaðið 2000/86 337
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