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Læknablaðið - 15.05.2000, Qupperneq 13

Læknablaðið - 15.05.2000, Qupperneq 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 L
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