KISEP Original Articles 13 1 2002 Korean J Child & Adol Psychiatr 13:129~138 ADHD 최적치료 지침을 위한 예비연구 * PRELIMINARY STUDY FOR ADHD TREATMENT GUIDELINE 이영식 ** 김은영 ** 나 철 ** Young-Sik Lee, M.D., ** Eun-Young Kim, M.D., ** Chul Ra, M.D. ** 목 적 방 법 결 과 결 론 중심 단어 서 론 Department of Psychiatry, College of Medicine, Chung Ang University, Seoul Corresponding author - 129 -
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연구대상 및 방법 1. 연구대상 2. 연구방법 1) 진단 검사도구 파악 2) 약물치료 현황파악 3) 비 약물치료 현황파악 Table 1. Present practise and the necessity of the diagnostic workup for ADHDn=32 Diagnostic workup Present practice - 131 - Necessity Routinely Selectively Not Routinely Selectively Not Conner s scale 45.2%14 32.3%10 22.6%07 66.7%20 26.7%08 06.7%02 CBCL 45.2%14 25.8%08 29.0%09 46.7%14 43.3%13 10.0%03 SCT 51.6%16 45.2%14 03.2%01 56.7%17 36.7%11 06.7%02 Intelligence test 58.1%18 41.9%13 000 %00 80.0%24 16.7%05 03.3%01 Projective test 22.6%07 74.2%23 03.2%01 23.3%07 70.0%21 06.7%02 ADS 30.0%09 06.7%02 63.3%19 50.0%14 35.7%10 14.3%04 TOVA 16.1%05 16.1%05 67.7%21 43.3%13 33.3%10 23.3%07 CPT 03.3%01 16.7%05 80.0%24 26.7%08 46.7%14 26.7%08 WCST 06.5%02 25.8%08 67.7%21 13.3%04 53.3%16 33.3%10 Stroop test 03.2%01 19.4%06 77.4%24 10.0%03 50.0%15 40.0%12 Trail making test 06.7%02 16.7%05 76.7%23 10.3%03 51.7%15 37.9%11 MRI/CT 000 %00 83.9%26 16.1%05 000 %00 86.7%26 13.3%04 SPECT 000 %00 38.7%12 61.3%19 000 %00 63.3%19 36.7%11 EEGsimple 25.8%08 67.7%21 06.5%02 26.7%08 70.0%21 03.3%01 EEGspecific 03.2%01 61.3%19 35.5%11 06.7%02 83.3%25 10.0%03 ERP 000 %00 38.7%12 61.3%19 000 %00 56.7%17 43.3%13 CBC,U/A,LFT 40.0%12 43.3%13 16.7%05 48.3%14 44.8%13 06.9%02 ECG 41.9%13 48.4%15 09.7%03 43.3%13 56.7%17 000 %00 TFT 12.9%04 67.7%21 19.4%06 20.0%06 76.7%23 03.3%01 Pb level 03.2%01 35.5%11 61.3%19 10.0%03 73.3%22 16.7%05 Chromosome test 000 %00 41.9%13 58.1%18 03.3%01 76.7%23 20.0%06 CBCLChild Behavior Checklist, SCTSentence Completion Test, ADSADHD Diagnostic System, TOVATest of Variables of Attention, CPTContinuous Performance Test, WCSTWisconsin Card Sorting Test, TFTThyroid Function Test
Table 2. Main trend of clinician s prescription for ADHD n=32 Drug classification Psychostimulant Antidepressant Mood stabilizer53.1% Antipsychotics71.9% Others Percentage of prescription metylphenidate100%, pemoline65.6% imipramine90.6%, fluoxetine65.6%, sertraline31.3%,moclobemide31.3%, nortriptyline25.0%, velafaxine12.5% Valproate43.8%, carbamazepine40.6%, lithium9.4% haloperidol65.6%, pimozide31.3%, risperidone21.9% Clonidine84.4% 3. 자료분석 연 구 결 과 1. 진단도구 및 의학적 검사 - - 2. 약물치료 실시현황 1) 전반적 약물사용 경험 - - 2) 공존질병이 없는 ADHD의 경우 3) 감정장애가 동반된 ADHD의 경우 4) 틱 장애가 동반된 ADHD의 경우 - 132 -
Table 3. Clinician s drug choice in variable situationsn=32 Without co-morbidity With emotional disorders With Tic disorder Situations 1st choice 2nd choice With aggression, conduct disorder MPH100% MPH43.8% AD34.4% MPHAD21.9% Stimulant25.0% Clonidine21.9% Antipsychotics21.9% Imipramine9.4% StimulantAntipsychotics6.3% ClonidineAntipsychotics6.3% MPH65.6% MPHAntipsychotics12.5% MPHMood stabilizer6.3% MPHAntidepressants6.3% Others9.4% Pemoline53.1% Imipramine34.4% SSRI6.3% Clonidine6.3%) Risperidone3.1% 1st2nd process MPHAD41.9% MPHMPH41.9% no choice of MPH16.1% MPH MPHAP/MS/AD/clonidine45.2% MPHNonstimulants19.4% MPHothersMPHothers 19.4% No choice of MPH in 1st, 2nd choice process9.4% Adolescent nonspecific50.0% SSRI34.4% Pemoline9.4% AD9.4% MS6.3% Clonodine6.3% Clomopramine, Clonazepam3.1% MPHMethylphenidate, APAntipsychotics, ADAntidepressant, SSRISelective Serotonine Reuptake Inhibitor MSMood Stabilizer - 5) 파탄적행동장애가 동반된 ADHD의 경우 6) 청소년 ADHD의 경우 - 133 -
Table 4. Clinician s present practise and opinion of necessity about the non-pharmacological treatment modalitiesn=32 Treatment modality Present practise Necessity Yes No Yes No Individual psychotherapy/play therapy 75.0%24 25.0%08 31.3%10 68.8%22 Individual CBT 65.6%21 34.4%11 56.3%18 43.8%14 Individual parents counselling 96.9%31 03.1%01 90.6%29 09.4%03 Child group therapy 37.5%12 62.5%20 29.0%09 71.0%22 Parents group therapy 43.8%14 56.3%18 61.3%19 38.7%12 CBTcognitive-behavioral therapy 3. 기타 치료의 실시현황 및 실시 필요성 고 찰 - 1. 진단적 접근에 관하여 - 134 -
Stage 1 Stage 2 *Non-medication *Treatment alternatives * monotherapy MPH100% partial response or nonresponse * Pemoline53.1% * Imipramine34.4% * SSRI6.3% * Clonidine6.3% * Risperidone3.1% * MPHAD41.9% * MPH43.8% *AD IMP8SSRI334.4% * MPH+AD 21.9% * MPHMPH41.9% * no MPHno MPH16.1% Stage 0 *Nonstimulants66% * Stimulants25% *StimulantsTic Medication9.4% *1, 2 stimulants 19.4% *1, 2 stimulants 38.7% *1 2 stimulants 61.3% * MPH65.6% * MPHAP12.5% * MPHMS6.3% * MPHAD6.3% * others 9.4% *MPHMPHAP/MS/AD/clonidine45.2% *MPHNonstimulants19.4% *MPHothersMPHothers 19.4% * 15.6% *1, 2 MPH 62.5% *1 MPH 25.8% *1, 2 MPH 9.4% * No difference50% * SSRI34.4% * Pemoline9.4% * AD9.4% * anticonvulsants6.3% * clonidine6.3% without cormorbid disorders with emotional disorders with Tic disorders with aggression adolescents Fig. 1. Algorithm for the medication treatments of ADHD without/with cormorbid psychiatric disorders in this study. 135
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