衛生福利部醫病共享決策平台
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決策輔助工具摘要表

我的小孩有過動症,應該吃藥治療嗎? 最新更新日期:2020年01月07日
科別 精神科
主題類別 9. 精神與行為
決策類型 治療
關鍵字 注意力不足、過動症、學齡兒童、藥物治療、Attention deficit and hyperkinetic disorders、ADHD、School-aged child、pharmacotherapy
適用病人條件 經醫師診斷為注意力不足過動症之學齡兒童(6-12歲)若小朋友有以下疾病或狀況,須讓醫師知道並評估 □症狀明顯是因為短暫壓力引起的 □甲狀腺機能亢進 □妥瑞氏症患者 □嚴重心血管疾病或先天心臟結構性異常 □嚴重高血壓 □合併嚴重精神疾病 (如躁症、自殺、攻擊性行為、幻覺) □癲癇
可供選擇決策方案 一、藥物治療,二、非藥物治療(如行為治療)
使用場所 診間
執行者 醫師、藥師
開發團隊、機構 奇美醫療財團法人柳營奇美醫院藥劑部、精神科
團隊成員
版本
輔助工具研發過程說明 研究指出過動兒服藥約有70%能獲得症狀的改善,但仍有30%病人療效不佳,同時由於藥物有可能出現:食慾不佳、腸胃不適、睡眠問題…等副作用,使得家長在抉擇服藥與不服藥時須全面性了解兩者的優點與缺點,藉此,發展一簡易且適合民眾閱讀的圖像式表單,幫助孩童家長認識注意力不集中/過動之治療概況,並檢視自我認知並考量孩子日後社交、學習與未來發展,權衡整體利弊得失,做出最適合孩子的決定。參考American Academy of Pediatrics guideline 及The Ottawa Hospital Research Institute Patient Decision Aids 並考量台灣現行健保制度及醫療環境,製作一份適合民眾之醫病共享決策表單「我的小孩有過動症,應該吃藥治療嗎?」。表單完成後將應用於兒童及青少年特別門診,以紙本手冊的形式,輔助符合此病症之兒童及家長,提供更完善及便利的資訊管道。
註:詳細研發報告如附件五
參考文獻 1. FerraÂn CatalaÂ-LoÂpez, Brian Hutton, Amparo Nu ñez-BeltraÂn, Matthew J. Page, Manuel Ridao, Diego MacõÂas Saint-Gerons, Miguel A. CatalaÂ, Rafael TabareÂs-Seisdedos, David Moher The pharmacological and non-pharmacological treatment of attention deficit hyperactivitydisorder in children and adolescents: A systematic review with network meta-analyses of randomised trials. PLoS One. 2017 Jul 12;12(7):e0180355. doi:10.1371/journal.pone.0180355.
2. Wolraich M, Brown L, Brown RT, DuPaul G, Earls M, Feldman HM, aniats TG, Kaplanek B, Meyer B, Perrin J, Pierce K, Reiff M, Stein MT, Visser S. ADHD: clinical practice guideline for the diagnosis, evaluation,and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011 Nov;128(5):1007-22. doi:10.1542/peds.2011-2654. Epub 2011 Oct 16.
3. Holmskov M, Storebø OJ, Moreira-Maia CR, Ramstad E, Magnusson FL, Krogh HB, Groth C, Gillies D, Zwi M, Skoog M, Gluud C, Simonsen E. Gastrointestinal adverse events during methylphenidate treatment of children and adolescents with attention deficit hyperactivity disorder: A systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials.PLoS One. 2017 Jun 15;12(6):e0178187. doi: 10.1371/journal.pone.0178187.
4. Harpin V, Mazzone L, Raynaud JP, Kahle J, Hodgkins P.J Atten Disord. Long-Term Outcomes of ADHD: A Systematic Review of Self-Esteem and Social Function.2016 Apr;20(4):295-305. doi: 10.1177/1087054713486516. Epub 2013 May 22.
5. Reed VA, Buitelaar JK, Anand E, Day KA, Treuer T, Upadhyaya HP, Coghill DR, Kryzhanovskaya LA, Savill NC. The Safety of Atomoxetine for the Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: A Comprehensive Review of Over a Decade of Research.CNS Drugs. 2016 Jul;30(7):603-28. doi: 10.1007/s40263-016-0349-0.
6. Catalá-López F, Hutton B, et al. The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomized trials. PLoS One. 2017 Jul 12;12(7):e0180355. doi: 10.1371/journal.pone.0180355. eCollection 2017.
7.BARBARA T. FELT, MD, MS, et al. Diagnosis and Management of ADHD in Children American Family Physician Volume 90, Number 7 October 1, 2014
8.Lipstein EA Lindly OJ , Anixt JS , Britto MT , Zuckerman KE . Shared Decision Making in the Care of Children with Developmental and Behavioral Disorders. Matern Child Health J. 2016 Mar;20(3):665-73.
9.William B. Brinkman a, Jessica Hartl Majcher a, Lauren M. Poling a, Gaoyan Shi b, Mike Zender b, Heidi Sucharew a, Maria T. Britto a, Jeffery N. Epstein a Shared decision-making to improve attention-deficit hyperactivity disorder care Patient Educ Couns. 2013 Oct;93(1):95-101.
10.Anson J Koshy, Dominic A Sisti, Assent as an ethical imperative in the treatment of ADHD . J Med Ethics 2015;0:1–5.
11.Ahmed et al. Research in Social and Administrative Pharmacy j (2016) 1–15 The evaluation of a question prompt list for attention-deficit/hyperactivity disorder in pediatric care: A pilot study
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