Dikkat Eksikliği Hiperaktivite Bozukluğunda 6 Aylık Bir Kesitin Tedavi Seçenekleri: Geriye Dönük Bir Çalışma

Abstract

Amaç: Dikkat eksikliği hiperaktivite bozukluğu (DEHB) tanılı çocuk ve ergenlere önerilen tedavi seçeneklerinin özellikleri geriye dönük araştırıldı. Yöntem: 1 Eylül 2018 tarihi ile 1 Mart 2019 tarihleri arasındaki 6 aylık sürede bir eğitim araştırma hastanesine başvurmuş olgulardan DSM-5’e göre DEHB tanısı konmuş çocuk ve ergenlerin elektronik dosyaları gözden geçirildi. Bulgular: 6 aylık sürede bölümümüze başvuran olguların toplam sayısı 21.893 olup, bunların %10’unun (n=2372) DEHB tanısı konmuş ya da bu tanı ile takip edilen olgular olduğu saptandı. Olguların yaş ortalaması 10.2 ± 3 yıl idi. Erkek/kız oranı 3.1/1 idi. Yalnızca DEHB tanısı olanlar olguların %75.3’ü (n=1787) iken, DEHB’ye eşlik eden en az bir komorbidite varlığı olguların %24.7’sinde (n=585) saptandı. En sık eşlik eden tanı özgül öğrenme güçlüğü idi (%10.6, n=251). Anksiyete bozukluğu ve depresif bozukluk kız DEHB’li olgularda, otizm spektrum bozukluğu (OSB) ve davranım bozukluğu komorbiditesinin erkek DEHB’li olgularda anlamlı düzeyde yüksek olduğu saptandı. En sık reçete edilen ilacın psikostimülanlar olduğu (%78.1, n=1853), ATX (ATX) reçeteleme oranının %14.5 (n=344) olduğu, bunu sırasıyla antipsikotiklerin (%10.5, n=250), antidepresanların (%2.7, n=63) ve omega-türevli ilaçların (%0.8, n=20) takip ettiği saptandı. Davranışçı terapilerin yalnızca DEHB’li olgularda, komorbidite eşlik eden olgulara oranla, daha yüksek oranlarda uygulandığı saptandı. ATX, atipik antipsikotik (AAP) ve antidepresan ilaç kullanımlarının komorbidite eşlik eden DEHB’li olgulardaki oranı anlamlı yüksek bulundu. AAP ilaçların erkek DEHB’li olgularda tercihi anlamlı yüksek bulunurken, antidepresanların kız DEHB’li olgularda tercihi anlamlı yüksek bulundu. 6 aylık süre içinde ilaç yan etkisi ya da etkinsizliği nedeniyle başka bir tedavi seçeneğine geçilmesi olguların %5.7’sinde (n=135) gerçekleştiği saptandı. Etkinsizlik nedeniyle ilaç değişiminin erkek DEHB’li olgulardaki oranı anlamlı yüksek bulundu. Tartışma: DEHB’li çocuk ve ergenlerin tedavisinde psikostimülanlar ilk tercih olarak görünmektedir. Eşlik eden komorbidite varlığında ATX tercihi öne çıkarken, OSB ve davranım bozukluğu eşlik eden erkek DEHB’li olgularda AAP, anksiyete ve depresyon eşlik eden DEHB’li kız olgularda antidepresanlar öne çıkmaktadır.

Keywords

• Çocuk
• DEHB
• Ergen
• Komorbidite
• Non-psikostimülan ilaçlar
• Psikostimülanlar

Attention-deficit/hyperactivity disorder treatment options over a 6-month period: A retrospective cross-sectional study

Abstract

Objectives: The characteristics of treatment options recommended for children and adolescents with attention deficit hyperactivity disorder (ADHD) were retrospectively evaluated. Methods: Electronic records of children and adolescents diagnosed with ADHD according to DSM-5, who applied to an education and research hospital between 6 September 2018 and 1 March 2019, were reviewed. Results: The total number of cases within 6 months was 21.893, 10% (n = 2372) of them were diagnosed or followed by ADHD. The mean age was 10.2 ± 3 years. Boys/Girls ratio was 3.1/1. Of 75.3% cases (n = 1787) had only ADHD whereas 24.7% of subjects (n = 585) had at least one psychiatric comorbidity, with a mostly specific learning disability (10.6%, n = 251). Anxiety and depressive disorder were found to be significantly higher in girls, whereas autism spectrum disorders (ASD) and conduct disorder (CD) were higher in boys. The most frequently prescribed drug was psychostimulants (78.1%, n = 1853). Atomoxetine (ATX) prescribing rate was 14.5% (n = 344). Other agents were antipsychotics (10.5%, n = 250), antidepressants (2.7%, n = 63) and omega-derived drugs (0.8%, n = 20). Behavioral therapies were found to be higher in sole ADHD cases compared to the subjects with comorbidities. The rate of ATX, atypical antipsychotic and antidepressant drug use in patients with ADHD accompanying comorbidity were significantly higher. While the preference of atypical antipsychotic drugs was higher in boys with ADHD, antidepressants were significantly higher in girls. Switching to another treatment option within 6-month period due to advers events or ineffectiveness was found to occur in 5.7% (n = 135) of the cases. The rate of drug change in male ADHD cases was found to be significantly higher due to ineffectiveness. Discussion: Psychostimulants are the first choice for the treatment of children and adolescents with ADHD. While the preference for ATX is prominent in ADHD with comorbidities, antidepressants are prominent choice in girls with ADHD with depression or anxiety and atypical antipsychotics are the first choice in boys with ADHD accompanied by ASD or CD.

Keywords

• ADHD
• Adolescent
• Child
• Comorbidity
• Non-psychostimulant drugs
• Psychostimulants

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