新治療對沮喪、焦慮不安的青少年癮君子具潛力


  December 13, 2007 — 一個實驗性質的青少年門診物質濫用合併內在異常(心情和/或焦慮問題)治療計畫之初步評估顯示有效。
  
  北卡羅來納醫學大學的Ashli J. Sheidow博士和Lisa Saldana博士,在美國成癮精神病學會(American Academy of Addiction Psychiatry)第18屆年會暨研討會中,口頭發表一篇比較實驗式治療和一般治療之前驅研究的研究發現。
  
  Sheidow醫師向Medscape精神病學表示,在那些有內在和物質濫用異常的青少年中,重點應在於治療焦慮和憂鬱,而非僅是針對物質濫用;他們發現,內在的異常獲得改善後,能預期物質濫用也可以獲得改善,但是物質濫用之改善並不會改變憂鬱和焦慮症狀。
  
  【憂鬱的青少年癮君子】
  Sheidow醫師表示,最近的一篇研究發現,51%的年輕門診物質濫用病患合併有內在異常,這種比率在住院的青少年病患更高;之前的研究顯示,相較於治療青少年的物質濫用卻未治療精神問題,這花費更長的時間治療這些精神狀況(72週相較於10 週),且花費超過兩倍。
  
  Sheidow醫師表示,用於發展物質濫用治療的實症臨床研究,往往排除有共病症的病患,這些病患可能可以從不同的治療策略中獲益。
  
  該團隊希望藉此一前驅研究比較青少年大麻、其他藥物、酒精或者多重物質濫用合併心情和/或焦慮異常之兩種治療類型的短期結果。
  
  實驗式治療是一個院內基礎、多系統治療方式,整合了認知行為、行為調整、以及家庭治療策略,需要病患和雙親共同參與;對照組是一般社區的門診治療。
  
  總共有43位年紀在13-17歲的青少年(63%是男性),合併有心情和/或焦慮異常,隨機接受上述兩種治療方式之一,超過半數的青少年(26位)同時有焦慮和憂鬱。
  
  【治療焦慮和憂鬱】
  Saldana醫師報告指出,整體的結果支持實驗式治療,因為該組的病患顯然減少了用藥且有迅速改善;相較於接受一般治療者,接受實驗式治療的青少年顯著改善了焦慮和憂鬱症狀(P = .03)。
  
  相較於接受一般治療者,接受實驗式治療的青少年在第3個月和第6個月的物質濫用自我報告中,各種物質的濫用情形顯著較低 (P < .001) 。
  
  此外,在6個月時,接受實驗式治療的青少年從物質濫用恢復者較多,證據為尿液檢測陰性;Saldana醫師指出,積極的雙親態度改變了恢復狀態。
  
  該團隊結論表示,這些發現指出了新治療方式的潛在利益,他們的研究值得繼續。
  
  該研究接受國家藥物濫用研究中心贊助。
  
  美國成癮精神病學會第18屆年會暨研討會。2007年11月29日-12月2日。

New Treatment for Depressed, A

By Marlene Busko
Medscape Medical News

December 13, 2007 — An experimental outpatient substance-abuse treatment program for adolescents with coexisting internalizing disorders (mood and/or anxiety problems) shows promise in a preliminary evaluation.

Findings from a pilot study comparing an experimental treatment vs usual treatment were conveyed in an oral paper presented at the American Academy of Addiction Psychiatry 18th Annual Meeting & Symposium by Ashli J. Sheidow, PhD, and Lisa Saldana, PhD, from the Medical University of South Carolina, in Charleston.

Among youth with concurrent internalizing and substance-use disorders, it is extremely important to "treat the anxiety and depression — not just the substance use," Dr. Sheidow told Medscape Psychiatry. They found that improvement in symptoms of internalizing disorders predicted improvement in substance use, but improvement in substance use was unrelated to changes in depressive and anxiety symptoms, she noted.

Depressed Teen Addicts

A recent study found that 51% of youth in outpatient substance-use treatment had a coexisting internalizing disorder, and these rates increase among studies of inpatient adolescents, said Dr. Sheidow. Previous studies showed that compared with treating young substance abusers without psychiatric problems, it takes longer to treat those with psychiatric comorbidities (72 weeks vs 10 weeks) and it costs more than twice as much.

Clinical studies that are used to develop evidence-based treatments for substance abuse generally exclude patients with comorbid conditions, Dr. Sheidow noted, adding that these patients might benefit from different treatment approaches.

The group aimed to investigate this by performing a pilot study comparing short-term outcomes from 2 types of treatments for adolescents who abused marijuana, another drug, alcohol, or multiple substances and had comorbid mood and/or anxiety disorders.

The experimental treatment was a primarily office-based, multisystemic therapy that integrated cognitive behavior, behavior modification, and family-therapy approaches and required intensive engagement by parents and their children.

The comparison treatment was outpatient "treatment as usual," available in the community.

A total of 43 adolescents (63% males), aged 13 to 17 years, with coexisting mood and/or anxiety disorders were randomized to the 2 treatment types. More than half of the adolescents (26) had both anxiety and depression.

"Treat the Anxiety and Depression"

Overall results support the experimental treatment, since the patients in this group had significantly less drug use and more rapid improvement, Dr. Saldana reported. Teens who received the experimental treatment had significantly improved anxiety and depression symptoms (P = .03) compared with teens who received existing treatment.

Self-reports of substance use at 3 and 6 months were significantly lower (P < .001) for all types of substances among teens who had been randomized to receive the experimental treatment vs regular treatment.

In addition, more teens in the experimental group than in the regular treatment group recovered from substance abuse at 6 months, based on negative urine drug test results. Positive parenting change predicted recovery, said Dr. Saldana.

These findings illustrate the potential benefit of the new treatment, the group concludes, adding that their research is ongoing.

The study was funded by the National Institute on Drug Abuse.

American Academy of Addiction Psychiatry 18th Annual Meeting & Symposium. November 29-December 2, 2007.

    
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