大部分心智健康異常的年輕人並未接受建議的照護


  August. 20, 2008(麻州波士頓) — 考量有心智健康異常的美國兒童和青少年多達75%未接受實證基礎的治療,美國心理學會(APA)的一個工作小組呼籲,心智健康照護專業人士的規範要更普及。
  
  美國心理學會第116屆年度研討會中,對心理醫師提出以下建議,與精神病醫生、學校心理學家、社會工作者和顧問合作,以確保心智健康異常的實證基礎規範可以迅速普及到開業醫師,並整合到臨床實務與心智健康政策。
  
  題為「普及化兒童與青少年的實證實務:促進照護的系統性方法 (Disseminating Evidence-Based Practice for Children and Adolescents: A Systems Approach to Enhancing Care) 」的報告指出,美國將近有1,500萬名兒童診斷有心智健康異常(佔所有小孩的10%-20%),只有約25%接受有科學基礎的適當心智健康照護。如果是貧窮、弱勢族群、物質濫用的年輕人,此狀況更嚴重。
  
  該小組主席、賓州費城兒童醫院心理科主任Anne E. Kazak 博士向Medscape Psychiatry表示,有許多方法可以有效地治療各種心智健康異常的孩童,挑戰之處在於如何將這些納入臨床實務。
  
  【深入探討】
  目前的報告根據之前在2005年的一篇文件,檢視實證基礎的心智健康實務;不過,此篇最新的文獻更深入探討與兒童和青少年有關的議題;特別的是,它指出使用實證方式評估、治療的重要性,最重要的是,持續監測心智健康異常的孩童。
  
  Medscape Psychiatry的顧問、凱斯西儲大學醫學院兒童與青少年精神科主任Robert L. Findling教授在訪談中表示,實際的挑戰在於找到適當資源來發展實證基礎的實務,並將此知識普及。
  
  根據Findling教授表示,心智健康異常的孩童通常沒有接受照護,因為有「他們只是有點不對勁」、「他們是先天劣根性」、或者「他們的行為是因為不佳的養育所導致」等等錯誤認知 。
  
  該報告提議,所有的心智健康治療— 不論是藥物或者非藥物的— 都應該要有科學證據支持,他表示,這不會有人反對吧?
  
  【文化上的敏感】
  至於其他區域,該報告指出,需要顧及不同文化、地區和社會經濟等面向的年輕人。
  
  這個有7個成員的小組,引述幾個有焦慮相關問題、注意力缺乏/過動異常、憂鬱、傳導異常、物質濫用問題等種族弱勢年輕人的有效的、文化敏感性、實證基礎治療的例子。
  
  它也指出,幾篇回顧和後設分析顯示,經驗治療計畫對於自閉症和飲食異常的小孩有用。
  
  此報告的建議包括:
  * 增加研究資金,以發展和傳遞實證基礎實務給各領域(家庭、學校、少年法律體系)之心智健康異常的孩童與青少年。
  * 發展跨領域的網路實證基礎心理實務訓練,與社工、教育、小兒科與精神科等合作。
  * 增加心理研究所訓練計畫,以及持續教育計畫中的實證基礎實務課程。
  * 發展可評估的網路互動系統,提供心智健康機構、開業醫師與需要治療的青少年家庭,從中獲得和分享實證實務的訊息。
  * 建立跨領域的、多元任務小組,以檢視提供實證基礎照護給這些病患的障礙。
  
  Kazak博士沒有財經宣告。 Findling 博士接受Abbott、Addrenex、AstraZeneca、Bristol-Myers Squibb、Forest、Johnson & Johnson、Lilly、Neuropharm、Otsuka、Pfizer、Shire、Supernus Pharmaceuticals與 Wyeth的研究資金;他擔任Abbott、AstraZeneca、Bristol-Myers Squibb、Forest、 GlaxoSmithKline、Johnson & Johnson、Lilly、Novartis、Organon、Otsuka、Pfizer、Sanofi-Aventis、Sepracore、Shire、Solvay 、Supernus Pharmaceuticals與 Wyeth的顧問。他也擔任Bristol-Myers Squibb、Johnson & Johnson與Shire的發言人。
  
  美國心理學會第116屆年度研討會。發布於2008年8月13日。

Most Youth With Mental Health Disorders Do Not Receive Recommended Care

By Marlene Busko
Medscape Medical News

August. 20, 2008 (Boston, Massachusetts) — Concerned that up to 75% of US children and adolescents with mental health disorders do not receive evidence-based treatment, an American Psychological Association (APA) task force is calling for greater dissemination of guidelines among mental health professionals.

Released here at the at the American Psychological Association 116th Annual Convention, the report recommends that psychologists — in collaboration with psychiatrists, school psychologists, social workers, and counselors — work to ensure that evidence-based practices for mental health disorders are rapidly disseminated to practitioners and integrated into clinical practice and mental health policies.

Entitled Disseminating Evidence-Based Practice for Children and Adolescents: A Systems Approach to Enhancing Care, the report points out that of approximately 15 million children in the United States who are diagnosed with a mental health disorder (10% to 20% of all children), only about 25% receive appropriate mental health care based on scientific evidence. The situation is even worse for youth who are poor, members of a minority, or involved in substance abuse.

"A variety of interventions have been developed that are quite effective for treating children with different [mental health] disorders, and the challenge becomes getting these out into [clinical] practice," task force chair Anne E. Kazak, PhD, director of the department of psychology at Children's Hospital of Philadelphia, in Pennsylvania, told Medscape Psychiatry.

Delving Deeper

The current report builds on an earlier 2005 document, which also examined evidence-based mental health practices. However, this latest iteration delves more deeply into issues related to children and adolescents. Specifically, it highlights the importance of using an evidence-based approach to assess, treat, and, most important, continuously monitor children with mental health disorders.

The real challenge lies in finding adequate resources to develop evidence-based practices and to disseminate this knowledge, Robert L. Findling, MD, professor of psychiatry and director of child and adolescent psychiatry at Case Western Reserve University School of Medicine, in Cleveland, Ohio, and consultant for Medscape Psychiatry, said in an interview.

According to Dr. Findling, children with mental health disorders often do not receive care, based on the false perception that they will "grow out of it," they are inherently "bad," or their behavior is the result of poor parenting.

The report advocates that all mental health treatment — whether pharmacological or nonpharmacological — be supported by scientific evidence. "How can one argue with that?" he said.

Culturally Sensitive

Among other areas, the report highlights the need to reach youth from different cultures, geographic regions, and socioeconomic groups.

The 7-member task force cites several examples of effective, culturally sensitive, evidence-based treatments in ethnic minority youth with anxiety-related problems, attention-deficit/hyperactivity disorder, depression, conduct disorder, and substance-use problems.

It also highlights several reviews and meta-analyses showing that empirically tested treatment programs benefit children with disorders such as autism and eating disorders.

The report's recommendations include:

  • Increase research funding to develop and deliver evidence-based practice to children and adolescents with mental health disorders who are seen in various settings (eg, family, school, the juvenile justice system).
  • Develop interdisciplinary Web-based training in evidence-based psychology practice in collaboration with other key disciplines such as social work, education, pediatrics, and psychiatry.
  • Increase the teaching of evidence-based practices in psychology graduate-school training programs and continuing-education programs.
  • Develop an accessible Web-based interactive system to allow mental health agencies, practitioners, and families of youth needing treatment to obtain and share information about evidence-based practices.
  • Establish a cross-disciplinary, multiagency task force to examine the barriers to providing evidence-based care for these patients.

Dr. Kazak has no financial disclosures. Dr. Findling has received grants for research from Abbott, Addrenex, AstraZeneca, Bristol-Myers Squibb, Forest, Johnson & Johnson, Lilly, Neuropharm, Otsuka, Pfizer, Shire, Supernus Pharmaceuticals, and Wyeth. He has served as a consultant for Abbott, AstraZeneca, Bristol-Myers Squibb, Forest, GlaxoSmithKline, Johnson & Johnson, Lilly, Novartis, Organon, Otsuka, Pfizer, Sanofi-Aventis, Sepracore, Shire, Solvay, Supernus Pharmaceuticals, and Wyeth. He has also served on the speaker's bureau for Bristol-Myers Squibb, Johnson & Johnson, and Shire.

American Psychological Association 116th Annual Convention. Released August 13, 2008.

    
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