目的:选择性5-羟色胺再摄取抑制剂(SSRIs)是儿童和青少年精神病学中主要用于治疗抑郁症的药物,焦虑和强迫症。总的来说,这些药物是安全的,耐受性良好。然而,它们会引起副作用,如激活综合征,如果没有确定,可能会对依从性和治疗反应产生负面影响。由于缺乏明确的定义和客观的诊断措施,激活综合征很少受到关注,并且很难识别。还因为它可能与抗抑郁药引发的精神疾病或躁狂症的恶化相混淆。对于上述所有,重要的是,在儿科人群中开处方抗抑郁药的专业人员能够在激活综合征发生时识别和管理激活综合征。我们的目的是根据定义对接受SSRIs治疗的儿童和青少年的激活综合征进行叙述性回顾,患病率,病理生理学,相关因素,与自杀风险的关系,在该人群中使用抗抑郁药时降低自杀行为风险的管理策略和建议。
方法:我们对儿童和青少年的激活综合征进行了非系统的叙述性回顾,涉及在PubMed中寻找信息,奥维德,EBSCO,ProQuest和Embase。评论文章,前瞻性和回顾性调查,系统评价,选择meta分析和其他与儿童和青少年激活综合征相关的文章。搜索仅限于以英语和西班牙语发表的涉及儿童和青少年的研究,并且对出版日期或研究设计没有限制。
结果:共包括62篇文章,其中61个是英语。结果分为以下主题:定义;患病率;病理生理学;相关因素;与自杀风险的关系;管理策略;以及在该人群中使用抗抑郁药时降低自杀行为风险的建议。激活综合征是指由冲动组成的一组症状,躁动,活动增加,失眠,烦躁,抑制和激动。这种综合症在定义上没有很好的描述,患病率,危险因素和病理生理学,一种限制其识别和评估的情况。有许多因素导致该综合征的发展,例如年龄,儿科人群大脑发育的差异,患者或抗抑郁药的特征,神经发育障碍,以及药物的剂量和血浆水平。人们认为激活综合征可能与自杀倾向有关。然而,支持这一联系的证据不一致,因此需要进一步的研究.
结论:激活综合征伴SSRI在儿童和青少年中是一种特别重要的不良反应,当它发生时,可能导致缺乏坚持或停止治疗。因此,建议在使用这些药物时保持警惕。
OBJECTIVE: Selective serotonin reuptake inhibitors (SSRIs) are medications used in child and adolescent psychiatry mainly for the treatment of depression, anxiety and obsessive compulsive disorder. In general, these medications are safe and well tolerated. However, they can cause adverse effects such as activation syndrome, which if not identified can negatively affect adherence and response to treatment. Activation syndrome has received little attention and can be difficult to recognise due to the lack of a clear definition and objective diagnostic measures, and also because it can be confused with a worsening of the psychiatric disorder or mania triggered by the
antidepressants. For all the above, it is important that professionals who prescribe
antidepressants in the paediatric population are able to identify and manage activation syndrome when it occurs. Our aim was to carry out a narrative review of activation syndrome in children and adolescents treated with SSRIs in terms of definition, prevalence, pathophysiology, associated factors, relationship with suicide risk, management strategies and recommendations for reducing the risk of suicidal behaviours when using
antidepressants in this population.
METHODS: We performed a non-systematic narrative review of activation syndrome in children and adolescents which involved finding information in PubMed, Ovid, EBSCO, ProQuest and Embase. Review articles, prospective and retrospective investigations, systematic reviews, meta-analyses and other articles related to activation syndrome in children and adolescents were selected. The search was limited to studies published in English and Spanish that involved children and adolescents and no limits were applied to the publication date or study design.
RESULTS: A total of 62 articles were included, 61 of them in English. The results were grouped into the following topics: definition; prevalence; pathophysiology; associated factors; relationship with suicide risk; management strategies; and recommendations for reducing the risk of suicidal behaviours when using
antidepressants in this population. Activation syndrome refers to a set of symptoms consisting of impulsiveness, restlessness, increased activity, insomnia, irritability, disinhibition and agitation. This syndrome is poorly characterised in terms of its definition, prevalence, risk factors and pathophysiology, a situation that limits its recognition and evaluation. There are many factors that predispose the development of the syndrome such as age, differences in brain development in the paediatric population, the characteristics of the patient or the antidepressant, disorders of neurological development, and the doses and plasma levels of the medications. It has been thought that activation syndrome may be related to suicidal tendencies. However, the evidence in support of this link is inconsistent and further studies are therefore necessary.
CONCLUSIONS: Activation syndrome with SSRI is a particularly important adverse effect in children and adolescents and, when it occurs, can cause lack of adherence to or discontinuation of treatment. Strict vigilance is therefore recommended during the use of these medications.