兴奋药物透皮贴剂治疗注意力缺陷多动障碍的临床技巧

248ARNOLDetalaDepartmentofPsychiatry,OhioStateUniversity,Columbus,Ohio;bArizonaChildStudyCenter,StJoseph’sHospitalandMedicalCenter,Phoenix,Arizona;cChildren’sDevelopmentalCenter,Maitland,Florida;dDepartmentofDermatologyandCutaneousSurgery,UniversityofMiami,Miami,Florida;ePediatricPsychopharmacologyDepartment,MassachusettsGeneralHospital,HarvardMedicalSchool,Boston,Massachusetts;fDepartmentsofPsychiatryandPediatrics,CaseWesternReserveUniversity,Cleveland,Ohio/L.EugeneArnold,MDa,RonaldL.Lindsay,MDb,FrankA.López,MDc,SharonE.Jacob,MDd,JosephBiederman,MDe,RobertL.Findling,MDfandYaserRamadan,MDa()/(ADHD)(mg/h)(mg/mg/d)(1)(mg/h)(2)()//(attention-deficit/hyperac-tivitydisorder);(methylphenidate);(transdermalsystem)MTS=methylphenidatetransdermalsystemADHD=attention-deficit/hy-peractivitydisorderAddresscorrespondencetoL.EugeneArnold,MD,Depart-mentofPsychiatry,OhioStateUniversity,479SGalenaRd,Sunbury,OH43074.E-mail:[e-mail]249PEDIATRICS2008434()/(ADHD)ADHD[13]()1937Bradley[4]ADHDADHD19961555768/[5,6]Spencer[1]70%Goldman[7](theCouncilonScientificAffairsfortheAmericanMedicalAssociation)90%ADHD1()1ADHD18[2](atomoxetine)d-(lisdexamfetamine)(MTS)(23/d)MTSADHDmg/d(mg/h)()1MTS()250ARNOLDetal[8][8]MTS[9]1MTSMTSADHD[10,11][12]()22%MTS26%[9,13,14]1()3(1)(2)(3)/3MTS12.5cm2(10mg)37.5cm2(30mg)()(2MTS9hMTS/MTSIR/cm2mg·h-1a9h/mgtidb/mg/mg12.501.10105.01818.751.65157.52725.002.202010.03637.503.303015.054IRtid3/dab15mg12hMTS15mg251PEDIATRICS2008434)12.5cm2MTS/MTS12.5cm29h—25kgMTS—25kgMTS—20mg3h1/wkMTS1wk1mo1/moMTS1wk1mo1/moMTS1/wk21/wk1/wk1MTS252ARNOLDetal9h10mg/d15mg(5mg/3/d)118mg20mg/d18.75cm29h15mg27mg20mg2MTS9h(1)(3h)16h3h(911h)[8]1wk(NationalInitiativeforChildrensHealthcareQuality)ADHD[15][16,17]40%60%34(mg/h)(mg/d)11wk2()()MTS253PEDIATRICS20084341/mo()()()1hMTSMTSMTS()MTS2()43dMTS3()MTSMTSMTS//3h()()1254ARNOLDetal48d/()MTS(1015min)MTS34MTS3060s()MTS[17,18]()()2436h2d2(MTS)()()CeraVe(CoriaLaboratoriesLtdFortWorthTX)Cetaphil(GaldermaLaboratoriesFortWorthTX)1%()255PEDIATRICS2008434/MTS24d(4)/()32dADHD()[3][19]ADHDADHDMTS1d(2)1SpencerT,etal.JAmAcadChildAdolescPsychiatry1996;35:409–4322AmericanPsychiatricAssociation.DiagnosticandStatisticalManualofMentalDisorders.4thed.Washington,DC:Ameri-canPsychiatricAssociation;19943ArnoldLE.ContemporaryDiagnosisandManagementofADHD.3ded.Newtown,PA:HandbooksinHealthCare;20044BradleyC.AmJPsychiatry1937;94:577–5855ConnersCK,etal.JAttenDisord2001;4(Suppl1):S1–S1286AmericanAcademyofPediatrics.Pediatrics2001;108:1033–10447GoldmanLS,etal.JAMA1998;279:1100–11078KaliaYN,etal.DermatolClin1998;16:289–2999GonzalezMA,etal.Methylphenidate(MPH)steady-statepharmacokineticswithaonce-dailytransdermalsystem.Pre-sentedat:annualmeetingoftheAmericanAssociationofPharmaceuticalScientists;November10–14,2002;Toronto,Ontario,Canada10BiedermanJ,etal.Pediatrics1999;104(2).Availableat::179–18512MolinaBSG,etal.JAmAcadChildAdolescPsychiatry2007;256ARNOLDetal46:1028–104013Questioningthebioequivalenceofmethylphenidateformulations:firstsprinkleadministrationapproved.BrownUnivChildAdolescPsychopharmacolUpdate2002;4:1–414PentikisHS,etal.JAmAcadChildAdolescPsychiatry2002;41:443–44915AmericanAcademyofPediatrics,etal.CaringforChildrenWithADHD:AResourceToolkitforClinicians.Cambridge,MA:NationalInitiativeforChildren’sHealthcareQuality;200216GreenhillLL,etal.Once-dailytransdermalmethylphenidateimprovesteacher,parent,andCGI-1ratings.Presentedat:49thannualmeetingoftheAmericanAcademyofChildandAdolescentPsychiatry;October22–27,2002;SanFrancisco,CA17Burrows-MacLeanL,etal.Improvednightlyparentratingswithonce-dailytransdermalmethylphenidate.Presentedat:110thannualmeetingoftheAmericanPsychiatricAssociation;August22–25,2002;Chicago,IL18PelhamWEJr,etal.Efficacyofoncedailytransdermalmeth-ylphenidateinchildrenwithADHD.Presentedat:110thAn-nualMeetingoftheAmericanPsychiatricAssociation;August22–25,2002;Chicago,IL19ArnoldLE.ClinPediatr(Phila)1973;12:35–41PEDIATRICS2007;120(5):1100–1106DEBATEONENDINGSATGAINSGROUND“ThesocialscientistCharlesMurrayhasaknackfornoisilytappingintoculturalpreoccupations.Inhis1984book,‘LosingGround,’hearguedthatwelfareperpetuateddependencyandshouldbeeliminated.InTheBellCurve(1994),whichhewrotewithRichardJ.Herrnstein,hearguedthatthosewhogetaheadinAmerica(mostlywhites)aregeneticallyendowedwithmoreintelligencethanthosewhodonot(disproportionatelyAfrican-Americans).NowMr.Murrayisatitagain,proposinginarecentarticletoabolishtheSAT.Thispositioncannothelpbutprovokeadouble-take.Afterall,whilemakinghisargumentsaboutgenes,raceandintelligence,Mr.MurraypromotedtheIQtestasareliablemeasureofaptitude.Yetheissuggestingthatoneofthemostwidelyusedassessmenttestsbeeliminated.WithsomanycollegeofficialsandparentsdissatisfiedwiththeSAT,eventhosewhothinkMr.Murray’sothertheoriesaremisguidedoroffensivecouldfindthemselvesagreeingwithhimonthisissue.UnlikeothercriticsoftheSAT,Mr.Murraydoesnotseethetestasflawed,nordoeshethinkthatthewealthyhaveanunfairadvantagebecausetheycanbu