奥氮平治疗儿童孤独症的临床研究

Clinical Study of Olanzapine in the Treatment of Childhood Autism

目的 研究奥氮平对儿童孤独症的疗效及其副作用。方法 用奥氮平对 17例 1岁半～ 8岁符合CCMD - 3诊断的孤独症患者进行治疗 ,剂量为 2 .5～ 10mg/d ,连续用药并观察 12周。由 2位精神科医生同时在治疗前和治疗后第 2、4、6、8、12周采用临床疗效总评量表、儿童孤独症评定量表及临床记录对患者进行评定 ,评估其病情严重程度及奥氮平的疗效和副反应。结果 2位精神科医生所得出得评定结果是相一致的 (Kappa =0 .86 )。从用药后第 6周起 ,临床疗效总评量表中的病情严重程度因子分值与治疗前相比明显降低 ,而总体疗效分值明显升高 ,二者均具有统计学差异 (P <0 .0 5 ) ;而CARS评定分值的降低也具有统计学意义 ,提示奥氮平对儿童孤独症有较好的疗效。治疗后 12周的评定结果与治疗后 6周的结果比较仍具有统计学差异 (P <0 .0 1) ,提示疗程的延长能提高疗效。奥氮平可显著改善易激惹症状、精神病性症状及睡眠障碍 ,对于刻板的行为模式、自伤行为、活动过度和注意力不集中也有一定效果。副反应出现极少 ,主要为可控性的体重增加以及强迫症状。结论 奥氮平治疗儿童孤独症是安全有效的 ,尤其对于易激惹、精神病性症状及睡眠障碍疗效较好。

Objective To investigate the effect and side effects of Olanzapine in the treatment of childhood autism.Methods 17 patients from 36 months to 8 years old diagnosed autism according to CCMD-3 were given oral olanzapine 2.5～10 mg per day for 12 weeks. All the patients were evaluated with Clinical Global Impression (CGI), Childhood Autism Rating Scale (CARS) and clinical records before treatment and at the end of the 2nd, 4th, 6th, 8th, 12th weeks during the treatment by two psychiatrists in order to value severity of disease, the effect and side effects of Olanzapine.Results The scores of CGI obtained by the two psychiatrists were unanimous (Kappa=0.86). The SI decreased and the GI increased significantly since the 6th week, both of them were statistically different with that before treatment. The scores of CARS had similar changes with that of CGI, and there was statistical difference since the 6th week compared with the score before treatment(P<0.05). Furthermore, the GI and SI of the 12th week had statistical difference with that of the 6th week(P<0.01), which suggested that the effect increased as the treatment prolonged. Irritablity, psychiatric symptoms and sleep disorders were greatly improved during the treatment. Stereotyped behaviors, self-harm, excessive activities and aprosexia were released too. Side effects appeared seldom, which mainly included controllable increases of weight and obsessive-compulsive symptoms.Conclusions Olanzapine is safe and effective in the treatment of childhood autism, especially to irritablity, psychiatric symptoms and sleep disorders accompanied.