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Yıl:2017; Cilt: 24; Sayı: 3>> Özet
Çocuk ve Gençlik Ruh Sağlığı Dergisi; 2017;24(3):271-282
Mental Retardasyonu Olan Çocuk ve Ergenlerin Tedavisinde Kullanılan Farmakolojik Ajanlar
M Karadağ, C Gökçen
Gaziantep Üniversitesi, Gaziantep
Amaç: Mental retardasyonda (zeka geriliği) psikotrop ilaç kullanımı günümüzün önemli sorunlarından biridir. Mental retarde çocuk ve ergenlerin, ilaçların rutin etki ve yan etki profi llerini göstermemesi de klinikte kullanımlarını zorlaştırmaktadır. Bu çalışmanın amacı, klinisyenlerin mental retardasyonda psikotrop ilaç kullanımları ile ilgili yayınlanmış kanıta dayalı tıbbi veriler hakkında kapsamlı bir bilgi vererek, tedavi yönetimlerine katkı sağlamaktır. Yöntem: Çalışma kapsamında Türkçe ve İngilizce veri tabanlarında “mental retardasyon tedavisi”, “psikofarmakoloji”, “davranış problemleri”, “hiperaktivite” anahtar sözcükleri kullanılarak ulaşılabilen çalışmalar gözden geçirilmiştir. Sonuçlar: Mental retardasyonun tedavisinde varsa alta yatan durumların tedavisi ve özel eğitim temel olmasına rağmen, bu çocuklarda psikotrop ilaç kullanım sıklığı oldukça fazladır. Özellikle agresyon, kendine zarar verme, dikkat ve hiperaktivite problemleri, depresyon ve anksiyete gibi problemler mental retardasyon olan çocuklar ve ergenlerde çok sık bulunmaktadır. Psikotrop ilaçların, mental retardasyonu olan çocukların, normal gelişim gösteren çocuklara göre daha az etki gösterdiği, daha fazla yan etki ortaya çıkardığı görülmüştür. Mental retardasyon olan bireylerde en sık kullanılan ilaç grubu antipsikotiklerdir. Bu makalede, mental retardasyon olan çocuklarda sıklıkla kullanılan ilaç grupları olan antipsikotikler, stimulanlar ve diğer dikkat eksikliği hiperaktivite bozukluğu ilaçları, duygudurum düzenleyiciler ve diğer antiepileptik ilaçlar, antidepresanlar, anksiyolitikler, endokrinolojik ajanlar, vitaminler ve diğer ajanlarla ilgili yayınları gözden geçirdik. Tartışma: Mental retardasyon olan çocuklarda ilaç seçimi konusunda yapılmış klinik çalışma sayısı çok azdır. Yapılan öneriler daha çok ampirik verilere ve klinik deneyimlere dayalıdır. Bu sebeple daha büyük örneklem gruplarıyla yeni çalışmalara ihtiyaç duyulmaktadır.
Pharmacological Agents Used in the Treatment of Children and Adolescents with Mental Retardation
Objective: Psychotropic drug use in intellectually disabled children is among the most challenging problems in current treatment modalities. The fact that many psychotropic agents fail to exhibit their expected routine action mechanisms, as well as present with unusual and rare side effects in this specifi c population, turns psychopharmacological intervention into a much more diffi cult process. With this study, we have aimed to contribute to existing literature involving pharmacological interventions with psychotropic drug use in children and adolescents, diagnosed with intellectual disability, through a thorough review of evidence-based research in relevant literature, that has been published so far. Method: By using following terms of' mental retardation treatment' , ' psychopharmacology' ' behavioral problem' ‘hyperactivity’, as keywords to search for research both in Turkish and English databases, related studies were found. Results: Although commonly suggested type of intervention of children and adolescents with intellectual disability is special education and to treat the cause of disability, if determined or specifi ed, psychotropic drug use among this specifi c population is not scarce. These agents are especially used much more commonly among children and adolescents that present with symptoms such as aggression, self harm behaviour and self- mutilation, attention defi cit and hyperactivity problems, or symptoms that might be suggestive of depressionor anxiety. . We are now better aware of the fact that psychotropic drugs tend to be less effi cient and present with more side-effects in this specifi c population, compared to those in children with normal development. Antipsychotics are the most commonly used drugs in children with intellectual disabilities. in this article, we have aimed to review relevant research that involve antipsychotics, psychostimulants and other type of pharmacological agents used in the treatment of attention defi cit and hyperactivity disorder, mood stabilizers and other antiepileptic drugs, antidepressants, anxiolytics, endocrinologic agents, vitamins and other drugs. Discussion: Limited number of clinical studies regarding psychotropic drug options in children with intellectual disability exist in literature. Recommendations so far have been mostly based on empirical data and prior clinical experience. Thus, further novel studies conducted with larger sample sizes are warranted.

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