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Identification and treatment of individuals with attentiondeficit/ hyperactivity disorder and substance use disorder: An expert consensus statement

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World Journal of Psychiatry 2023年第3期13卷 84-112页

作者： Susan Young Cyrus Abbasian Zainab Al-Attar Polly Branney Bill Colley Samuele Cortese Sally Cubbin Quinton Deeley Gisli Hannes Gudjonsson Peter Hill Jack Hollingdale Steve Jenden Joe Johnson Deborah Judge Alexandra Lewis Peter Mason Raja Mukherjee David Nutt Jane Roberts Fiona Robinson Emma Woodhouse Kelly Cocallis Department of Psychology Psychology Services LimitedCroydon CR97AEUnited Kingdom Department of Psychology Reykjavik UniversityReykjavikIceland Psychiatry-UK Limited Cornwall PL339ETUnited Kingdom ADHD and Autism Oxford ADHD&Autism CentreHeadington OX37BXUnited Kingdom CLC Consultancy Dunkeld PH80AYUnited Kingdom center for Innovation in Mental Health School of PsychologyFaculty of Environmental and Life SciencesUniversity of SouthamptonSouthampton SO171BJUnited Kingdom Adult ADHD Adult ADHD Clinic LtdOxford OX37RPUnited Kingdom Forensic and Neurodevelopmental Science Institute of PsychiatryPsychology&NeuroscienceKing's College London Institute of PsychiatryLondon SE58AFUnited Kingdom Department of Psychology Institute of PsychiatryPsychology&NeuroscienceKing's College LondonLondon SE58AFUnited Kingdom Department of Psychiatry University of LondonLondon WC1E 7HUUnited Kingdom Department of Psychology Compass Psychology Services LtdLondon BR19DXUnited Kingdom Birribi Ltd Narberth SA677DUUnited Kingdom Halton and Knowsley Adult ADHD Team Merseycare NHS Foundation TrustWinwick WA29WAUnited Kingdom Department of Psychiatry Fulbourn HospitalCambridge CB215EFUnited Kingdom Department of Psychiatry Dr Peter Mason ADHD&Psychiatry Services LimitedLiverpool L19ARUnited Kingdom Adult Neurodevelopmental Service Horizon HouseEpsom KT174QJUnited Kingdom Department of Psychiatry Imperial College LondonLondon WS120NNUnited Kingdom Service User Representative Gloucestershire GL13NNUnited Kingdom Drug&Alcohol Services Surrey&Borders Partnership TrustLeatherhead KT227ADUnited Kingdom Forensic and Neurodevelopmental Sciences Institute of PsychiatryPsychology&NeuroscienceKing's College LondonLondon SE58AFUnited Kingdom Wansbeck General Hospital Northumbria Healthcare NHS Foundation TrustAshington NE639JJUnited Kingdom

Attention-deficit/hyperactivity disorder(ADHD)often co-occurs with substance use(SU)and/or substance use disorder(SUD).Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and *** can be further complicated by the context in which services are ***,when working with young people and adults with co-existing ADHD and SU/SUD,there is uncertainty among healthcare practitioners on how best to meet their *** February 2022,the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these *** presentations providing attendees with an overview of the literature,group discussions were held synthesizing research evidence and clinical *** included:(1)A review of substances and reasons for use/misuse;(2)identification,assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services;and(3)identification,assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient *** highlighted inter-service barriers and fragmentation of *** was concluded that a multimodal and multi-agency approach is *** consensus group generated a table of practice recommendations providing guidance on:identification and assessment;pharmacological and psychological treatment;and multi-agency interventions.

关键词： Attention-deficit/hyperactivity disorder substance use Pharmacokinetics Assessment Treatment Comorbidity

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四联与三联抗逆转录病毒疗法作为HIV感染者一线治疗效果比较:一项随机对照试验的系统综述和meta分析

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英国医学杂志中文版 2020年第1期23卷 19-28页

作者：冯倚(译) 周傲霜邹华春 Suzanne M Ingle Margaret T May 蔡卫平 Chien-Yu Cheng 杨祖耀唐金陵冯琦(译) 唐金陵(译) Division of Epidemiology Jockey Club School of Public Health and Primary CareChinese University of Hong KongHong KongChina School of Public Health(Shenzhen) Sun Yat-Sen UniversityShenzhenChina Kirby Institute University of New South WalesSydneyAustralia Population Health Sciences Bristol Medical SchoolUniversity of BristolBristolUK Department of Infectious Disease Guangzhou Eighth People′s HospitalGuangzhouChina Division of Infectious Diseases Department of Internal MedicineTaoyuan General HospitalMinistry of Health and WelfareTaoyuanTaiwanChina School of Public Health National Yang-Ming UniversityTaipeiTaiwanChina Shenzhen Key Laboratory for Health Risk Analysis Shenzhen Research Institute of the Chinese University of Hong KongShenzhenChina 香港中文大学公共卫生及基层医疗学院

目的比较四药联用(四联)和三药联用(三联)的抗逆转录病毒疗法作为HIV感染者一线治疗的疗效和安全性,并探讨现有的临床试验对临床实践及未来研究的启示。研究设计随机对照试验的系统综述和meta分析。数据来源系统检索了PubMed、EMBASE、C... 详细信息

目的比较四药联用(四联)和三药联用(三联)的抗逆转录病毒疗法作为HIV感染者一线治疗的疗效和安全性,并探讨现有的临床试验对临床实践及未来研究的启示。研究设计随机对照试验的系统综述和meta分析。数据来源系统检索了PubMed、EMBASE、CENTRAL、Web of Science及Allied Health Literature数据库2001年3月至2016年12月期间发表的研究(其中PubMed和EMBASE的检索更新至2018年6月),以及合格研究和相关综述的参考文献。入选标准比较四联与三联抗逆转录病毒疗法作为HIV感染者一线治疗的作用,并评价了至少一种疗效或安全性结局的随机对照试验。分析方法对检测不到的HIV-1 RNA、CD4 T细胞计数、病毒学失败、新发艾滋病事件、死亡和严重不良反应等结局的资料采用随机效应模型进行meta分析。结果共找到12项合格研究,包括4251例HIV感染者。四联和三联抗逆转录病毒疗法对各个疗效和安全性结局的影响均类似,且没有一个总体效应估计值的点值落在支持四联疗法的一侧。与三联疗法相比,四联疗法组出现不同结局的相对危险度及其95%可信区间如下:检测不到的HIV-1 RNA,0.99(0.93~1.05);病毒学失败,1.00(0.90~1.11);新发艾滋病事件,1.17(0.84~1.63);死亡,1.23(0.74~2.05);严重不良反应,1.09(0.89~1.33)。两组CD4 T细胞计数增加的平均差值为-19.55个细胞/μl(-43.02~3.92)。无论联合抗逆转录病毒疗法的具体方案如何,上述2组比较的结果大体不变,且在所有亚组和敏感性分析中均变化不大。结论在HIV感染者的一线治疗中,四联抗逆转录病毒疗法的效果并不优于三联疗法。这一发现为当前推荐三联疗法作为一线治疗的指南提供了支持。除非对现有证据的系统综述显示确有必要,否则不应该再开展新的临床试验去比较四联与三联疗法。当然,本系统综述并不排除当有新的抗逆转录病毒药物种类出现时包含该类药物的四联疗法比三联疗法更好的可能性。

关键词： meta分析相对危险度四联疗法三联疗法系统综述 HIV感染者临床试验随机效应模型

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Antecedents and sex/gender differences in youth suicidal behavior

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World Journal of Psychiatry 2014年第4期4卷 120-132页

作者： Anne E Rhodes Michael H Boyle Jeffrey A Bridge Mark Sinyor Paul S Links Lil Tonmyr Robin Skinner Jennifer M Bethell Corine Carlisle Sarah Goodday Travis Salway Hottes Amanda Newton Kathryn Bennett Purnima Sundar Amy H Cheung Peter Szatmari Institute for Clinical Evaluative Sciences Toronto M4N 3M5 Ontario Canada Department of Psychiatry University of Toronto Toronto M5T 1R8 Ontario Canada Suicide Studies Unit St. Michael’s Hospital Toronto M5B 1W8 Ontario Canada Dalla Lana School of Public Health University of Toronto Toronto M5T 3M7 Ontario Canada Department of Psychiatry and Behavioural Neurosciences Mc Master University Hamilton L8N 3K7 Ontario Canada The Offord Centre for Child Studies Hamilton L8S 4K1 Ontario Canada The research Institute at Nationwide Children’s Hospital Columbus OH 43205 United States The Ohio State University College of Medicine Columbus OH 43210 United States Sunnybrook Health Sciences Centre Toronto M4N 3M5 Ontario Canada Department of Psychiatry University of Western Ontario London N6A 5W9 Ontario Canada The Injury and Child Maltreatment Section Public Health Agency of Canada Ottawa K1A 0K9 Ontario Canada The Centre for Addiction and Mental Health Toronto M6J 1H4 Ontario Canada Department of Pediatrics University of Alberta Edmonton Alberta T6G 1C9 Canada The Department of Clinical Epidemiology and Biostatistics Mc Master University Hamilton L8S 4K1 Ontario Canada The Ontario Centre of Excellence for Child and Youth Mental Health Ottawa K1G 0Z1 Ontario Canada The Hospital for Sick Children Toronto M5G 1X8 Ontario Canada

Suicide is the second leading cause of death in youth globally; however, there is uncertainty about how best to intervene. Suicide rates are typically higher in males than females, while the converse is true for suicide attempts. We review this "gender paradox" in youth, and in particular, the age-dependency of these sex/gender differences and the developmental mechanisms that may explain them. Epidemiologic, genetic,neurodevelopmental and psychopathological research have identified suicidal behaviour risks arising from genetic vulnerabilities and sex/gender differences in early adverse environments, neurodevelopment, mental disorder and their complex interconnections. Further, evolving sex-/gender-defined social expectations and norms have been thought to influence suicide risk. In particular, how youth perceive and cope with threats and losses(including conforming to others' or one's own expectations of sex/gender identity) and adapt to pain(through substance use and helpseeking behaviours). Taken together, considering brain plasticity over the lifespan, these proposed antecedents to youth suicide highlight the importance of interventions that alter early environment(s)(e.g., childhood maltreatment) and/or one's ability to adapt to them. Further, such interventions may have more enduring protective effects, for the individual and for future generations, if implemented in youth.

关键词： Suicide Attempted suicide Sex Gender Child Adolescent Review

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