RI LON TNG NG GIM CH

(DHD)

BS. PHM THI MINH CH

B MN TM THN
I HOC DOC TP. H CHI MINH
 MC TI
1. Nm c cc tri chng bnh l c DHD
2. Bit cc ngn nhn c th c c DHD
3. Nm c cc ti chn chn n v ph n li c
DHD
4. Nm c cc h q c DHD.
5. Nm c cc ngn tc i tri DHD
 DHD L GI ?
DHD: ttentin Deficit Hperctivitive Disrder
: Ri ln tng ng gim ch
- M chn n ICD-10: F90
DHD l mt ri ln pht trin tm thn c bi hi
n cc bt thng v ch , tng ht ng h xng
ng khng ph hp vi l ti.
 NGN NHN
ADHD l mt ri lon hnh vi c tnh hn hp v c th c
nhiu nguyn nhn

Yu t gii phu TK
Yu t mi trng
Cht dn truyn TK

ADHD

Tn thng CNS Yu t di truyn

CNS = central nervous system: h TK trung ng

 HI BI T HI N N V DHD
DHD c tm th trn tn c
5-8% tr em, 3-5% ngi ln
DHD l mt ri ln tm thn d pht trin thn kin
h c cc vng n i khin chc nng thc hin v
c ch
DHD ch d cc t sinh hc g r
Di trn, thn kinh, cc tn thng mc
phi v cc tng
tc gi
cc t n.
65-75% t di trn; 25-35% t cc tn thng/xm l n
Cc t x hi h nh hng n mc s gi
m, ng c ch cc ri ln km, v tip cn cc ng
n lc
 B NH S T NHI N C DHD
1. TRI TR PHT TRIN
30%
Vt q cc vn

2. BI HIN KO DI
40%
Cc tri chng s gim chc nng k di n t i tr ng thnh
Cc kh khn v mt x hi v cm xc

3. RI LON PHT TRIN TM THN

30%
Bi hin k di c cc tri chng chnh c DHD
Pht trin cc bnh l tm l nghim trng hn n nh nghi n r
, lm dng cht, ri ln c x, ri ln nh n cch ch ng i x h
i
 nh h ng pht tri n t m th n c DHD
Cc vn hc tp
Kh khn trong cc tng tc x Suy gim trong ngh nghip
hi Cc vn v lng t trng
Ri lon Cc vn v lng t trng Cc vn trong cc mi
hnh vi Cc rc ri php lut, ht thuc quan h
v thng tn Tn thng/ Cc tai nn
Lm dng cht

Mm non thiu nin trng thnh

Tui hc ph thng tui hc i hc

Tht bi trong hc tp
Ri lon Hnh vi
Cc kh khn v ngh nghip
Gp vn trong hc tp
Cc vn v lng t trng
Kh khn vi cc tng tc x hi
Lm dng cht
Cc vn v lng t trng
Tn thng/ Cc tai nn
Cc phn nhm c DHD
DHD, th hn hp

DHD, th mt ch chim th

DHD, th tng ng xng ng chim th

Ti ch n the DSM-IV : M t ch
C s h hn cc tri chng sbi hin thng xn:

Khng ch n cc ti
tit/ lm cc li d bt
cn Kh khn trng vic t ch
Kh khn trng vic d c
tr s ch Trnh n cc cng vic cn
C v nh khng lng n d tr s ch
ghe Lm mt c
Khng hn thnh cc D dng bi x lng
cng vic H qn
Ti ch n the DSM-IV : Xng ng / Tn g ng
C s h hn cc tri chng s bi hin thng xn:

Tng ng
Khng n
Khng th ngi n Xng ng
Ch/ le tr khng th Bt r c tr li trc khi
ch ng (khng n) c hi c n ht
Kh khn trng vic th Ch i n lt mt cch
m gi cc ht ng gii kh khn
tr n lng Ngt ngng hc ln v n
ng bn... gi khc
Ni q mc
 Ti ch n ch n n
Cc ti chn tri chng phi xt hi n trng 6 th
ng q
Tri chng phi xt hin trc 7 ti
Cc s gim d cc tri chng bnh phi x t hi n t
rng 2 h hn linh vc
Cc tri chng dn n s gim r rt
Cc tri chng khng li tr d cc ri ln t m th
n khc
Lm s t m st DHD ?
Tm st din rng:
Bn c hi cc im v kh khn (SDQ)

Tm st din hep:
SNP-IV
Vnderbilt
 N H GI- CH N ON DHD
XC INH TRI CHNG CHINH
NH GI CC S GIM.
XC INH NGN NHN N CO.
XM XT CC BNH L KM THO.
DHD l m t ch n n l m sng.
Kh ng c n cc th nghi m c n l
m sng xc in h ch n n c
DHD.
Bn c n c n l m sng ch khi bn
nghi ng cc b nh l kh khc.
 CH N ON PH N BI T C DHD

Tng ng trng l ti ph hp .
Vn ni d tr
Cc bnh l kh
Cc bnh l tm thn:
RL Trm cm
RL L
Ri ln trng ph t k
CHN ON PHN BIT C DHD

TNG NG TRONG L TI P
H HOP

 CHN ON PHN BIT C DHD
VN NI D TR
Khp v k lt
Q bng lng
 CHN ON PHN BIT C DHD

CC BNH L KHO
Ng c ch
Cng gip
Hi chng n thc th
D thc men: Ds, thc ging gi cm, v.v..
 CHN ON PHN BIT C DHD

TRM CM
Kh sc trm cm
Th
Mt cm gic thm n
Mt ng
Khc
tng t st
CC RI LON LO
 CHN ON PHN BIT C DHD

RI LON TRONG PH T K
Cc gi tip x hi s gim
Pht trin ngn ng s gim
Cc hnh vi lp li
 I TRI
TM L GIO DC
I CHNH HNH VI
HO DOC LI PHP
MT (NIMH Cllbrtive Mltisite Mltimdl
Tretment Std f Children with DHD)

T l thnh cng c cc hnh thc tri li

i tri phi hp 68%

i tri bn
g thc 56%
i tri hnh vi tch cc 34%
S snh cng ng 25%
(bt c cch tri li n m cc gi nh l chn q
cc nh cng cp ti i phng)
 H n g d n i tri DHD
Tm l gio dc

iu chnh hnh vi
iu chnh hnh vi
+ methylphenidate

p ng mt phn Khng p ng p ng tt
hay cc tc dng ph
khng dung np c
iu chnh liu Tip tc thuc
+ Hng dn ph huynh/ nh trng
 Cc thuc kch thch khc

p ng mt phn Khng p ng hay p ng tt

cc tc dng ph
khng dung np c
iu chnh liu Tip tc thuc
+ Hng dn ph huynh/ nh trng

Cc la chn thuc:
Atomoxetine
Bupropion
Venlafaxine
Imipramine
Clonidine
Guanfacine
TM L GIO DC
( i bn nn gi i thch ch gi nh)
Chn n
Cc tri chng
Ngn nhn
Cc l chn i tri
Cc phng php i chnh hnh vi c bn
Cch dng thc
 I CHNH HNH VI DHD
Gim ng tr
Sp xp ch ngi
Ch cc phn hi thng xn
inh hng, cc ht ng c t chc
T nhi c hi hn thm gi cc ht ng t
d, th th, nh m, ht, v.v..
S dng cc hnh vi cng c tch cc hn l trng p
ht
Ni dng lng t trng c tr
 HO DOC TRI LI
Cc thc c th s dng i chnh tnh trng n:
Methlphenidte (MPH)
tmxetine
Bprpin
Venlfxine
Imiprmine
Clnidine
Gnfcine
Cc hn ch c IR-MPH
Thi gin tc dng ngn
Ritlin: Li 2-3 ln/ng
D ng gi nng nh/ thp x r trng ng
Cn li trng v li s khi tn trng

Cc vn tn th i tri

Cc vn n tn - cc ch t c ki m st thng c n
c gi vn phng trng v c t trng ch s dng

Cc vn ring t Tr em bi DHD thng c m th bi k

hc n v c phi i n vn phng / gp t trng
Li ch c OROS-MPH
Li mi ng 1 ln
Li tr s cn thit phi s dng thc trng nhn
gg
i hc, v trc bt k cc ht ng s gi hc n
Lp v phng thch-tc thi
Hi q k di 12 gi
Ph hnh thch thi gin tc dng 12 gi - t n th
i tri tt hn.
Bi ht thnh c
D ng nng thc trng ht thnh gi nh
thp ti thi
Bi thc trng ht thnh ti ch d tr hi
q
L :
DHD nh hng khng ch trng hc
nh hng khng ch n thnh tch hc t p m c
n nh hng n cc mi qn h c bn v ngi k
hc
nh hng mi lc, khng thn gim khi ngh h
, ngh mt, ngh ngi..
Tri chng c th nhnh chng ti pht s khi d
ng thc.
TR N TRON G CM ON