ABSTRACT
Objective:To investigate the clinical efficacy of atomoxetine combined with cognitive-behavioral therapy (CBT) on children with attention deficit hyperactivity disorder (ADHD).Methods:Totally 104 children diagnosed with ADHD were randomly divided into atomoxetine group ( n=34), CBT group ( n=35) and atomoxetine combined with CBT group ( n=35). After 12 weeks of treatment, questionnaire-children with difficulties (QCD), Swanson child behavior checklist (SNAP-Ⅳ) and Conners parents rating scales (CPRS) were used to evaluate the efficacy and recorded the adverse reactions during the treatment. SPSS 23.0 software was used for statistical analysis. Paired sample t-test was used to compare the scores of the same group before and after treatment, and one-way ANOVA was used to compare the difference between the three groups after treatment. Results:(1)Compared with baseline, the score of QCD increased(32.96±3.01, 43.00±2.22) ( t=-13.35, P<0.01) , while the attention deficit(15.67±3.46, 6.07±1.73), hyperactivity/impulse(13.59±3.41, 7.30±2.43), opposition disobedience(9.85±3.98, 2.59±2.17) and total score(39.11±6.65, 16.59±3.91) of SNAP-Ⅳ decreased in atomoxetine combined with CBT group after treatment ( t=14.96, 10.87, 11.77, 21.49, all P<0.01). The factor scores of behavior problems(0.81±0.30, 0.70±0.26), learning problems(1.58±0.31, 0.32±0.13), psychosomatic disorders(0.22±0.25, 0.16±0.20), impulse hyperactivity(1.27±0.37, 0.71±0.18), anxiety(0.32±0.26, 0.23±0.17) and hyperactivity index(1.19±0.40, 0.79±0.22) of CPRS also decreased ( t=2.71, 21.23, 2.41, 8.87, 2.96, 6.19, all P<0.05) in atomoxetine combined with CBT group after treatment. (2) After treatment, the changes of QCD scores, attention deficit dimension in SNAP-Ⅳ scale, learning problems and impulse hyperactivity dimension in CPRS scale of the three groups before and after treatment were statistically significant (all P<0.05). (3) Post LSD comparison showed that the change in CBT group was significantly lower than that in atomoxetine group and atomoxetine combined CBT group in QCD score(both P<0.05). In the dimension of attention deficit of SNAP-Ⅳ, the difference in CBT group was significantly lower than that in atomoxetine combined CBT group ( P<0.01). In the learning problems and impulse hyperactivity dimensions of CPRS, the changes of atomoxetine combined with CBT group were significantly higher than those of atomoxetine group and CBT group (all P<0.01). Conclusion:Atomoxetine combined with CBT has better curative effect than atomoxetine or CBT alone in patients with ADHD. It can effectively improve the core symptoms and daily life function of ADHD children, and has high safety.
ABSTRACT
This paper introduces the background, implication and construction of the county health services community (County medical alliance) model in Anhui Province under the background of new medical reform,and briefly introduces the relationship between medical insurance, enhancing the ability to upgrade and standardize services and medical treatment integration of the typical experience.It also analyses the challenges faced in the construction of medical syndicate, such as the mechanism of regional environmental restriction, compensation and assessment mechanisms which have not been established yet, and the sustainable development of information technology that has lagged behind, and put forward the policy suggestion to improve the construction of medical community, with a view to providing reference for the next work.