Diamond I R, Tannock R, Schachar R J
Hospital for Sick Children, Toronto, Ontario, Canada.
J Am Acad Child Adolesc Psychiatry. 1999 Apr;38(4):402-9. doi: 10.1097/00004583-199904000-00012.
To determine whether comorbid anxiety alters response to methylphenidate (MPH) in children with attention-deficit hyperactivity disorder (ADHD).
Ninety-one children with ADHD were assessed for anxiety. Children were randomly assigned to receive MPH or placebo, titrated to a dose of 0.7 mg/kg, while side effects were minimized. Measures of side effects and behavioral response were obtained from parents and teachers before treatment, after titration to optimal dose, and after 4 months of treatment. These measures, dose of drug, and rate of adherence to assigned medication assignment were compared for nonanxious (ADHD- ANX) and anxious ADHD children (ADHD+ ANX).
Rates of adherence to original medication assignment did not differ between the groups. ADHD+ ANX on both MPH and placebo titrated to a lower dose at the end of titration, although the dose of drug did not differ among the groups after 4 months of treatment. No differential response to MPH between ADHD+ ANX and ADHD- ANX was noted at end-titration or at 4 months on any side effect or behavioral measures.
Comorbid anxiety does not appear to influence development of side effects or behavioral response to MPH when dose is titrated as in standard clinical practice.
确定共病焦虑是否会改变注意力缺陷多动障碍（ADHD）儿童对哌甲酯（MPH）的反应。
对91名患有ADHD的儿童进行焦虑评估。将儿童随机分配接受MPH或安慰剂治疗，滴定至0.7mg/kg的剂量，同时将副作用降至最低。在治疗前、滴定至最佳剂量后以及治疗4个月后，从家长和教师处获取副作用和行为反应的测量数据。比较非焦虑型（ADHD-ANX）和焦虑型ADHD儿童（ADHD+ANX）的这些测量数据、药物剂量以及对指定药物治疗的依从率。
两组对原始药物治疗的依从率没有差异。在滴定结束时，接受MPH和安慰剂治疗的ADHD+ANX儿童滴定至较低剂量，尽管在治疗4个月后各组之间的药物剂量没有差异。在滴定结束时或4个月时，在任何副作用或行为测量方面，未发现ADHD+ANX和ADHD-ANX对MPH有不同反应。
按照标准临床实践进行剂量滴定时，共病焦虑似乎不会影响MPH副作用的发生或行为反应。
