Wender P H, Wolf L E, Wasserstein J
Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
Ann N Y Acad Sci. 2001 Jun;931:1-16.
Attention-Deficit Hyperactivity Disorder (ADHD) is a common, genetically transmitted neurological disorder, with onset in childhood, probably mediated by decreased brain dopaminergic functioning. The first author was one of the earliest to describe the persistence of symptoms into adulthood. Prevalence and natural history data suggest that of the 3 to 10% of children diagnosed with ADHD, one- to two-thirds (somewhere between 1 and 6% of the general population) continue to manifest appreciable ADHD symptoms into adult life. This paper describes how ADHD in adults can be readily diagnosed and treated, despite resembling or coexisting with other psychiatric disorders. The Wender Utah diagnostic criteria address adult characteristics of the disorder. Informant and patient interviews and rating scales are used to determine the psychiatric status of the patient as a child, make a retroactive diagnosis of childhood ADHD, and establish the current diagnosis of the adult. Stringent diagnosis is key to determining effective treatment. Dopamine agonist stimulant medications appear to be the most effective in treating ADHD. About 60% of patients receiving stimulant medication showed moderate-to-marked improvement, as compared with 10% of those receiving placebo. The core symptoms of hyperactivity, inattention, mood lability, temper, disorganization, stress sensitivity, and impulsivity have been shown to respond to treatment with stimulant medications. Non-dopaminergic medications, such as the tricyclic antidepressants and SSRIs have generally not been useful in adults with ADHD in the absence of depression or dysthymia. Pemoline is no longer approved for use in these patients, despite early favorable reports. Appropriate management of adult patients with ADHD is multimodal. Psychoeducation, counseling, supportive problem-directed therapy, behavioral intervention, coaching, cognitive remediation, and couples and family therapy are useful adjuncts to medication management. Concurrent supportive psychosocial treatment or polypharmacy may be useful in treating the adult with comorbid ADHD.
注意缺陷多动障碍（ADHD）是一种常见的、由基因传递的神经障碍，起病于儿童期，可能由大脑多巴胺能功能减退介导。第一作者是最早描述该症状持续至成年期的人之一。患病率和自然史数据表明，在被诊断患有ADHD的儿童中，有三分之一至三分之二（占总人口的1%至6%）在成年后仍表现出明显的ADHD症状。本文描述了尽管成人ADHD与其他精神障碍相似或并存，但仍可轻松诊断和治疗。温德犹他诊断标准涉及该障碍的成人特征。通过对 informant 和患者的访谈以及评定量表来确定患者儿童时期的精神状态，对儿童期ADHD进行追溯诊断，并确立成人期的当前诊断。严格诊断是确定有效治疗的关键。多巴胺激动剂兴奋剂药物似乎是治疗ADHD最有效的药物。与接受安慰剂的患者中10%相比，约60%接受兴奋剂药物治疗的患者显示出中度至显著改善。多动、注意力不集中、情绪不稳定、脾气、杂乱无章、压力敏感性和冲动等核心症状已被证明对兴奋剂药物治疗有反应。非多巴胺能药物，如三环类抗抑郁药和选择性5-羟色胺再摄取抑制剂（SSRI），在没有抑郁或心境恶劣的成人ADHD患者中通常没有效果。尽管早期有良好报告，但匹莫林已不再被批准用于这些患者。对成人ADHD患者进行适当管理是多模式的。心理教育、咨询、支持性问题导向治疗、行为干预、辅导、认知矫正以及夫妻和家庭治疗是药物管理的有用辅助手段。同时进行支持性心理社会治疗或联合用药可能对治疗合并ADHD的成人有用。
