Spencer Thomas J, Biederman Joseph, Wilens Timothy E, Faraone Stephen V
Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, USA.
J Clin Psychiatry. 2002;63 Suppl 12:3-9.
Although attention-deficit/hyperactivity disorder (ADHD) impairs millions of people worldwide, both the prevalence and existence of the disorder are being reevaluated at the phenotypic level. To safeguard against overdiagnosis, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), demands that individuals with ADHD have pervasive impairment, that is, impairment in more than 1 setting. However, the appropriateness of the DSM-IV classification of ADHD is also undergoing reevaluation. Like the symptoms of a developmental disability, the symptoms of ADHD must be evaluated in the context of age-based norms; therefore, the current criteria for ADHD, which are not age referenced, may minimize the rate of persistence of ADHD into adulthood. In an effort to better understand the pathophysiology of ADHD, recent research has focused on identifying the etiology of ADHD. These studies have revealed that the disorder is highly heritable and may be associated with neurobiological deficits in the prefrontal cortex and related subcortical systems. Etiologic studies have also identified candidate genes and prenatal and perinatal risk factors for ADHD. As the causes and course of ADHD are better understood, a new generation of medications is being developed for the disorder. Although stimulants are often effective in reducing the symptoms of the disorder, as a class they have limitations such as a lack of 24-hour-a-day coverage, unwanted side effects, potential for abuse, and lessened effectiveness in the context of some comorbidities. Therefore, the treatment characteristics of newer, more selective treatments such as atomoxetine should continue to be explored in ADHD.
尽管注意缺陷多动障碍（ADHD）影响着全球数百万人，但该疾病的患病率和存在情况正在表型层面上重新评估。为防止过度诊断，《精神疾病诊断与统计手册》第四版（DSM-IV）要求患有ADHD的个体存在广泛损害，即在不止一种环境中存在损害。然而，DSM-IV对ADHD的分类是否恰当也正在重新评估。与发育障碍的症状一样，ADHD的症状必须在基于年龄的规范背景下进行评估；因此，目前未参考年龄的ADHD标准可能会降低ADHD持续至成年期的比例。为了更好地理解ADHD的病理生理学，最近的研究集中在确定ADHD的病因。这些研究表明，该疾病具有高度遗传性，可能与前额叶皮质及相关皮质下系统的神经生物学缺陷有关。病因学研究还确定了ADHD的候选基因以及产前和围产期风险因素。随着对ADHD病因和病程的了解日益深入，针对该疾病的新一代药物正在研发中。尽管兴奋剂通常能有效减轻该疾病的症状，但作为一类药物，它们存在局限性，如无法提供全天24小时的疗效、存在不良副作用、有滥用风险以及在某些合并症情况下疗效降低。因此，应继续探索像托莫西汀这样更新、更具选择性的治疗方法在ADHD治疗中的特点。
