Pliszka Steven R
Division of Child and Adolescent Psychiatry, Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Paediatr Drugs. 2003;5(11):741-50. doi: 10.2165/00148581-200305110-00003.
Attention deficit hyperactivity disorder (ADHD) is frequently comorbid with a variety of psychiatric disorders. These include oppositional defiant disorder and conduct disorder (CD), as well as affective, anxiety, and tic disorders. ADHD and ADHD with comorbid CD appear to be distinct subtypes; children with ADHD/CD are at higher risk of antisocial personality and substance abuse as adults. Stimulants are often effective treatments for aggressive or antisocial behavior in patients with ADHD, but mood stabilizers or atypical antipsychotics may be used to treat explosive aggressive outbursts. Response to stimulants is not affected by comorbid anxiety, but children with ADHD/anxiety disorder may show greater benefit from psychosocial interventions than those with ADHD alone. The degree of prevalence of major depressive disorder (MDD) and bipolar disorder among children with ADHD is controversial, but a subgroup of severely emotionally labile ADHD children who present serious management issues for the clinician clearly exists. Antidepressants may be used in conjunction with stimulants to treat MDD, while mood stabilizers and atypical antipsychotics are often required to treat manic symptoms or aggression. After resolution of the manic episode, stimulant treatment of the comorbid ADHD may be safely undertaken. Recent research suggests that stimulants can be safely used in children with comorbid ADHD and tic disorders, but the addition of anti-tic agents to stimulants is often necessary. Clinicians who work with patients with ADHD should be prepared to deal with a wide range of emotional and behavioral problems beyond the core symptoms of inattention and impulsivity/hyperactivity.
注意缺陷多动障碍（ADHD）常与多种精神障碍共病。这些包括对立违抗障碍和品行障碍（CD），以及情感、焦虑和抽动障碍。ADHD以及合并CD的ADHD似乎是不同的亚型；患有ADHD/CD的儿童成年后出现反社会人格和药物滥用的风险更高。兴奋剂通常是治疗ADHD患者攻击性行为或反社会行为的有效方法，但情绪稳定剂或非典型抗精神病药物可用于治疗爆发性攻击行为。对兴奋剂的反应不受共病焦虑的影响，但患有ADHD/焦虑症的儿童可能比单纯患有ADHD的儿童从心理社会干预中获益更多。ADHD儿童中重度抑郁症（MDD）和双相情感障碍的患病率存在争议，但显然存在一组严重情绪不稳定的ADHD儿童，给临床医生带来了严重的管理问题。抗抑郁药可与兴奋剂联合用于治疗MDD，而情绪稳定剂和非典型抗精神病药物通常用于治疗躁狂症状或攻击行为。躁狂发作缓解后，可安全地对共病的ADHD进行兴奋剂治疗。最近的研究表明，兴奋剂可安全用于合并ADHD和抽动障碍的儿童，但通常需要在兴奋剂中添加抗抽动药物。治疗ADHD患者的临床医生应准备好应对注意力不集中和冲动/多动等核心症状之外的广泛情绪和行为问题。
