Reimherr Frederick W, Marchant Barrie K, Strong Robert E, Hedges Dawson W, Adler Lenard, Spencer Thomas J, West Scott A, Soni Poonam
Mood Disorders Clinic, Department of Psychiatry, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.
Biol Psychiatry. 2005 Jul 15;58(2):125-31. doi: 10.1016/j.biopsych.2005.04.040.
Before 1980, attention-deficit/hyperactivity disorder (ADHD) was called minimal brain dysfunction and included emotional symptoms now listed as "associated features" in DSM-IV. Data from two multicenter, placebo-controlled studies with 536 patients were reexamined to assess: 1) the pervasiveness of these symptoms in samples of adults with ADHD; 2) the response of these symptoms to atomoxetine; and 3) their association with depressive/anxiety symptoms.
The Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) was used to assess temper, affective lability, and emotional overreactivity, thus identifying patients exhibiting "emotional dysregulation." Other DSM-IV Axis I diagnoses were exclusionary. Outcome measures were the Conners' Adult ADHD Rating Scale (CAARS) and the WRAADDS.
Thirty-two percent of the sample met post hoc criteria for emotional dysregulation and had higher baseline scores on ADHD measures, a lower response to placebo, and greater response to atomoxetine (p = .048). Symptoms of emotional dysregulation had a treatment effect (p < .001) at least as large as the CAARS (p = .002) and the total WRAADDS (p = .001). Emotional dysregulation was present in the absence of anxiety or depressive diagnosis.
Symptoms of emotional dysregulation were present in many patients with ADHD and showed a treatment response similar to other ADHD symptoms.
1980年以前，注意力缺陷多动障碍（ADHD）被称为轻微脑功能障碍，其中包括现在在《精神疾病诊断与统计手册》第四版（DSM-IV）中列为“相关特征”的情绪症状。对两项有536名患者参与的多中心、安慰剂对照研究的数据进行了重新分析，以评估：1）这些症状在患有ADHD的成人样本中的普遍性；2）这些症状对托莫西汀的反应；3）它们与抑郁/焦虑症状的关联。
使用温德-莱姆赫尔成人注意力缺陷障碍量表（WRAADDS）评估脾气、情感不稳定和情绪过度反应，从而识别表现出“情绪调节障碍”的患者。其他DSM-IV轴I诊断为排除标准。结果测量指标为康纳斯成人ADHD评定量表（CAARS）和WRAADDS。
32%的样本符合情绪调节障碍的事后标准，在ADHD测量指标上基线得分更高，对安慰剂反应较低，对托莫西汀反应更大（p = 0.048）。情绪调节障碍症状的治疗效果（p < 0.001）至少与CAARS（p = 0.002）和WRAADDS总分（p = 0.001）一样大。在没有焦虑或抑郁诊断的情况下也存在情绪调节障碍。
许多ADHD患者存在情绪调节障碍症状，并且显示出与其他ADHD症状相似的治疗反应。
