Reimherr Frederick W, Williams Erika D, Strong Robert E, Mestas Ruth, Soni Poonam, Marchant Barrie K
Mood Disorders Clinic, Department of Psychiatry, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA.
J Clin Psychiatry. 2007 Jan;68(1):93-101. doi: 10.4088/jcp.v68n0113.
The realization that attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood has led to increased frequency of diagnosis and treatment in adults. Osmotic release oral system (OROS) methylpheni-date is a long-acting stimulant demonstrated to be effective in the treatment of children and adolescents with ADHD.
Forty-seven adults entered and 41 completed this double-blind, placebo-controlled, crossover trial of OROS methylphenidate. Each double-blind arm lasted 4 weeks; data were collected from August 2004 through December 2005. Subjects met both DSM-IV-TR and Utah Criteria for ADHD in adults. Outcome measures included the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS), the adult ADHD-Rating Scale (ADHD-RS), and the Clinical Global Impressions-Improvement scale (CGI-I). At baseline, subjects were categorized as having significant emotional symptoms with the WRAADDS and/or significant oppositional-defiant symptoms using a self-report scale assessing the DSM-IV criteria for oppositional defiant disorder.
17% of the sample (N = 8) had ADHD alone, 38% (N = 18) had ADHD plus significant emotional symptoms, and 40% (N = 19) had ADHD with both significant emotional and oppositional symptoms. At a mean +/- SD dose of 64.0 +/- 23.3 (0.75 mg/kg), OROS methylphenidate proved superior to placebo for all clinical measures: total WRAADDS score decrease of 42% versus 13%, respectively, p < .001 and total ADHD-RS score decrease of 41% versus 14%, respectively, p = .003, plus the subscales addressing inattention, hyperactivity/ impulsivity, and emotional dysregulation.
OROS methylphenidate proved effective in treating adult ADHD. ADHD alone was relatively uncommon. Over 80% of our patients had ADHD with a combination of emotional and/or oppositional symptoms.
注意缺陷多动障碍（ADHD）常持续至成年期这一认识，使得成人ADHD的诊断和治疗频率增加。渗透泵控释口服系统（OROS）哌醋甲酯是一种长效兴奋剂，已证明对治疗儿童和青少年ADHD有效。
47名成人参与了这项OROS哌醋甲酯的双盲、安慰剂对照、交叉试验，41人完成试验。每个双盲阶段持续4周；数据收集时间为2004年8月至2005年12月。受试者符合成人ADHD的DSM-IV-TR标准和犹他州标准。疗效指标包括温德-赖姆赫尔成人注意缺陷障碍量表（WRAADDS）、成人ADHD评定量表（ADHD-RS）以及临床总体印象改善量表（CGI-I）。在基线时，使用评估对立违抗障碍DSM-IV标准的自我报告量表，将受试者分类为具有显著情绪症状（根据WRAADDS）和/或显著对立违抗症状。
样本中17%（N = 8）仅患有ADHD，38%（N = 18）患有ADHD并伴有显著情绪症状，40%（N = 19）患有ADHD且伴有显著情绪和对立症状。在平均±标准差剂量为64.0±23.3（0.75mg/kg）时，OROS哌醋甲酯在所有临床指标上均优于安慰剂：WRAADDS总分下降分别为42%和13%，p < 0.001；ADHD-RS总分下降分别为41%和14%，p = 0.003，以及注意力不集中、多动/冲动和情绪失调的分量表。
OROS哌醋甲酯被证明对治疗成人ADHD有效。单纯ADHD相对少见。我们超过80%的患者患有ADHD并伴有情绪和/或对立症状。
