Sinzig Judith, Döpfner Manfred, Lehmkuhl G, Uebel H, Schmeck K, Poustka F, Gerber W D, Günter M, Knölker U, Gehrke M, Hässler F, Resch F, Brünger M, Ose C, Fischer R
Department for Psychiatry and Psychotherapy of Children & Adolescents at the University of Cologne, Köln, Germany.
J Child Adolesc Psychopharmacol. 2007 Aug;17(4):421-32. doi: 10.1089/cap.2007.0011.
Aggression is frequently observed in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to assess the efficacy with regard to oppositional and aggressive behavior of a new long-acting methylphenidate preparation (Medikinet retard, MPH-MR), with equal portions of the immediate-release and the sustained-release active substance, and especially to look at correlations between either teacher or parent assessment of aggression and ADHD sub-symptomatology.
Eighty five children and adolescents (6-16 years) were investigated in a double-blind, randomized, clinical trial over 5 weeks under a treatment with MPH-MR using symptom checklists for ADHD, oppositional-defiant and conduct disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).
A total of 64.9% of the children showed oppositional defiant disorder/conduct disorder (ODD/CD) symptoms. A statistically significant effect was found in the group treated with MPH (verum-group). On the basis of Cohen's criteria, high effects were found for aggressive symptoms in school (d = 1.0), but not in the afternoon (d = 0.4). There were also lower effect sizes for more severe aggressive symptoms. We found characteristic correlations between ODD/CD symptoms and the ADHD subscale hyperactivity/impulsivity compared to the subscale inattention.
Long-acting MPH is effective in the treatment of oppositional-defiant and aggressive behavior, especially concerning milder symptoms. The expected correlation between impulsivity and aggressiveness could be confirmed.
在患有注意力缺陷多动障碍（ADHD）的儿童和青少年中，攻击行为很常见。本研究的目的是评估一种新的长效哌甲酯制剂（美达莫缓释片，MPH-MR）对对立和攻击行为的疗效，该制剂含有等量的速释和缓释活性成分，尤其要研究教师或家长对攻击行为的评估与ADHD亚症状之间的相关性。
在一项为期5周的双盲、随机临床试验中，使用根据《精神疾病诊断与统计手册》第4版（DSM-IV）制定的ADHD、对立违抗和品行障碍症状清单，对85名6至16岁的儿童和青少年进行了MPH-MR治疗研究。
共有64.9%的儿童表现出对立违抗障碍/品行障碍（ODD/CD）症状。在接受MPH治疗的组（真药组）中发现了具有统计学意义的效果。根据科恩标准，在学校中攻击症状有显著效果（d = 1.0），但下午没有（d = 0.4）。对于更严重的攻击症状，效应量也较低。与注意力不集中亚量表相比，我们发现ODD/CD症状与ADHD多动/冲动亚量表之间存在特征性相关性。
长效MPH对对立违抗和攻击行为有效，尤其是对较轻的症状。冲动性与攻击性之间的预期相关性得到了证实。
