Ratey J J, Greenberg M S, Bemporad J R, Lindem K J
J Child Adolesc Psychopharmacol. 1992 Winter;2(4):267-75. doi: 10.1089/cap.1992.2.267.
ABSTRACT Adult patients with significant childhood and current symptoms of attention-deficit hyperactivity disorder (ADHD), but whose ADHD had not been previously recognized, were evaluated by three clinical consultants working with diverse referral populations. These 60 adults shared common characteristics of physical and mental restlessness, impulsivity, disabling distractibility, low self-esteem, self-loathing, and a gnawing sense of underachievement. Specific learning or behavior problems were often present. These patients were chronically disaffected. The diagnosis of ADHD appeared to be missed because these individuals presented with atypical symptoms or had found ways to compensate for their deficits. Descriptive generalizations are offered concerning their coping strategies. These adults had sought previous psychiatric care for non-ADHD symptoms but had numerous unsuccessful treatment attempts. Most patients had been treated for mood or anxiety disorders. Traditional defense analysis had little beneficial effect and aggravated problems of self-esteem; modifications of the psychotherapeutic process are recommended. In open clinical trials without formal measures, the majority of such patients appeared to respond to low doses of antidepressants (i.e., desipramine 10-30 mg daily) and seemed to lose the therapeutic effect at higher antidepressant doses.
摘要 成年患者童年时期及当前存在明显的注意力缺陷多动障碍（ADHD）症状，但此前未被确诊。三位临床顾问对来自不同转诊人群的此类患者进行了评估。这60名成年患者具有身心不安、冲动、注意力分散、自卑、自我厌恶以及强烈的挫败感等共同特征。他们常伴有特定的学习或行为问题。这些患者长期心怀不满。ADHD的诊断似乎被遗漏，原因在于这些个体表现出非典型症状，或者已找到弥补自身缺陷的方法。文中给出了关于他们应对策略的描述性概括。这些成年患者此前曾因非ADHD症状寻求精神科治疗，但多次治疗均未成功。大多数患者曾接受过情绪或焦虑障碍的治疗。传统的防御分析几乎没有益处，反而加重了自尊问题；建议对心理治疗过程进行调整。在未采用正式测量方法的开放临床试验中，大多数此类患者似乎对低剂量抗抑郁药（即每日10 - 30毫克地昔帕明）有反应，而在较高抗抑郁药剂量时似乎失去治疗效果。
