Hegerl U, Sander C, Olbrich S, Schoenknecht P
Department of Psychiatry, University of Leipzig, Leipzig, Germany.
Pharmacopsychiatry. 2009 Sep;42(5):169-74. doi: 10.1055/s-0029-1220888. Epub 2009 Sep 1.
Mania and attention-deficit hyperactivity disorder (ADHD) show a high degree of symptom overlap and comorbidity. Clinical trials and case reports indicate that psychostimulants do not or only rarely trigger or aggravate manic episodes but can even produce rapid and pronounced antimanic effects. An explanatory model is presented here in which the sensation seeking, hyperactive behaviour observed in mania and ADHD is interpreted as an autoregulatory attempt to stabilize vigilance by increasing external stimulation. Accordingly, patients with both mania and ADHD show rapid declines to lower vigilance levels (e.g., sleep spindles in EEG) under resting conditions with low external stimulation. The "paradoxical" antimanic effect of psychostimulants possibly results from their vigilance stabilizing properties.
躁狂症与注意力缺陷多动障碍（ADHD）表现出高度的症状重叠和共病现象。临床试验和病例报告表明，精神兴奋剂不会或仅很少引发或加重躁狂发作，甚至还能产生迅速而显著的抗躁狂作用。本文提出一种解释模型，其中在躁狂症和ADHD中观察到的寻求刺激、多动行为被解释为通过增加外部刺激来稳定警觉性的一种自我调节尝试。因此，患有躁狂症和ADHD的患者在外部刺激较低的静息状态下会迅速降至较低的警觉水平（例如脑电图中的睡眠纺锤波）。精神兴奋剂的“ paradoxical”抗躁狂作用可能源于其稳定警觉性的特性。
