Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Postgrad Med. 2011 Mar;123(2):177-84. doi: 10.3810/pgm.2011.03.2276.
Oppositional defiant disorder (ODD) is a common comorbidity of attention-deficit/hyperactivity disorder (ADHD) in both children and adolescents. Although there is research demonstrating that ADHD persists into adulthood, less is known about the frequency of its persistence, clinical characteristics, and impairment when associated with comorbid ODD in adults with ADHD.
Data from a randomized clinical trial of adults with ADHD were analyzed to determine the prevalence and clinical correlates of comorbid ODD. As per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria, patients who reported having ≥ 4 symptoms "often" or "very often" were classified as meeting the symptom criteria for the disorder.
Forty percent of this sample met symptom criteria for ODD. Subjects with ODD were more likely to have other comorbid disorders, lower investigator ratings of overall functioning, and lower patient life satisfaction (P < 0.05). A regression analysis using these variables predicted 40% of the variance of ODD as a comorbid condition in addition to ADHD. Although the presence or absence of ODD at baseline does not moderate response of ADHD symptoms with treatment, improvement in ODD symptoms was mediated by improvement in ADHD symptoms (P < 0.0001). Oppositional defiant disorder treatment was more responsive to dextroamphetamine than paroxetine, despite the contribution of irritability and reactive tantrums, as symptoms of the disorder.
Oppositional defiant disorder is a valid and impairing disorder requiring evaluation and treatment in adults.
对立违抗障碍（ODD）是儿童和青少年注意力缺陷/多动障碍（ADHD）的常见共病。虽然有研究表明 ADHD 会持续到成年期，但对于 ADHD 成人中 ODD 的持续性、临床特征和损害的频率知之甚少。
分析了一项针对 ADHD 成人的随机临床试验数据，以确定共患 ODD 的患病率和临床相关性。根据《精神障碍诊断与统计手册》第四版标准，报告有≥4 项症状“经常”或“非常频繁”的患者被归类为符合该障碍的症状标准。
该样本中有 40%符合 ODD 的症状标准。患有 ODD 的患者更有可能患有其他共病障碍、研究人员对整体功能的评分较低和患者生活满意度较低（P<0.05）。使用这些变量的回归分析预测了 ADHD 共病 ODD 的 40%的方差。尽管 ADHD 症状治疗时 ODD 的存在与否不能调节，但 ODD 症状的改善是通过 ADHD 症状的改善来介导的（P<0.0001）。尽管易怒和反应性发脾气是该障碍的症状，但与帕罗西汀相比，右旋安非他命治疗 ODD 的效果更好。
对立违抗障碍是一种有效的、导致损害的障碍，需要在成人中进行评估和治疗。
