Purper-Ouakil D, Franc N
Service de psychopathologie de l'enfant et de l'adolescent, AP-HP, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
Arch Pediatr. 2011 Jun;18(6):679-85. doi: 10.1016/j.arcped.2011.03.003. Epub 2011 Apr 14.
Inattention, motor instability, and impulsivity, associated in varying degrees of severity depending on the clinical subtype, constitute the key symptoms of attention deficit/hyperactivity disorder (ADHD). However, emotional symptoms are frequent in patients with ADHD and may, in some cases, be responsible for a major part of the negative impact on functioning and outcome. Emotional problems have been described in ADHD even in the absence of characterized comorbid conditions such as depressive or anxiety disorders. They can manifest acutely in the form of severe tantrums and aggressive behaviour, generally in reaction to an environmental trigger, or show a more chronic course of irritable or labile mood. Symptoms of emotional undercontrol seem to occur more frequently when ADHD is associated with oppositional defiant behaviour, but they are not specific and may contribute to difficulties in making a differential diagnosis, especially with bipolar disorder and prodromal symptoms of personality disorders. The frequency and negative impact of emotional symptoms and the need to differentiate them from bipolar disorder has led some authors to the description of a novel clinical entity called "severe mood dysregulation" or "temper dysregulation with dysphoria." This article aims to review the recent literature on emotional symptoms associated with ADHD and to discuss relevant clinical and biological issues. Current research highlights the links between emotional self-regulation and executive functions and possible involvement of motivational systems. The role of environmental factors in the development of emotional regulation and self-control is another important issue, especially because environmental modification is the major focus of current preventive and therapeutic interventions.
注意力不集中、运动不稳定和冲动，根据临床亚型严重程度各不相同，是注意力缺陷多动障碍（ADHD）的关键症状。然而，情绪症状在ADHD患者中很常见，在某些情况下，可能是对功能和预后产生负面影响的主要原因。即使在没有如抑郁或焦虑症等特定共病的情况下，ADHD患者也存在情绪问题。它们可能以严重发脾气和攻击行为的形式急性发作，通常是对环境触发因素的反应，或者表现为更慢性的易怒或情绪不稳定。当ADHD与对立违抗行为相关时，情绪控制不足的症状似乎更频繁出现，但它们并不具有特异性，可能会导致鉴别诊断困难，尤其是与双相情感障碍和人格障碍的前驱症状鉴别时。情绪症状的频率和负面影响以及将它们与双相情感障碍区分开来的必要性，促使一些作者描述了一种名为“严重情绪失调”或“烦躁不安伴情绪调节障碍”的新型临床实体。本文旨在综述近期关于ADHD相关情绪症状的文献，并讨论相关的临床和生物学问题。当前研究突出了情绪自我调节与执行功能之间的联系以及动机系统可能的参与。环境因素在情绪调节和自我控制发展中的作用是另一个重要问题，特别是因为环境改变是当前预防和治疗干预的主要重点。
