Wietecha Linda, Young Joel, Ruff Dustin, Dunn David, Findling Robert L, Saylor Keith
Lilly USA, LLC, Lilly Corporate Center, Indianapolis, IN 46285, USA.
Clin Neuropharmacol. 2012 May-Jun;35(3):125-33. doi: 10.1097/WNF.0b013e3182560315.
To assess the efficacy of atomoxetine (ATX) and impact of treatment on family functioning in adults with ADHD.
Adults with attention-deficit/hyperactivity disorder (ADHD) having both a spouse/partner and child were randomized to placebo (n = 234) or ATX (n = 268) for 24 weeks. Attention-deficit/hyperactivity disorder measures included the Conners Adult ADHD Rating Scale total ADHD Symptoms score and Clinical Global Impression-ADHD-Severity. Marital measures included the Dyadic Adjustment Scale and the Family Assessment Measure Dyadic Relationship Scale (FAM III). Parenting measures included the Parenting Stress Index, Alabama Parenting Questionnaire, and Parenting Sense of Competence Scale (PSCS).
Improvement was greater with ATX over placebo at 24 weeks on the Conners Adult ADHD Rating Scale (-16.43 vs -8.65; P < 0.001, repeated measures) and Clinical Global Impression (P < 0.001, last observation carried forward). Baseline-to-end point changes in marital and parenting measures were significant but not between treatment groups. Post hoc analyses showed significant interaction of treatment and impairment for the FAM III Task Accomplishment (patient) and Role Performance (patient and spouse) items and PSCS efficacy. Further stratification by sex or presence of a child with ADHD yielded significant interaction and treatment differences for the FAM III Task Accomplishment and the FAM III and Dyadic Adjustment Scale affective expression items, PSCS total score, Alabama Parenting Questionnaire Corporal Punishment, and Parenting Stress Index attachment items.
Atomoxetine demonstrated significant ADHD symptom reduction over 24 weeks. Although both groups demonstrated baseline-to-end point changes on many marital and parenting measure items, there were no treatment differences. Maladaptive behaviors of long-standing ADHD may benefit from both medication and behavioral-psychosocial intervention.
评估托莫西汀（ATX）对成人注意力缺陷多动障碍（ADHD）的疗效以及治疗对家庭功能的影响。
患有ADHD且有配偶/伴侣和孩子的成年人被随机分为安慰剂组（n = 234）或ATX组（n = 268），治疗24周。ADHD评估指标包括康纳斯成人ADHD评定量表的ADHD症状总分和临床总体印象-ADHD-严重程度。婚姻评估指标包括二元调整量表和家庭评估测量二元关系量表（FAM III）。养育评估指标包括养育压力指数、阿拉巴马养育问卷和养育能力感量表（PSCS）。
在24周时，与安慰剂相比，ATX在康纳斯成人ADHD评定量表上的改善更大（-16.43对-8.65；P < 0.001，重复测量），在临床总体印象上也有改善（P < 0.001，末次观察结转）。婚姻和养育评估指标从基线到终点的变化显著，但治疗组之间无差异。事后分析显示，治疗与FAM III任务完成（患者）和角色表现（患者和配偶）项目以及PSCS疗效的损伤存在显著交互作用。按性别或家中是否有患ADHD的孩子进一步分层后，FAM III任务完成、FAM III和二元调整量表情感表达项目、PSCS总分、阿拉巴马养育问卷体罚以及养育压力指数依恋项目存在显著的交互作用和治疗差异。
托莫西汀在24周内显著减轻了ADHD症状。虽然两组在许多婚姻和养育评估项目上都显示出从基线到终点的变化，但治疗上并无差异。长期ADHD的适应不良行为可能从药物治疗和行为心理社会干预中获益。
