Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, University of Heidelberg, J 5, 68159 Mannheim, Germany.
Eur Psychiatry. 2013 Aug;28(6):379-85. doi: 10.1016/j.eurpsy.2012.08.001. Epub 2012 Oct 10.
To investigate effects of a 12-week treatment with atomoxetine (ATX) on driving performance in real traffic, driving-related neuropsychological performance tests and self-evaluation of driving in adult patients with ADHD compared to an untreated control group with ADHD.
Parallel group design with an ATX and a waiting list group. At baseline and endpoint patients were evaluated with a standardized on-road driving test (SDBO), a driving-related neuropsychological test battery (Act and React Test System [ART2020]), and subjective measures of driving performance (one-week driving diary, Driver Coping Questionnaire).
Forty-three of the 64 included patients completed the study (n=22 ATX, n=21 controls). Mean intervention period was 11.9±3.0 weeks, mean daily ATX dosage was 71.6±14.9mg. At endpoint, 60.1% of patients treated with ATX and 0% of waiting list group had reduced ADHD symptoms by greater or equal to 30%. In SDBO, ATX group reduced driving errors in three of four driving performance categories (attention, P<0.05; risk-related self-control, P<0.005; driver skills, P<0.001), number of driving errors remained stable in control group. At endpoint, 47.6% of control group and 18.2% of ATX group (P<0.05) did not fulfil the driving fitness criteria according to German Guidelines (percentile rank less or equal to 16 in one or more subtests in ART2020). Total number of self-reported critical traffic situations decreased from 12.0 to 6.8 per week in ATX group (P<0.05) and remained stable in controls by 9.3 and 9.9 at baseline and endpoint (ns). Coping strategies with stressful traffic situations did not change within both groups.
Our study provides first evidence that treatment with ATX improves driving performance in real traffic in adults with ADHD.
研究 12 周安非他命（ATX）治疗对成年 ADHD 患者真实交通驾驶表现、与驾驶相关的神经心理测试表现和驾驶自评的影响，与未经治疗的 ADHD 对照组进行比较。
采用 ATX 组和等待名单组的平行组设计。在基线和终点时，患者接受标准化道路驾驶测试（SDBO）、与驾驶相关的神经心理测试组合（Act 和 React 测试系统[ART2020]）以及驾驶表现的主观测量（一周驾驶日记、驾驶员应对问卷）。
64 名纳入患者中有 43 名完成了研究（n=22 ATX，n=21 对照组）。平均干预期为 11.9±3.0 周，平均每日 ATX 剂量为 71.6±14.9mg。在终点时，60.1%的 ATX 治疗患者和 0%的等待名单组患者的 ADHD 症状减轻了≥30%。在 SDBO 中，ATX 组在四个驾驶表现类别中的三个（注意力，P<0.05；风险相关自我控制，P<0.005；驾驶员技能，P<0.001）中减少了驾驶错误，而对照组的驾驶错误数量保持稳定。在终点时，47.6%的对照组和 18.2%的 ATX 组（P<0.05）未达到德国指南的驾驶适应性标准（ART2020 中一个或多个子测试的百分位数排名≤16）。ATX 组每周自我报告的危急交通情况总数从 12.0 减少到 6.8（P<0.05），而对照组则保持稳定，分别为 9.3 和 9.9，基线和终点（无统计学意义）。两组的应激交通情况下的应对策略均无变化。
我们的研究首次提供了证据，表明 ATX 治疗可改善成年 ADHD 患者的真实交通驾驶表现。
