Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
J Psychiatr Res. 2013 Aug;47(8):1019-23. doi: 10.1016/j.jpsychires.2013.04.005. Epub 2013 Apr 30.
Attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), and oppositional defiant disorder (ODD) are frequently comorbid. Previous studies suggested that the comorbidity of CD and ODD in ADHD may increase the risk of a further development of mood disorder, but most studies had a small sample size. Using a population-based prospective study design, a large sample composed of 1277 adolescents with ADHD-alone, 46 with ADHD + ODD, 87 with ADHD + CD, and 5640 age/gender-matched controls were enrolled in 2003. These cases were followed to 2010 to identify the cases developing unipolar depressive disorder and bipolar disorder. ADHD + CD groups exhibited a higher prevalence of unipolar depressive disorder (23.0% vs. 13.0% vs. 8.7% vs. 0.7%, p < 0.001) and bipolar disorder (3.4% vs. 2.2% vs. 1.3% vs. 0.2%, p < 0.001) than ADHD + ODD group, ADHD-alone group, and control group. Adolescents with ADHD + CD, those with ADHD + ODD, and those with ADHD-alone had a higher likelihood of developing unipolar depressive disorder (hazard ratio [HR]: 44.34, 95% confidence interval [CI]: 23.95-71.36; HR: 18.76, 95%CI: 7.87-44.71; HR: 13.01, 95%CI: 8.99-18.82) and bipolar disorder (HR: 14.39, 95%CI: 4.00-51.80; HR: 8.32, 95%CI: 1.06-65.32; HR: 5.24, 95%CI: 2.44-11.24) than the controls. Adolescents with ADHD had elevated risks of unipolar depression and bipolar disorder in their later life, and especially, those with ADHD and comorbidity of CD or ODD exhibited the highest risk. Further study would be required to evaluate whether prompt intervention for ADHD and disruptive behavior problems would decrease the risk of developing mood disorder.
注意缺陷多动障碍（ADHD）、品行障碍（CD）和对立违抗性障碍（ODD）经常同时存在。先前的研究表明，ADHD 中 CD 和 ODD 的共病可能会增加进一步发展为情绪障碍的风险，但大多数研究的样本量都较小。本研究使用基于人群的前瞻性研究设计，入组了 2003 年的 1277 名 ADHD 单一障碍、46 名 ADHD 合并 ODD、87 名 ADHD 合并 CD 和 5640 名年龄/性别匹配的对照者，随访至 2010 年，以确定发生单相抑郁障碍和双相障碍的病例。ADHD 合并 CD 组单相抑郁障碍（23.0% vs. 13.0% vs. 8.7% vs. 0.7%，p < 0.001）和双相障碍（3.4% vs. 2.2% vs. 1.3% vs. 0.2%，p < 0.001）的发生率均高于 ADHD 合并 ODD 组、ADHD 单一障碍组和对照组。ADHD 合并 CD、ADHD 合并 ODD 和 ADHD 单一障碍者发生单相抑郁障碍的可能性更高（危险比 [HR]：44.34，95%置信区间 [CI]：23.95-71.36；HR：18.76，95%CI：7.87-44.71；HR：13.01，95%CI：8.99-18.82）和双相障碍（HR：14.39，95%CI：4.00-51.80；HR：8.32，95%CI：1.06-65.32；HR：5.24，95%CI：2.44-11.24）的可能性均高于对照组。ADHD 患者在以后的生活中发生单相抑郁和双相障碍的风险增加，特别是合并 CD 或 ODD 的 ADHD 患者风险最高。需要进一步研究以评估及时干预 ADHD 和破坏性行为问题是否会降低发生情绪障碍的风险。
