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注意力缺陷多动障碍(ADHD)的病理生理学、病因学和治疗的综述。

A review of the pathophysiology, etiology, and treatment of attention-deficit hyperactivity disorder (ADHD).

机构信息

MCPHS University, Worcester/Manchester, NH, USA.

出版信息

Ann Pharmacother. 2014 Feb;48(2):209-25. doi: 10.1177/1060028013510699. Epub 2013 Nov 1.

Abstract

OBJECTIVE

To review the pathophysiology, etiology, and treatment of attention-deficit hyperactivity disorder (ADHD).

DATA SOURCES AND DATA EXTRACTION

A literature search was conducted in PubMed and EMBASE using the terms attention deficit hyperactive disorder, ADHD, pathophysiology, etiology, and neurobiology. Limits applied were the following: published in the past 10 years (January 2003 to August 2013), humans, review, meta-analysis, and English language. These yielded 63 articles in PubMed and 74 in EMBASE. After removing duplicate/irrelevant articles, 86 articles and their relevant reference citations were reviewed.

DATA SYNTHESIS

ADHD is a neurological disorder that affects children, but symptoms may persist into adulthood. Individuals suffering from this disorder exhibit hyperactivity, inattention, impulsivity, and problems in social interaction and academic performance. Medications used to treat ADHD such as methylphenidate, amphetamine, and atomoxetine indicate a dopamine/norepinephrine deficit as the neurochemical basis of ADHD, but the etiology is more complex. Moreover, these agents have poor adverse effect profiles and a multitude of drug interactions. Because these drugs are also dispensed to adults who may have concomitant conditions or medications, a pharmacist needs to be aware of these adverse events and drug interactions. This review, therefore, focuses on the pathophysiology, etiology, and treatment of ADHD and details the adverse effects and drug interaction profiles of the drugs used to treat it.

CONCLUSIONS

Published research shows the benefit of drug therapy for ADHD in children, but given the poor adverse effect and drug interaction profiles, these must be dispensed with caution.

摘要

目的

综述注意缺陷多动障碍(ADHD)的病理生理学、病因学和治疗方法。

资料来源和资料提取

使用“注意力缺陷多动障碍、ADHD、病理生理学、病因学和神经生物学”等术语在 PubMed 和 EMBASE 中进行文献检索。应用的限制条件为:过去 10 年(2003 年 1 月至 2013 年 8 月)发表的文献,人类,综述,荟萃分析,英语。这在 PubMed 中产生了 63 篇文章,在 EMBASE 中产生了 74 篇文章。在去除重复/不相关的文章后,对 86 篇文章及其相关参考文献进行了综述。

资料综合

ADHD 是一种影响儿童的神经障碍疾病,但症状可能持续到成年。患有这种疾病的人表现出多动、注意力不集中、冲动和社交互动及学业成绩方面的问题。用于治疗 ADHD 的药物,如哌醋甲酯、安非他命和托莫西汀,表明多巴胺/去甲肾上腺素不足是 ADHD 的神经化学基础,但病因更为复杂。此外,这些药物的不良反应谱较差,且存在多种药物相互作用。由于这些药物也用于可能伴有合并症或药物的成年人,因此药剂师需要了解这些不良反应和药物相互作用。因此,本综述重点关注 ADHD 的病理生理学、病因学和治疗方法,并详细介绍了用于治疗 ADHD 的药物的不良反应和药物相互作用谱。

结论

已发表的研究表明药物治疗 ADHD 对儿童有效,但鉴于较差的不良反应和药物相互作用谱,必须谨慎使用这些药物。

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