Research Unit for Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Denmark; Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Switzerland; Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland.
Research Unit for Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Denmark.
Eur Neuropsychopharmacol. 2014 Feb;24(2):232-41. doi: 10.1016/j.euroneuro.2013.11.003. Epub 2013 Nov 18.
The association of substance use disorders (SUD) with attention-deficit disorder (ADHD), co-morbid mental disorders, and medication has only been studied in isolation and in rather small samples.
Data were based on four Danish national registers covering a total of 20,742 patients with ADHD, their dispensed medications, co-morbid mental disorders, and associated SUD between 1994 and 2010. The analyses considered the risk of various medications (methylphenidate only, antidepressants only, antipsychotic only, mixed medication) in comparison to a control group of non-medicated patients with ADHD, various co-morbid disorders, duration of medication, age at diagnosis, year of birth, and sex for developing SUD.
The observation period of the cohort ranged between 2.25 and 66.21 years and the prevalence for SUD was 9.51%. The SUD rates were significantly higher prior to, compared to following the onset of medication in the methylphenidate and the mixed medication subgroup, whereas they were significantly higher following onset of medication in the antidepressants and the antipsychotics subgroups. However, the SUD rates were significantly higher in all drug conditions except for methylphenidate after onset of medication compared to the non-medicated subgroup. Risk factors obtained by regression analysis did not include methylphenidate but did include antidepressants, antipsychotics, and mixed medications, in combination with co-morbid mood, anxiety, personality, and conduct disorders, and older age at diagnosis. Longer duration of medication and female sex were protective factors.
This representative study based on a large nationwide psychiatric sample provides solid evidence into the patterns of SUD in patients with ADHD based on medication use and co-morbidities.
物质使用障碍（SUD）与注意力缺陷障碍（ADHD）、合并精神障碍和药物治疗的关联仅在孤立和较小样本中进行了研究。
数据基于丹麦四个国家登记处，涵盖了 1994 年至 2010 年间总共 20742 名患有 ADHD 的患者、他们的药物治疗、合并的精神障碍以及相关的 SUD。分析考虑了各种药物（仅哌醋甲酯、仅抗抑郁药、仅抗精神病药、混合药物）与 ADHD 非药物治疗患者、各种合并障碍、药物治疗持续时间、诊断年龄、出生年份和性别相比，发生 SUD 的风险。
该队列的观察期为 2.25 年至 66.21 年，SUD 的患病率为 9.51%。在哌醋甲酯和混合药物亚组中，药物治疗前的 SUD 发生率明显高于药物治疗后，而在抗抑郁药和抗精神病药亚组中，药物治疗后的 SUD 发生率明显高于药物治疗前。然而，除了哌醋甲酯之外，在所有药物治疗情况下，包括药物治疗后的 SUD 发生率均明显高于非药物治疗亚组。回归分析获得的风险因素不包括哌醋甲酯，但包括抗抑郁药、抗精神病药和混合药物，以及合并的情绪、焦虑、人格和行为障碍，以及诊断时年龄较大。药物治疗时间较长和女性是保护因素。
这项基于大型全国性精神病学样本的代表性研究提供了确凿的证据，表明 ADHD 患者基于药物使用和合并症的 SUD 模式。
