Retz Wolfgang, Retz-Junginger Petra
Forensic Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, University Medical Center, 55131, Mainz, Germany,
Eur Arch Psychiatry Clin Neurosci. 2014 Nov;264 Suppl 1:S35-43. doi: 10.1007/s00406-014-0542-4. Epub 2014 Sep 18.
Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent mental disorder of childhood, which often persists in adulthood. Methylphenidate (MPH) is one of the most effective medications to treat ADHD, but also few adult patients show no sufficient response to this drug. In this paper, we give an overview regarding genetic, neuroimaging, clinical and other studies which have tried to reveal the reasons for non-response in adults with ADHD, based on a systematic literature search. Although MPH is a well-established treatment for adults with ADHD, research regarding the prediction of treatment outcome is still limited and has resulted in inconsistent findings. No reliable neurobiological markers of treatment response have been identified so far. Some findings from clinical studies suggest that comorbidity with substance use disorders and personality disorders has an impact on treatment course and outcome. As MPH is widely used in the treatment of adults with ADHD, much more work is needed regarding positive and negative predictors of long-term treatment outcome in order to optimize the pharmacological treatment of adult ADHD patients.
注意力缺陷多动障碍(ADHD)是一种在儿童期高度流行的精神障碍,常常持续至成年期。哌甲酯(MPH)是治疗ADHD最有效的药物之一,但也有少数成年患者对该药反应不足。在本文中,我们基于系统的文献检索,概述了遗传学、神经影像学、临床及其他试图揭示成年ADHD患者无反应原因的研究。尽管MPH是治疗成年ADHD患者的成熟疗法,但关于治疗结果预测的研究仍然有限,且结果不一致。目前尚未确定可靠的治疗反应神经生物学标志物。临床研究的一些结果表明,合并物质使用障碍和人格障碍会对治疗过程和结果产生影响。由于MPH广泛用于治疗成年ADHD患者,为了优化成年ADHD患者的药物治疗,在长期治疗结果的正性和负性预测因素方面还需要做更多工作。