Lin Yu-Ju, Yang Li-Kuang, Gau Susan Shur-Fen
Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan.
Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan Department of Psychiatry, National Defense Medical Center, Tri-Service General Hospital, Beitou Branch, Taipei, Taiwan.
Aust N Z J Psychiatry. 2016 Jun;50(6):548-56. doi: 10.1177/0004867415609423. Epub 2015 Oct 12.
We evaluated the psychiatric comorbidities in adults who were diagnosed with Diagnostic and Statistical Manual of Mental disorders, 5th edition attention-deficit/hyperactivity disorder as a function of recalled symptom onset before and after the age of 7 years and whether the childhood attention-deficit/hyperactivity disorder symptoms were associated with psychiatric comorbidities.
In all, 214 adults who were diagnosed with Diagnostic and Statistical Manual of Mental disorders, 5th edition attention-deficit/hyperactivity disorder and 174 non-attention-deficit/hyperactivity disorder controls (aged 17-40 years) received psychiatric interviews to confirm their previous and current attention-deficit/hyperactivity disorder status and other psychiatric diagnoses. Demographics and risks of lifetime psychiatric disorders were compared among three groups: (1) attention-deficit/hyperactivity disorder, onset <7 years (early-onset); (2) attention-deficit/hyperactivity disorder, onset between 7 and 12 years (late-onset) and (3) non-attention-deficit/hyperactivity disorder controls. We also tested the effects of attention-deficit/hyperactivity disorder symptoms on the risk of later psychiatric comorbidities by Cox regression analyses.
Regardless of the age of onset, attention-deficit/hyperactivity disorder was significantly associated with a wide range of psychiatric comorbidities. There were similar comorbid patterns between early- and late-onset attention-deficit/hyperactivity disorder. Regardless of attention-deficit/hyperactivity disorder diagnosis, increased severity of attention-deficit/hyperactivity disorder symptoms was associated with higher risks of oppositional defiant disorder, conduct disorder, dysthymia and sleep disorder but not major depression, which was associated with the attention-deficit/hyperactivity disorder diagnosis.
Our findings suggest that elevating the threshold of age of onset to 12 years in Diagnostic and Statistical Manual of Mental disorders, 5th edition would not over-diagnose attention-deficit/hyperactivity disorder in the adult population. Recalled childhood attention-deficit/hyperactivity disorder symptom severity was correlated with conduct disorder, oppositional defiant disorder, dysthymia and sleep disorders.
我们评估了被诊断为《精神疾病诊断与统计手册》第5版注意力缺陷多动障碍（ADHD）的成年人的精神共病情况，这些共病情况是根据回忆起的症状在7岁之前和之后出现的情况，以及儿童期ADHD症状是否与精神共病相关。
总共214名被诊断为《精神疾病诊断与统计手册》第5版ADHD的成年人和174名非ADHD对照组（年龄在17至40岁之间）接受了精神科访谈，以确认他们之前和当前的ADHD状态以及其他精神科诊断。在三组人群中比较了人口统计学特征和终生精神疾病风险：（1）ADHD，起病年龄<7岁（早发型）；（2）ADHD，起病年龄在7至12岁之间（晚发型）；（3）非ADHD对照组。我们还通过Cox回归分析测试了ADHD症状对后期精神共病风险的影响。
无论起病年龄如何，ADHD都与广泛的精神共病显著相关。早发型和晚发型ADHD之间存在相似的共病模式。无论是否诊断为ADHD，ADHD症状严重程度增加都与对立违抗障碍、品行障碍、恶劣心境和睡眠障碍的风险较高相关，但与重度抑郁症无关，重度抑郁症与ADHD诊断相关。
我们的研究结果表明，在《精神疾病诊断与统计手册》第5版中将起病年龄阈值提高到12岁不会对成年人群体中的ADHD进行过度诊断。回忆起的儿童期ADHD症状严重程度与品行障碍、对立违抗障碍、恶劣心境和睡眠障碍相关。
