Wang Liang-Jen, Shyu Yu-Chiau, Yuan Shin-Sheng, Yang Chun-Ju, Yang Kang-Chung, Lee Tung-Liang, Lee Sheng-Yu
Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Institute of Molecular Biology, Academia Sinica, Nankang, Taipei, Taiwan.
J Psychiatr Res. 2016 Jan;72:6-14. doi: 10.1016/j.jpsychires.2015.10.014. Epub 2015 Oct 19.
In this study, we aimed to evaluate the relationship between attention-deficit/hyperactivity disorder (ADHD) during childhood and subsequent diagnoses of bipolar disorder (BD), as well as to determine whether the pharmacotherapy for ADHD (methylphenidate and atomoxetine) influence the risks of developing BD. A nationwide cohort of patients newly diagnosed with ADHD (n = 144,920) and age- and gender-matching controls (n = 144,920) were found in Taiwan's National Health Insurance database from January 2000 to December 2011. Both patients and controls were observed until December 31, 2011. To determine the effect that the duration of methylphenidate and atomoxetine exposure had on BD, the difference in the risk of developing BD was compared among non-users, short-term users (≤ 365 days), and long-term users (>365 days). In comparison to the control group, the ADHD group showed a significantly increased risk of developing BD (ADHD: 2.1% vs.
0.4%; aHR: 7.85, 95% CI: 7.09-8.70), and had a younger mean age at the time of first diagnosis (ADHD: 12.0 years vs.
18.8 years). Compared to ADHD patients that had never taken methylphenidate, patients with long-term use of methylphenidate were less likely to be diagnosed with BD (aOR: 0.72, 95% CI: 0.65-0.80). However, the duration of exposure to atomoxetine did not have a significant relationship to a BD diagnosis. The results suggested that a previous diagnosis of ADHD was a powerful indicator of BD, particularly juvenile-onset BD. Nevertheless, the exact mechanisms of the relationships among ADHD, its pharmacotherapy, and BD require further clarification in the future.
在本研究中，我们旨在评估儿童期注意力缺陷多动障碍（ADHD）与后续双相情感障碍（BD）诊断之间的关系，并确定ADHD的药物治疗（哌甲酯和托莫西汀）是否会影响患BD的风险。2000年1月至2011年12月期间，在台湾全民健康保险数据库中发现了一个全国性队列，其中包括新诊断为ADHD的患者（n = 144,920）以及年龄和性别匹配的对照组（n = 144,920）。对患者和对照组均观察至2011年12月31日。为确定哌甲酯和托莫西汀暴露持续时间对BD的影响，比较了未使用者、短期使用者（≤365天）和长期使用者（>365天）患BD风险的差异。与对照组相比，ADHD组患BD的风险显著增加（ADHD：2.1% vs. 对照组：0.4%；调整后风险比：7.85，95%置信区间：7.09 - 8.70），且首次诊断时的平均年龄更小（ADHD：12.0岁 vs. 对照组：18.8岁）。与从未服用过哌甲酯的ADHD患者相比，长期使用哌甲酯的患者被诊断为BD的可能性较小（调整后比值比：0.72，95%置信区间：0.65 - 0.80）。然而，托莫西汀的暴露持续时间与BD诊断没有显著关系。结果表明，既往ADHD诊断是BD的有力指标，尤其是青少年期起病的BD。然而，ADHD、其药物治疗与BD之间关系的确切机制未来还需要进一步阐明。
