Porteret R, Bouchez J, Baylé F J, Varescon I
Laboratoire de psychopathologie et processus de santé, université Paris Descartes, Sorbonne Paris Cité, IUPDP, 92774 Boulogne-Billancourt, France.
Hôpital Paul-Guiraud-Villejuif, centre hospitalier Sainte-Anne, service hospitalo-universitaire des professeurs Lôo et Olié, 7, rue Cabanis, 75674 Paris cedex 14, France.
Encephale. 2016 Apr;42(2):130-7. doi: 10.1016/j.encep.2015.12.013. Epub 2016 Feb 28.
Attention deficit hyperactivity disorder (ADH/D) is a neuropsychological developmental disorder characterized by pervasive and impairing symptoms of inattention, hyperactivity, and impulsivity. Whereas it is well known in children, there is still little information about ADH/D in adults, including prevalence. Indeed, there are actually no epidemiological studies in France, despite the considerable impact of this disorder in a patient's professional and affective life. Moreover, ADH/D rarely stays isolated, and many comorbidities often complicate the diagnostic investigation. It is well known that the so-called ADH/D is composed of two main categories of symptoms (Attentional Disorder/Hyperactiviy Disorder), but Impulsiveness also remains a major symptom.
The aim of this study was to evaluate not only the prevalence of Impulse Control Disorders (ICD) but also psychological and addictive comorbidities among adult patients with ADH/D. A total of 100 patients from specialized consultations of adult ADH/D were evaluated in this study, but only 81 were included after presenting all the clinical criteria of ADH/D.
We used the DSM IV-T-R for ADH/D, the Minnesota Impulsive Disorders Interview a semi-structured clinical interview assessing impulse control disorders (ICD) (compulsive buying, trichotillomania, compulsive sexual behaviour, kleptomania, pyromania and intermittent explosive disorder), and the Mini International Neuropsychiatric Interview in order to evaluate psychiatric and addictive comorbidities.
More than 90 % of the patients met the early apparition criteria of ADH/D (before 7years). More than half of the patients presented a mixed type of ADH/D (both inattentive and hyperactive-impulsive forms): 55.6 % vs 44.4 % for the inattentive type. The vast majority of patients showed a complete form (with a total of 6 or more symptoms out of 9, of inattentive and/or impulsive-hyperactivity category): 93.8 % and only 6.2 % presented a sub-syndromic form of ADH/D (with 3 symptoms at least of one and/or the other category). Regarding the ICDs, we found a proportion of 66 % of patients manifesting at least one, the most frequent ICD being the Intermittent Explosive Disorder (IED): 29.6 %, followed by Compulsive Buying (CB): 23.4 %, Pathological Gambling (PG): 7.4 %, Kleptomania and Compulsive Sexual Behaviour: 2.4 %, and Trichotillomania: 1.2 %. Among the psychiatric comorbidities evaluated, generalized anxiety disorder: 61.7 %, followed by dysthymia: 44.4 %, major depressive episode: 28.3 %, Agoraphobia: 22.2 %, panic disorder: 17.2 %, hypomanic episode: 16 %, social phobia: 11.1 %, bulimia nervosa: 8.6 %, and antisocial personality disorder and obsessive-compulsive disorder: 3.7 %. Regarding the addictive comorbidities, we found a prevalence of 14.8 % of substance abuse (non-alcohol), followed by 7.4 % of alcohol abuse, 6.1 % of substance dependence (non-alcohol), and 3.7 % of alcohol dependence.
ADH/D in adults continues to be unrecognized in France. The aim of this study was to evaluate the prevalence of impulse control disorders, psychiatric and addictive comorbidities in adults with ADH/D. The results enable us to appreciate quantitative and qualitative data for 81 French adults with ADH/D. This disorder rarely remains isolated and is often associated with many others, especially anxiety and mood disorders. We also observed that impulsivity stays at the heart of the ADH/D, either through impulsive behaviours or addictive disorders. Considering the lack of studies with ADH/D adults, it is difficult to compare our data. The diagnosis of ADH/D is complex and stays controversial, moreover the strong prevalence of comorbidities points out the importance of differential diagnosis.
注意缺陷多动障碍（ADH/D）是一种神经心理发育障碍，其特征为注意力不集中、多动和冲动等普遍且有损害性的症状。虽然在儿童中广为人知，但关于成人ADH/D的信息仍然很少，包括患病率。实际上，在法国，尽管这种疾病对患者的职业和情感生活有相当大的影响，但却没有流行病学研究。此外，ADH/D很少单独出现，许多合并症常常使诊断调查变得复杂。众所周知，所谓的ADH/D由两类主要症状（注意力障碍/多动障碍）组成，但冲动性也是一个主要症状。
本研究的目的不仅是评估冲动控制障碍（ICD）的患病率，还评估成人ADH/D患者的心理和成瘾合并症。本研究共评估了100名来自成人ADH/D专科门诊的患者，但只有81名患者在符合ADH/D的所有临床标准后被纳入。
我们使用《精神疾病诊断与统计手册》第四版修订版（DSM IV-T-R）来诊断ADH/D，使用明尼苏达冲动障碍访谈（一种半结构化临床访谈，用于评估冲动控制障碍（ICD），包括强迫性购物、拔毛癖、强迫性行为、盗窃癖、纵火狂和间歇性爆发障碍），以及迷你国际神经精神访谈来评估精神和成瘾合并症。
超过90%的患者符合ADH/D的早期出现标准（7岁之前）。超过一半的患者表现为混合型ADH/D（注意力不集中和多动-冲动型均有）：注意力不集中型占55.6%，多动-冲动型占44.4%。绝大多数患者表现为完整形式（在9项注意力不集中和/或冲动-多动类别症状中，共有6项或更多症状）：93.8%，只有6.2%的患者表现为ADH/D的亚综合征形式（至少有一类症状中的3项）。关于ICD，我们发现66%的患者至少表现出一种，最常见的ICD是间歇性爆发障碍（IED）：29.6%，其次是强迫性购物（CB）：23.4%，病理性赌博（PG）：7.4%，盗窃癖和强迫性行为：2.4%，拔毛癖：1.2%。在评估的精神合并症中，广泛性焦虑障碍：61.7%，其次是心境恶劣：44.4%，重度抑郁发作：28.3%，广场恐惧症：22.2%，惊恐障碍：17.2%，轻躁狂发作：16%，社交恐惧症：11.1%，神经性贪食症：8.6%，反社会人格障碍和强迫症：3.7%。关于成瘾合并症，我们发现药物滥用（非酒精）的患病率为14.8%，其次是酒精滥用7.4%，药物依赖（非酒精）6.1%，酒精依赖3.7%。
在法国，成人ADH/D仍然未得到充分认识。本研究的目的是评估成人ADH/D患者中冲动控制障碍、精神和成瘾合并症的患病率。研究结果使我们能够了解81名法国成人ADH/D患者的定量和定性数据。这种疾病很少单独存在，常常与许多其他疾病相关，尤其是焦虑和情绪障碍。我们还观察到，冲动性处于ADH/D的核心，无论是通过冲动行为还是成瘾性疾病。鉴于缺乏针对成人ADH/D的研究，很难将我们的数据进行比较。ADH/D的诊断很复杂且仍有争议，此外合并症的高患病率指出了鉴别诊断的重要性。
