Hutchison Shari L, Ghuman Jaswinder K, Ghuman Harinder S, Karpov Irina, Schuster James M
Community Care Behavioral Health, UPMC Insurance Services Division, 339 Sixth Avenue, Suite 1300, Pittsburgh, PA 15222, USA.
Community Care Behavioral Health, UPMC Insurance Services Division, Pittsburgh, PA, USA.
Ther Adv Psychopharmacol. 2016 Oct;6(5):317-334. doi: 10.1177/2045125316647686. Epub 2016 May 20.
Attention-deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed mental health disorders and is associated with higher incidence of comorbid oppositional or conduct, mood, anxiety, pervasive developmental, and substance-use disorders. Comorbid mental health conditions may alter the presence of symptoms and treatment of ADHD. Atomoxetine (ATX), a nonstimulant medication for the treatment of ADHD, may be prescribed for individuals with ADHD and comorbid conditions despite some risk for certain undesirable side effects and lower effectiveness for the treatment of ADHD than stimulants. In this paper, we review studies utilizing randomized, placebo-controlled trials (RCTs) as well as within-subject designs to determine the effectiveness of ATX in the treatment of children and adults with ADHD and comorbid conditions. The current review uses an expanded methodology beyond systematic review of randomized controlled trials in order to improve generalizability of results to real-world practice. A total of 24 articles published from 2007 to 2015 were reviewed, including 14 RCTs: 1348 ATX, and 832 placebo. The majority of studies show that ATX is effective in the treatment of ADHD symptoms for individuals with ADHD and comorbid disorders. Cohen's effect sizes (ES) for improvement in ADHD symptoms and behaviors range from 0.47 to 2.21. The effectiveness of ATX to improve symptoms specific to comorbidity varied by type but appeared to be most effective for diminishing the presence of symptoms for those with comorbid anxiety, ES range of 0.40 to 1.51, and oppositional defiant disorder, ES range of 0.52 to 1.10. There are mixed or limited results for individuals with ADHD and comorbid substance-use disorders, autism spectrum disorders, dyslexia or reading disorder, depression, bipolar disorder, and Tourette syndrome. Results from this review suggest that ATX is effective in the treatment of some youth and adults with ADHD and comorbid disorders, and may be a treatment option in these patients.
注意缺陷多动障碍（ADHD）是最常被诊断出的精神健康障碍之一，与对立违抗或品行、情绪、焦虑、广泛性发育障碍以及物质使用障碍的更高共病发生率相关。共病的精神健康状况可能会改变ADHD症状的表现及治疗。托莫西汀（ATX）是一种用于治疗ADHD的非兴奋剂药物，尽管存在某些不良副作用的风险且治疗ADHD的效果低于兴奋剂，但仍可能被开给患有ADHD及共病的个体。在本文中，我们回顾了利用随机、安慰剂对照试验（RCT）以及受试者内设计来确定ATX治疗患有ADHD及共病的儿童和成人有效性的研究。当前的综述采用了超出随机对照试验系统评价的扩展方法，以提高结果对实际临床实践的可推广性。我们回顾了2007年至2015年发表的24篇文章，其中包括14项RCT：1348例使用ATX，832例使用安慰剂。大多数研究表明，ATX对患有ADHD及共病的个体治疗ADHD症状有效。ADHD症状和行为改善的科恩效应量（ES）范围为0.47至.21。ATX改善特定共病症状的有效性因共病类型而异，但似乎对减轻共病焦虑（ES范围为0.40至1.51）和对立违抗障碍（ES范围为0.52至1.10）患者的症状最为有效。对于患有ADHD及共病物质使用障碍、自闭症谱系障碍、阅读障碍或诵读困难、抑郁症、双相情感障碍和抽动秽语综合征的个体，结果不一或有限。本综述结果表明，ATX对一些患有ADHD及共病的青少年和成人有效，可能是这些患者的一种治疗选择。
