IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Viale del Tirreno 331, 56128, Calambrone, Italy.
Department of Psychology, Centre for Innovation in Mental Health, University of Southampton, Highfield Campus, Clinical and Experimental Sciences (CNS and Psychiatry) and Solent NHS Trust, Southampton SO17 1BJ, UK; New York University Child Study Center, One Park Ave, 7th floor, New York City, New York 10016, USA.
Neurosci Biobehav Rev. 2018 Jan;84:359-367. doi: 10.1016/j.neubiorev.2017.08.010. Epub 2017 Aug 26.
Emotional dysregulation (ED) is a dysfunction in modifying an emotional state in an adaptive and goal oriented way, with excitability, ease anger, and mood lability. It is present in up to 70% of adults with ADHD, regardless of other comorbidities, and substantially worsens the psychosocial outcomes of the disorder. Besides fronto-parietal circuits mediating top-down control, brain regions involved in bottom-up processes (e.g., amygdala, orbitofrontal cortex, and ventral striatum) are implicated in ED. We performed a systematic review/meta-analysis of double-blind randomized controlled trials of ADHD medications to assess their effects on ED in adults with ADHD. We searched an extensive set of databases, international trials registries, and contacted study authors/drug companies for unpublished data. We retained 21 trials. We found small-to-moderate effects (methylphenidate: SMD=0.34, 95% CI=0.23-0.45; atomoxetine: SMD=0.24, 95% CI=0.15-0.34; lisdexamfetamine: SMD=0.50, 95% CI=0.21-0.8). We suggest that, whilst ADHD medications are effective on ADHD core symptoms, they may be less effective on bottom-up mechanisms underlying ED. Further research on novel pharmacological and non-pharmacological strategies for ED in adults with ADHD is warranted.
CRD42017068426.
情绪调节障碍（ED）是一种以适应和目标为导向的方式调节情绪状态的功能障碍，表现为兴奋性、易激惹、情绪不稳定。高达 70%的 ADHD 成人存在 ED，无论是否存在其他合并症，这都大大恶化了该疾病的社会心理结局。除了介导自上而下控制的额顶叶回路外，涉及自下而上过程的脑区（例如杏仁核、眶额皮质和腹侧纹状体）也与 ED 有关。我们对 ADHD 药物的双盲随机对照试验进行了系统评价/荟萃分析，以评估它们对 ADHD 成人 ED 的影响。我们搜索了广泛的数据库、国际试验登记处，并联系了研究作者/药物公司以获取未发表的数据。我们保留了 21 项试验。我们发现了小到中等的效果（哌醋甲酯：SMD=0.34，95%CI=0.23-0.45；阿托莫西汀：SMD=0.24，95%CI=0.15-0.34；左乙拉西坦：SMD=0.50，95%CI=0.21-0.8）。我们认为，虽然 ADHD 药物对 ADHD 的核心症状有效，但它们对 ED 的潜在自下而上机制可能效果较差。需要进一步研究针对 ADHD 成人 ED 的新型药理学和非药理学策略。
CRD42017068426。
