Bond W S
Department of Pharmacy, Philadelphia College of Pharmacy and Science, PA 19104.
Clin Pharm. 1987 Aug;6(8):617-24.
The proposed etiologies, clinical features, prognosis, and drug therapy of attention deficit disorder (ADD) are reviewed. Attention deficit disorder is a common neurobehavioral problem in children that manifests as hyperactivity, impulsivity, and inattention. It may persist into adolescence and adulthood and predispose the patient to antisocial and substance-abuse disorders. Stimulant agents are the drugs of first choice for pharmacologic treatment of ADD. Methylphenidate is the most frequently used stimulant because of its reduced potential for abuse and less troublesome adverse effects compared with dextroamphetamine. Stimulant medications are usually well tolerated, with nervousness and insomnia being the most common adverse effects. The potential for stimulant-induced growth suppression during long-term treatment should be dealt with prospectively by providing drug holidays. Tricyclic antidepressants and monoamine oxidase inhibitors may be used in patients who do not respond adequately to stimulant agents. Low doses of the antipsychotic agents haloperidol, chlorpromazine, or thioridazine may be used as adjunctive treatment for ADD symptoms of hyperactivity and aggressiveness. Attention deficit disorder is not a benign disorder that children necessarily outgrow. Pharmacologic therapy should be combined with nonpharmacologic therapy to provide the greatest long-term benefits.
本文综述了注意力缺陷障碍（ADD）的病因、临床特征、预后及药物治疗。注意力缺陷障碍是儿童常见的神经行为问题，表现为多动、冲动和注意力不集中。该疾病可能持续至青少年期及成年期，并使患者易患反社会及物质滥用障碍。兴奋剂是药物治疗ADD的首选药物。与右旋苯丙胺相比，哌甲酯因滥用可能性较低且不良反应较少，是最常用的兴奋剂。兴奋剂药物通常耐受性良好，最常见的不良反应是紧张和失眠。长期治疗期间，兴奋剂导致生长抑制的可能性应通过安排药物假期来前瞻性地应对。三环类抗抑郁药和单胺氧化酶抑制剂可用于对兴奋剂治疗反应不佳的患者。低剂量的抗精神病药物氟哌啶醇、氯丙嗪或硫利达嗪可作为ADD多动及攻击症状的辅助治疗。注意力缺陷障碍并非一种儿童必然会自愈的良性疾病。药物治疗应与非药物治疗相结合，以提供最大的长期益处。
