Bijlenga Denise, Kulcu Semahat, van Gellecum Trevor, Eryigit Zeynep, Kooij J J Sandra
From the *PsyQ, Expertise Center Adult ADHD and †Program Adult ADHD, The Hague; and ‡Department of Psychiatry and EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
J Clin Psychopharmacol. 2017 Dec;37(6):689-696. doi: 10.1097/JCP.0000000000000787.
Little is known about the long-term persistence and adherence of psychostimulant use in adults with attention-deficit/hyperactivity disorder (ADHD) and its relationship to their psychological well-being.
The persistence and adherence to psychostimulants and psychological well-being were examined in adults with ADHD in a naturalistic follow-up, starting directly after discharge from their specialized treatment of ADHD at an outpatient ADHD clinic. Ninety-six patients were included at the time of discharge, who were interviewed by telephone at 6 months, 1 year, and 3 years after discharge.
At the time of discharge, 78% used a psychostimulant prescribed by a psychiatrist. Of those on psychostimulants at the time of discharge, approximately half still used any of these psychostimulants 3 years after discharge. However, adherence rates were good for those who persisted to use psychostimulants. The female sex and middle educational level (relative to a higher educational level) were near-significantly related to nonpersistence, and having a higher educational level and the combined ADHD subtype were related to nonadherence. In turn, nonadherence was related to worse general functioning, lower mood, and poorer sleep quality.
The importance of adherence should be discussed at the time of discharge, especially with female ADHD patients, those with a higher educational level, and those with a combined ADHD subtype, because nonadherence is associated with poorer outcomes.
关于注意力缺陷/多动障碍（ADHD）成人使用精神兴奋剂的长期持续性、依从性及其与心理健康的关系，目前所知甚少。
在一家门诊ADHD诊所对ADHD成人患者进行自然随访，直接从其ADHD专科治疗出院后开始，考察其对精神兴奋剂的持续性、依从性以及心理健康状况。出院时纳入96名患者，在出院后6个月、1年和3年通过电话进行访谈。
出院时，78%的患者使用精神科医生开具的精神兴奋剂。出院时使用精神兴奋剂的患者中，约一半在出院3年后仍在使用其中任何一种。然而，对于持续使用精神兴奋剂的患者，依从率良好。女性以及中等教育水平（相对于高等教育水平）与未持续使用精神兴奋剂接近显著相关，高等教育水平以及ADHD混合型与未依从相关。反过来，未依从与总体功能较差、情绪低落和睡眠质量较差有关。
出院时应讨论依从性的重要性，尤其是对于女性ADHD患者、高等教育水平患者以及ADHD混合型患者，因为未依从与较差的预后相关。
