Department of Neuroscience, Psychiatry, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.
Eur Arch Psychiatry Clin Neurosci. 2018 Jun;268(4):337-347. doi: 10.1007/s00406-017-0850-6. Epub 2017 Nov 15.
There are very few studies on the long-term outcome in subjects diagnosed with ADHD as adults. The objective of the present study was to assess this and relate the outcome to whether there was current medication or not and to other potential predictors of favourable outcome. A prospective clinical cohort of adults diagnosed with ADHD according to DSM-IV criteria was followed-up on an average of 6 years after first evaluation (n = 124; mean age 42 years, 51% males). ADHD symptom trajectories were assessed as well as medication, global functioning, disability, health-related quality of life, and alcohol and drug consumption at follow-up. Ninety percent of those diagnosed were initially treated pharmacologically and half of them discontinued treatment. One-third reported remission, defined as not fulfilling any ADHD subtype and a GAF-value last year ≥ 70, which was not affected by comorbidity at baseline. Current medication was not associated with remission. Subjects evaluated and first diagnosed with ADHD as adults are functionally improved at follow-up 6 years later despite a high percentage of psychiatric comorbidity at baseline. Half dropped out of medication, and there was no difference in ADHD remission between subjects with on-going medication at follow-up or subjects without medication, although current medication was related to a higher degree of self-reported global improvement.
针对成年 ADHD 患者的长期预后研究非常有限。本研究旨在评估这一问题,并将结果与当前是否存在药物治疗以及其他可能的有利预后预测因素相关联。对符合 DSM-IV 标准的成年 ADHD 患者进行前瞻性临床队列研究,在首次评估后的平均 6 年进行随访(n=124;平均年龄 42 岁,51%为男性)。在随访时评估 ADHD 症状轨迹、药物治疗、整体功能、残疾、健康相关生活质量以及酒精和药物使用情况。90%的诊断患者最初接受药物治疗,其中一半停止治疗。三分之一的患者报告缓解,定义为不满足任何 ADHD 亚型,去年 GAF 值≥70,这与基线时的合并症无关。目前的药物治疗与缓解无关。尽管基线时存在较高的精神共病率,但成年后首次评估和诊断为 ADHD 的患者在 6 年后的随访中功能得到改善。一半的患者停止药物治疗,在随访时持续药物治疗的患者和未接受药物治疗的患者之间,ADHD 缓解率没有差异,尽管目前的药物治疗与更高程度的自我报告整体改善相关。