Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Department of Pediatrics, University of California, Irvine, USA.
Mol Psychiatry. 2019 Mar;24(3):390-408. doi: 10.1038/s41380-018-0116-3. Epub 2018 Jun 28.
Attention-deficit/hyperactivity disorder (ADHD) is a common and impairing disorder affecting children, adolescents, and adults. Several treatment strategies are available that can successfully ameliorate symptoms, ranging from pharmacological to dietary interventions. Due to the increasing range of available options, an informed selection or prioritization of treatments is becoming harder for clinicians. This review aims to provide an evidence-based appraisal of the literature on ADHD treatment, supplemented by expert opinion on plausibility. We outline proposed mechanisms of action of established pharmacologic and non-pharmacologic treatments, and we review targets of novel treatments. The most relevant evidence supporting efficacy and safety of each treatment strategy is discussed. We review the individualized features of the patient that should guide the selection of treatments in a shared decision-making continuum. We provide guidance for optimizing initiation of treatment and follow-up of patients in clinical settings.
注意缺陷多动障碍（ADHD）是一种常见且会造成损害的疾病，影响儿童、青少年和成年人。有多种治疗策略可供选择，包括药物治疗和饮食干预，可以成功改善症状。由于可供选择的方案越来越多，临床医生在选择或优先考虑治疗方法时变得更加困难。本综述旨在提供 ADHD 治疗文献的循证评估，并结合对合理性的专家意见。我们概述了已确立的药物和非药物治疗的作用机制，并综述了新型治疗方法的靶点。讨论了每种治疗策略的最相关证据，以支持其疗效和安全性。我们还综述了应指导在共同决策连续体中选择治疗方法的患者个体特征。我们为优化临床环境中患者的治疗开始和随访提供了指导。
