Mahadevan Jayant, Kandasamy Arun, Benegal Vivek
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Indian J Psychiatry. 2019 Jan-Feb;61(1):3-12. doi: 10.4103/psychiatry.IndianJPsychiatry_549_18.
Adult attention-deficit/hyperactivity disorder (ADHD) has a population prevalence of 5%. However, its prevalence is much higher in mental health and substance use treatment settings. It is associated with significant physical and psychiatric morbidity, as well as social, occupational, and legal consequences. Adult ADHD is considered to be a part of the externalizing spectrum with which it shares both homotypic comorbidity and heterotypic continuity across the lifespan. This is attributable to a shared genetic basis, which interacts with environmental risk factors such as nutritional deficiencies and psychosocial adversity to bring about epigenetic changes. This is seen to result in a lag in brain maturation particularly in the areas of the brain related to executive functioning (top-down regulation) such as the prefrontal and cingulate cortices. This delay when coupled with impairments in reward processing, leads to a preference for immediate small rewards and is common to externalizing disorders. Adult ADHD is increasingly understood to not merely be associated with the classically described symptoms of hyperactivity, impulsivity and inattention, but also issues with motivation, emotional recognition and regulation, excessive mind wandering, and behavioral self-regulation. These symptoms are also observed in other disorders which overlap with the externalizing spectrum such as oppositional defiant disorder, conduct disorder, antisocial and borderline personality disorder. It is therefore important to develop both broad-based and specific interventions to be able to target these deficits which can reduce the burden and improve outcomes.
成人注意力缺陷多动障碍（ADHD）在人群中的患病率为5%。然而，在心理健康和物质使用治疗环境中，其患病率要高得多。它与严重的身体和精神疾病以及社会、职业和法律后果相关。成人ADHD被认为是外化谱系的一部分，在整个生命周期中，它与外化谱系共享同型共病和异型连续性。这归因于共同的遗传基础，该遗传基础与营养缺乏和心理社会逆境等环境风险因素相互作用，从而导致表观遗传变化。这被认为会导致大脑成熟滞后，尤其是在与执行功能（自上而下调节）相关的大脑区域，如前额叶和扣带回皮质。这种延迟加上奖励处理受损，导致对即时小奖励的偏好，这在外化障碍中很常见。人们越来越认识到，成人ADHD不仅与经典描述的多动、冲动和注意力不集中症状有关，还与动机、情绪识别和调节、过度走神以及行为自我调节问题有关。在其他与外化谱系重叠的疾病中也观察到这些症状，如对立违抗障碍、品行障碍、反社会和边缘型人格障碍。因此，制定广泛且具体的干预措施以针对这些缺陷非常重要，这可以减轻负担并改善结果。
