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[注意缺陷多动障碍与物质使用障碍共病患者的筛查、诊断和治疗建议]

[Recommendations for the screening, diagnosis and treatment of patients with comorbid attention deficit hyperactivity- and substance use disorder].

作者信息

Kapitány-Fövény Máté, Barta Csaba, Crunelle Cleo L, van den Brink Wim, Moggi Franz, Konstenius Maija, Franck Johan, Levin Frances R, van de Glind Geurt, Coetzee Corné, Luderer Mathias, Schellekens Arnt, Matthys Frieda, Demetrovics Zsolt

机构信息

Semmelweis Egyetem, Egeszsegtudomanyi Kar, Addiktologiai Tanszek, Budapest, Hungary, E-mail:

出版信息

Psychiatr Hung. 2020;35(4):435-447.

Abstract

Among patients with substance use disorders (SUD), adult attention deficit hyperactivity disorder (ADHD) is one of the most frequently co-occuring disorder. Those SUD patients with comorbid ADHD show earlier onset of substance use, more severe SUD and poor treatment outcomes. Therefore, early recognition of ADHD is highly rele - vant within this patient population. The results of available screening instruments may lay the foundation of timely ADHD diagnosis. Considering the integrated treatment of patients with a dual ADHD+SUD diagnosis, the applica tion of combined pharmaco- and psychotherapy is recommended. Based on the evidence-and consensus-based suggestions, prescription of long-acting methylphenidate, extended-release amphetamines and atomoxetine with up-titration might be the best choice in the treatment of patients who are either unresponsive to standard dose or characterized by therapy resistance. The main purpose of this manuscript is to establish a standing-ground for the effective screening, diagnosis and treatment of ADHD+SUD patients.

摘要

在物质使用障碍(SUD)患者中,成人注意力缺陷多动障碍(ADHD)是最常共病的疾病之一。那些患有共病ADHD的SUD患者物质使用开始得更早,SUD更严重,治疗效果也较差。因此,在这一患者群体中早期识别ADHD非常重要。现有筛查工具的结果可能为及时诊断ADHD奠定基础。考虑到对ADHD+SUD双重诊断患者的综合治疗,建议联合药物治疗和心理治疗。基于循证和共识性建议,长效哌醋甲酯、缓释苯丙胺和托莫西汀逐步滴定给药可能是治疗对标准剂量无反应或具有治疗抵抗特征患者的最佳选择。本手稿的主要目的是为ADHD+SUD患者的有效筛查、诊断和治疗奠定基础。

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