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成人注意缺陷多动障碍(ADHD):一种针对未来注意力不集中严重障碍的多层次方法。

Attention-deficit/hyperactivity disorder (ADHD) in adults: a multilayered approach to a serious disorder of inattention to the future.

机构信息

Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina, Núcleo de Neurociências, Porto Alegre RS, Brazil.

Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Serviço de Neurologia, Porto Alegre RS, Brazil.

出版信息

Arq Neuropsiquiatr. 2024 Jul;82(7):1-12. doi: 10.1055/s-0044-1791513. Epub 2024 Oct 2.

Abstract

Attention-deficit/hyperactivity disorder (ADHD) affects people of all ages, yet its presentation varies as the person matures and social demands increase from childhood into adulthood. Interestingly, when analyzing the disorder in adults, it is not immediately clear what the 'attention deficit' in the ADHD denomination exactly means. Adults with ADHD have a broad range of difficulties, far beyond an attentional deficit, that impact negatively their social functioning and often lead to failures in all walks of life. Therefore, in this review, I attempt to reconcile the notion of attention deficit with the protean manifestations of ADHD in adults through a proposal that ADHD symptoms have as a common denominator an . I build this construct through a multilayered approach, progressing from the epidemiological and clinical considerations for Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis, to a deeper understanding of the disorder, discussing how these patients fail to anchor the present into the future (i.e., to be attentive to future consequences), thus failing to approximate future goals from present action. Integrating cognitive observations with imaging abnormalities, it is possible to propose that ADHD in adults is perhaps the most prevalent frontal lobe disorder in humans, ultimately impacting upon psychosocial management and treatment strategies.

摘要

注意缺陷多动障碍(ADHD)影响各个年龄段的人,但其表现随着人的成熟以及从儿童期到成年期社会需求的增加而变化。有趣的是,当分析成年人的这种障碍时,ADHD 名称中的“注意力缺陷”到底意味着什么并不明显。患有 ADHD 的成年人存在广泛的困难,远远超出了注意力缺陷的范围,这对他们的社交功能产生负面影响,并且常常导致他们在生活的各个方面失败。因此,在这篇综述中,我试图通过提出 ADHD 症状的共同特征来调和注意力缺陷的概念与 ADHD 在成年人中的多态表现。我通过多层次的方法构建了这个概念,从精神障碍诊断和统计手册(DSM)诊断的流行病学和临床考虑开始,深入了解该障碍,讨论这些患者如何无法将现在与未来联系起来(即,关注未来的后果),从而无法从当前的行动中接近未来的目标。将认知观察与影像学异常相结合,我们可以提出 ADHD 是成年人中最常见的额叶障碍,最终会影响心理社会管理和治疗策略。

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