注意缺陷多动障碍合并抽动秽语综合征的受控兴奋剂治疗：兴奋剂及剂量的影响
Controlled stimulant treatment of ADHD and comorbid Tourette's syndrome: effects of stimulant and dose.
作者信息
Castellanos F X, Giedd J N, Elia J, Marsh W L, Ritchie G F, Hamburger S D, Rapoport J L
机构信息
Child Psychiatry Branch, NIMH, Bethesda, MD, USA.
出版信息
J Am Acad Child Adolesc Psychiatry. 1997 May;36(5):589-96. doi: 10.1097/00004583-199705000-00008.
OBJECTIVE
To determine the effects of methylphenidate (MPH) and dextroamphetamine (DEX) on tic severity in boys with attention-deficit/hyperactivity disorder (ADHD) comorbid with Tourette's syndrome.
METHOD
A 9-week, placebo-controlled, double-blind crossover using a wide range of doses was completed by 20 subjects in three cohorts.
RESULTS
Relatively high doses of MPH and DEX in the first cohort produced significant increases in tic severity which were sustained on higher doses of DEX but which attenuated on MPH. Overall, 14 of 20 subjects continued stimulant treatment for 1 to 3 years, generally in combination with other psychotropics. Stimulant-associated adverse effects, including tic exacerbations, were reversible in all cases.
CONCLUSION
A substantial minority of comorbid subjects had consistent worsening of tics on stimulants, although the majority experienced improvement in ADHD symptoms with acceptable effects on tics. MPH was better tolerated than DEX.
目的
确定哌甲酯（MPH）和右旋苯丙胺（DEX）对患有注意缺陷多动障碍（ADHD）合并抽动秽语综合征的男孩抽动严重程度的影响。
方法
三个队列中的20名受试者完成了一项为期9周、安慰剂对照、双盲交叉试验，使用了多种剂量。
结果
第一队列中相对高剂量的MPH和DEX使抽动严重程度显著增加，在更高剂量的DEX下这种增加持续存在，但在MPH下则减弱。总体而言，20名受试者中有14名继续接受兴奋剂治疗1至3年，通常与其他精神药物联合使用。在所有病例中，包括抽动加重在内的与兴奋剂相关的不良反应都是可逆的。
结论
相当一部分合并症患者在使用兴奋剂时抽动症状持续恶化，尽管大多数患者的ADHD症状有所改善，且对抽动症状的影响可接受。MPH比DEX耐受性更好。
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