Pliszka S R
Department of Psychiatry, The University of Texas Health Science Center at San Antonio, 78284-7792, USA.
J Clin Psychiatry. 1998;59 Suppl 7:50-8.
Attention-deficit/hyperactivity disorder (ADHD) has been noted to be comorbid with a variety of psychiatric disorders. These include oppositional defiant and conduct disorders, as well as affective, anxiety, and learning disorders. Considerable debate has revolved as to the meaning of this overlap. Does it occur by chance or is it an artifact of referral bias? Are the comorbid conditions secondary to the ADHD, or can other psychiatric disorders masquerade as attentional problems? Alternatively, ADHD may exist as distinct subtypes, each with its specific comorbidity. Studies that have examined the comorbidity of oppositional, conduct, affective, anxiety, and learning disorders in ADHD are reviewed. ADHD and ADHD with conduct disorder appear to be distinct subtypes, possibly with different etiologies. While the short-term response to stimulants is the same in these two groups, children with ADHD and conduct disorder children have higher rates of antisocial personality as adults. Coexisting anxiety appears to attenuate impulsivity in ADHD, and stimulant response is poorer in ADHD children with comorbid anxiety. Anxiety and ADHD appear to be inherited independently. A subset of ADHD children also meet criteria for bipolar disorder, although the exact prevalence of this diagnosis in ADHD children is strongly debated. Regardless of prevalence, this is a severely impaired group of ADHD children, with high rates of aggression and psychiatric disorder in their families. The comorbidity of ADHD and major depression is much less studied, and few firm conclusions can be made about it. Finally, about 20%-25% of ADHD children meet criteria for a learning disorder, but learning disorders appear to be independent of ADHD.
注意缺陷多动障碍（ADHD）已被发现与多种精神障碍共病。这些包括对立违抗和品行障碍，以及情感、焦虑和学习障碍。关于这种重叠的意义一直存在相当多的争论。它是偶然发生的还是转诊偏倚的产物？共病情况是ADHD的继发症状，还是其他精神障碍可能伪装成注意力问题？或者，ADHD可能以不同的亚型存在，每种亚型都有其特定的共病情况。本文综述了研究ADHD中对立、品行、情感、焦虑和学习障碍共病情况的研究。ADHD和患有品行障碍的ADHD似乎是不同的亚型，可能有不同的病因。虽然这两组对兴奋剂的短期反应相同，但患有ADHD的儿童和患有品行障碍的儿童成年后出现反社会人格的比率更高。共存的焦虑似乎会减轻ADHD中的冲动性，并且患有共病焦虑的ADHD儿童对兴奋剂的反应较差。焦虑和ADHD似乎是独立遗传的。一部分ADHD儿童也符合双相情感障碍的标准，尽管ADHD儿童中这种诊断的确切患病率存在激烈争论。无论患病率如何，这都是一组严重受损的ADHD儿童，他们的家庭中攻击行为和精神障碍的发生率很高。ADHD与重度抑郁症的共病情况研究较少，关于这一点很难得出确切结论。最后，约20%-25%的ADHD儿童符合学习障碍的标准，但学习障碍似乎与ADHD无关。
