The relationship between tourette syndrome, attention deficit hyperactivity disorder, and stimulant medication: a critical review.
The relationship between tourette syndrome, attention deficit hyperactivity disorder, and stimulant medication: a critical review.
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DOI：
10.1016/j.spen.2005.12.003
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发表时间：
2005-12-01
影响因子：
2.7
通讯作者：
Erenberg, Gerald
中科院分区：
文献类型：
--
作者：
Erenberg, Gerald
抽动障碍和注意缺陷多动障碍（ADHD）之间的关系具有重要的临床意义，因为这两种疾病都可能导致情感，社会和学术困难。使这种相互关系进一步复杂化的是，使用精神兴奋剂药物治疗ADHD将有助于多动和注意力问题，但会导致抽搐发作或使先前存在的抽搐恶化。本综述的第一部分调查了抽动秽语综合症（TS）与ADHD相关的频率，发现35%至90%的TS儿童报告患有ADHD。审查的第二部分着眼于TS中看到的ADHD是否与没有抽搐的儿童相同。最近的研究得出的结论是，在TS中看到的ADHD是相同的，尽管在TS中看到的注意力困难也受到抽搐本身的分心以及内部分心的影响，例如在共病焦虑或强迫行为中看到的。评论的最后一部分调查了精神兴奋剂是否会恶化或导致抽搐的问题。有22项研究调查了这种可能的关系。早期的研究被TS中所见的自然模式所混淆，其中抽搐在发生、强度和频率上自发地增加和减少。最近的双盲、安慰剂对照研究表明，精神兴奋剂在改善ADHD症状方面同样有效，无论这种疾病是否与抽搐有关。当对组数据进行分析时，与对照组相比，在抽搐患者中使用精神兴奋剂时，抽搐没有显著增加。然而，个别患者可能会经历抽搐的增加。这一增长在对群体数据的分析中没有得到重视。总之，在ADHD症状严重影响生活质量的抽搐患者中，使用精神兴奋剂药物进行治疗在医学上是适当的。
The relationship between tic disorders and attention deficit hyperactivity disorder (ADHD) is of great clinical importance because both disorders can lead to emotional, social, and academic difficulties. To further complicate this interrelationship is the concern that the use of psychostimulant medication to treat ADHD will help the hyperactivity and attention problems but will lead to the onset of tics or will worsen preexisting tics. The first part of this review investigates how often Tourette syndrome (TS) is associated with ADHD and finds that ADHD has been reported in 35% to 90% of children with TS. The second part of the review looks at whether the ADHD seen in TS is the same as in children who do not have tics. Recent studies lead to the conclusion that the ADHD seen in TS is the same, although the attentional difficulties seen in TS are influenced also by the distraction of the tics themselves as well as by internal distractions such as is seen in comorbid anxiety or obsessive-compulsive behavior. The final part of the review investigates the question of whether psychostimulants worsen or cause tics. Twenty-two studies were found that investigated this possible relationship. Earlier studies were confounded by the natural pattern seen in TS in which tics spontaneously wax and wane in occurrence, intensity, and frequency. More recent double-blind, placebo-controlled studies have shown that psychostimulants are equally effective in improving ADHD symptoms whether the disorder is associated with tics or not. When group data are analyzed, there is no significant increase in tics when psychostimulants are used in patients with tics compared with controls. Individual patients, however, may experience an increase in tics. This increase is not appreciated in analysis of group data. In conclusion, it is medically appropriate to provide treatment with psychostimulant medication in persons with tics where the ADHD symptoms are significantly disturbing their quality of life.