Mania and attention-deficit/hyperactivity disorder: common symptomatology, common pathophysiology and common treatment?
Mania and attention-deficit/hyperactivity disorder: common symptomatology, common pathophysiology and common treatment?
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DOI：
10.1097/yco.0b013e328331f694
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发表时间：
2010-01-01
影响因子：
6.9
通讯作者：
Hensch, Tilman
中科院分区：
文献类型：
--
作者：
Hegerl, Ulrich;Himmerich, Hubertus;Hensch, Tilman
注意缺陷/多动障碍（ADHD）与躁狂症具有广泛的症状重叠，ADHD与双相情感障碍存在较高的合并症。这就提出了关于共同神经生物学病理机制和共同治疗的问题。从遗传学、生物化学、电生理、脑形态学和神经心理学等方面概述了ADHD与躁狂症的共性以及ADHD与双相情感障碍的共性（独立于躁狂状态）。一个有趣的发现是，ADHD和躁狂症的特点都是不稳定的清醒调节，通过脑电图的警觉性测量、嗜睡评级和持续注意力任务的缺陷来评估。在躁狂症和多动症中，这种不稳定的清醒调节被认为是导致注意力缺陷和诱导多动、冲动和寻求感觉行为的中心致病因素，作为一种通过增加外部刺激来稳定清醒的自我调节尝试。越来越多的证据表明，精神兴奋剂没有引发或加重躁狂的高风险，但甚至可能是急性躁狂的一种治疗选择。adhd和躁狂症有许多共同的症状和致病方面。人们普遍认为兴奋剂在躁狂症中是禁忌症，这一观点受到了挑战，研究兴奋剂等稳定警惕性药物可能产生的抗躁狂效果的对照试验是合理的，也是必要的。
Purpose of reviewAttention-deficit/hyperactivity disorder (ADHD) and mania show broad symptom overlap, and high comorbidity exists between ADHD and bipolar disorder. This raises the question concerning common neurobiological pathomechanisms and concerning common treatments.Recent findingsOn genetic, biochemical, electrophysiological, brain morphological and neuropsychological levels, the commonalities of ADHD and mania and the commonalities between ADHD and bipolar disorder (independent of manic state) are outlined. An intriguing finding is that both ADHD and mania are characterized by an unstable wakefulness regulation assessed by EEG measures of vigilance, by ratings of sleepiness and by deficits in sustained attention tasks. In both mania and ADHD, this unstable wakefulness regulation is supposed to be a central pathogenetic factor leading to attention deficits and inducing the hyperactive, impulsive and sensation-seeking behavior as an autoregulatory attempt to stabilize wakefulness by increasing external stimulation. Evidence is accumulating to suggest that psychostimulants do not have a high risk of triggering or aggravating mania, but might even be a treatment option in acute mania.SummaryADHD and mania share many symptoms and several pathogenetic aspects. The common belief that stimulants are contraindicated in mania has been challenged, and controlled trials to study the possible antimanic effects of vigilance-stabilizing drugs such as stimulants are justified and necessary.