Clinical assessment and treatment of attention deficit hyperactivity disorder in adults.
Clinical assessment and treatment of attention deficit hyperactivity disorder in adults.
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DOI：
10.1586/14737175.5.4.525
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发表时间：
2005-07-01
影响因子：
4.3
通讯作者：
Asherson, Philip
中科院分区：
文献类型：
--
作者：
Asherson, Philip
注意力缺陷多动障碍（ADHD）是一种常见的儿童期疾病，经常持续到成年期，具有显著水平的注意力不集中，多动和冲动行为。与成人ADHD相关的障碍包括症状带来的痛苦，在工作和学术环境中发挥作用的能力受损，以及维持稳定关系的问题。这种疾病通常与情绪波动、反社会行为、药物和酒精滥用有关。患焦虑、抑郁、人格障碍、药物和酒精依赖共病的风险增加。尽管哌醋甲酯、右旋苯丙胺和托莫西汀等药物已被证明有效，但在英国，很少有ADHD病例得到承认和治疗。原因尚不清楚，因为大多数从事儿童和青少年工作的精神科医生都知道ADHD通常会持续到成年生活，他们也看到这种疾病影响ADHD儿童的父母。从儿童护理到成人精神病治疗的过渡问题以及需要将ADHD儿童的成年亲属转介到合适的精神病服务是一个主要问题。此外，许多成人ADHD病例未被识别，或者被不熟悉成人表现的微妙之处的心理健康团队看到。因此，误诊和治疗的条件，如非典型抑郁症，混合型情感障碍，循环性心境障碍，边缘和不稳定的情绪人格障碍并不罕见。因此，需要在这方面进行进一步培训。本综述将描述常见的临床表现，并为成人ADHD的诊断和治疗提供指导。任何受过精神病学训练的医生使用标准的精神病学评估程序都可以对成人ADHD进行临床评估。与成年期的其他精神疾病一样，多动症有其独特的发病、病程和精神病理学特征。ADHD的症状是特质样的，从幼儿期开始就具有稳定的特征，并且通常与情感不稳定同时发生。兴奋剂是治疗的主要手段，在大约70%的病例中有效。心理治疗干预也具有重要作用。这些指南将帮助精神科医生和其他成人精神卫生工作者识别和治疗成人ADHD患者。
Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder that frequently persists into adulthood, with significant levels of inattentive, hyperactive and impulsive behavior. Impairments associated with adult ADHD include distress from the symptoms, impaired ability to function in work and academic settings, and problems sustaining stable relationships. The disorder is commonly associated with volatile moods, antisocial behavior, and drug and alcohol misuse. There is an increased risk of developing comorbid anxiety, depression, personality disorders, and drug and alcohol dependence. Despite the proven effectiveness of drugs such as methylphenidate, dexamphetamine and atomoxetine, few cases of ADHD are recognized and treated in the UK. The reasons for this are unclear, since most psychiatrists working with children and adolescents are aware that ADHD commonly persists into adult life and they also see the disorder affecting parents of children with ADHD. Issues of transition from the care of child to adult psychiatry and the need to refer adult relatives of children with ADHD to suitable psychiatric services are a major concern. Furthermore, many cases of adult ADHD go unrecognized or are seen by mental health teams that are not familiar with the subtleties of the adult presentation. As a result, misdiagnosis and treatment for conditions such as atypical depression, mixed affective disorder, cyclothymia, and borderline and unstable emotional personality disorders is not uncommon. There is therefore a requirement for further training in this area. This review will describe the common clinical presentation and provide guidelines for the diagnosis and treatment of ADHD in adults. Any psychiatrically trained physician using standard psychiatric assessment procedures can perform clinical evaluations for adult ADHD. As with other psychiatric disorders in adulthood, ADHD has its own characteristic onset, course and psychopathology. Symptoms of ADHD are trait-like, being stable characteristics from early childhood, and commonly co-occur with affective instability. Stimulants are the mainstay of treatment and are effective in around 70% of cases. Psychotherapeutic interventions also have an important role. These guidelines will assist psychiatrists and other adult mental health workers in identifying and treating individuals with adult ADHD.