A double-blind, placebo-controlled, crossover study of osmotic release oral system methylphenidate in adults with ADHD with assessment of oppositional and emotional dimensions of the disorder.
A double-blind, placebo-controlled, crossover study of osmotic release oral system methylphenidate in adults with ADHD with assessment of oppositional and emotional dimensions of the disorder.
复制标题
一项双盲、安慰剂对照、交叉研究，针对成人多动症患者哌醋甲酯的渗透释放口腔系统，评估该疾病的对立和情绪维度。
DOI：
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发表时间：
2007
影响因子：
5.3
通讯作者：
Barrie K. Marchant
中科院分区：
文献类型：
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作者：
F. Reimherr;E. Williams;Robert E. Strong;R. Mestas;Poonam Soni;Barrie K. Marchant
背景
注意力缺陷多动障碍（ADHD）往往持续到成年期的认识，导致成人诊断和治疗的频率增加。渗透释放口服系统（OROS）是一种长效兴奋剂，已被证明可有效治疗儿童和青少年多动症。
方法
47名成年人进入，41人完成了OROS哌甲酯的双盲，安慰剂对照，交叉试验。每个双盲组持续4周;数据收集时间为2004年8月至2005年12月。受试者符合DSM-IV-TR和犹他州成人ADHD标准。结果测量包括Wender-Reimherr成人注意力缺陷障碍量表（WRAADDS），成人ADHD评定量表（ADHD-RS）和临床总体印象改善量表（CGI-I）。在基线时，受试者被归类为具有WRAADDS的显著情绪症状和/或使用DSM-IV对立违抗性障碍标准评估的自我报告量表的显著对立违抗性症状。
结果
17%的样本（N = 8）仅患有ADHD，38%（N = 18）患有ADHD+显著的情绪症状，40%（N = 19）患有ADHD+显著的情绪和对立症状。平均+/- SD剂量为64.0 +/- 23.3（0.75 mg/kg），OROS哌甲酯在所有临床指标方面均上级安慰剂：总WRAADDS评分分别降低42%和13%，p <0.001，总ADHD-RS评分分别降低41%和14%，p = 0.003，加上解决注意力不集中的子量表，多动/冲动和情绪失调。
结论
OROS哌甲酯被证明对治疗成人ADHD有效。ADHD是相对罕见的。超过80%的患者患有ADHD，并伴有情绪和/或对立症状。
BACKGROUND
The realization that attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood has led to increased frequency of diagnosis and treatment in adults. Osmotic release oral system (OROS) methylpheni-date is a long-acting stimulant demonstrated to be effective in the treatment of children and adolescents with ADHD.
METHOD
Forty-seven adults entered and 41 completed this double-blind, placebo-controlled, crossover trial of OROS methylphenidate. Each double-blind arm lasted 4 weeks; data were collected from August 2004 through December 2005. Subjects met both DSM-IV-TR and Utah Criteria for ADHD in adults. Outcome measures included the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS), the adult ADHD-Rating Scale (ADHD-RS), and the Clinical Global Impressions-Improvement scale (CGI-I). At baseline, subjects were categorized as having significant emotional symptoms with the WRAADDS and/or significant oppositional-defiant symptoms using a self-report scale assessing the DSM-IV criteria for oppositional defiant disorder.
RESULTS
17% of the sample (N = 8) had ADHD alone, 38% (N = 18) had ADHD plus significant emotional symptoms, and 40% (N = 19) had ADHD with both significant emotional and oppositional symptoms. At a mean +/- SD dose of 64.0 +/- 23.3 (0.75 mg/kg), OROS methylphenidate proved superior to placebo for all clinical measures: total WRAADDS score decrease of 42% versus 13%, respectively, p < .001 and total ADHD-RS score decrease of 41% versus 14%, respectively, p = .003, plus the subscales addressing inattention, hyperactivity/ impulsivity, and emotional dysregulation.
CONCLUSIONS
OROS methylphenidate proved effective in treating adult ADHD. ADHD alone was relatively uncommon. Over 80% of our patients had ADHD with a combination of emotional and/or oppositional symptoms.