Common and Unique Therapeutic Mechanisms of Stimulant and Nonstimulant Treatments for Attention-Deficit/Hyperactivity Disorder
Common and Unique Therapeutic Mechanisms of Stimulant and Nonstimulant Treatments for Attention-Deficit/Hyperactivity Disorder
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DOI：
10.1001/archgenpsychiatry.2011.2053
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发表时间：
2012-09-01
影响因子：
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通讯作者：
Newcorn, Jeffrey H.
中科院分区：
文献类型：
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作者：
Schulz, Kurt P.;Fan, Jin;Newcorn, Jeffrey H.
内容：注意力缺陷/多动障碍（ADHD）是一种高度流行和损害性精神疾病，影响儿童和成人。有食品和药物管理局批准的兴奋剂和非兴奋剂药物治疗ADHD;然而，很少有人知道这些不同的治疗发挥其治疗效果的机制。目的：对比与使用兴奋剂盐酸哌甲酯与非兴奋剂盐酸托莫西汀症状改善相关的脑激活变化。设计：采用平行组设计，在哌甲酯（n = 18）或托莫西汀（n = 18）治疗6 - 8周前后进行功能性磁共振成像。设置：纽约西奈山医学院专门的ADHD临床研究项目。参与者：36名ADHD青少年（平均[SD]年龄，11.2 [2.7]岁; 27名男孩）从随机临床试验中招募。主要结果测量：在ADHD评定量表IV-父母版上，在反应抑制的进行/不进行测试和完成的评估中，大脑激活的变化。结果：哌甲酯与托莫西汀治疗相比，在go/no-go测试的反应抑制和ADHD症状评分的平均（SD）改善方面具有可比性（55% [30%] vs 57% [25%]）。ADHD症状的改善与两种治疗的双侧运动皮层激活的共同减少有关。症状改善还与托莫西汀任务相关激活的增加以及右额下回、左前扣带回/补充运动区和双侧后扣带回皮质中哌甲酯激活的减少有差异。这些研究结果并不归因于基线差异activation.Conclusions：哌甲酯和托莫西汀治疗产生症状改善，通过共同和不同的神经生理学行动，额顶叶区域，已牵连在ADHD的病理生理。这些结果代表了第一步，在描绘的神经生物学基础的差异反应的兴奋剂和非兴奋剂药物治疗多动症。
Context: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent and impairing psychiatric disorder that affects both children and adults. There are Food and Drug Administration-approved stimulant and nonstimulant medications for treating ADHD; however, little is known about the mechanisms by which these different treatments exert their therapeutic effects.Objective: To contrast changes in brain activation related to symptomatic improvement with use of the stimulant methylphenidate hydrochloride vs the nonstimulant atomoxetine hydrochloride.Design: Functional magnetic resonance imaging before and after 6 to 8 weeks of treatment with methylphenidate (n = 18) or atomoxetine (n = 18) using a parallel-groups design.Setting: Specialized ADHD clinical research program at Mount Sinai School of Medicine, New York, New York.Participants: Thirty-six youth with ADHD (mean [SD] age, 11.2 [2.7] years; 27 boys) recruited from randomized clinical trials.Main Outcome Measures: Changes in brain activation during a go/no-go test of response inhibition and investigator-completed ratings on the ADHD Rating Scale-IV-Parent Version.Results: Treatment with methylphenidate vs atomoxetine was associated with comparable improvements in both response inhibition on the go/no-go test and mean (SD) improvements in ratings of ADHD symptoms (55% [30%] vs 57% [25%]). Improvement in ADHD symptoms was associated with common reductions in bilateral motor cortex activation for both treatments. Symptomatic improvement was also differentially related to gains in task-related activation for atomoxetine and reductions in activation for methylphenidate in the right inferior frontal gyrus, left anterior cingulate/supplementary motor area, and bilateral posterior cingulate cortex. These findings were not attributable to baseline differences in activation.Conclusions: Treatment with methylphenidate and atomoxetine produces symptomatic improvement via both common and divergent neurophysiologic actions in frontoparietal regions that have been implicated in the patho-physiology of ADHD. These results represent a first step in delineating the neurobiological basis of differential response to stimulant and nonstimulant medications for ADHD.