New drugs for the treatment of attention-deficit/hyperactivity disorder.
New drugs for the treatment of attention-deficit/hyperactivity disorder.
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DOI：
10.1517/14728214.9.2.293
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发表时间：
2004-11-01
影响因子：
3.4
通讯作者：
McGough, James J
中科院分区：
文献类型：
--
作者：
Pataki, Caroly S;Feinberg, David T;McGough, James J
注意力缺陷多动障碍（ADHD）是儿童期最常见的神经精神障碍。最近的研究表明，ADHD通常持续到青春期和成年期，并与学术，社会和职业功能的障碍有关。ADHD的诊断基于病史和临床检查。没有客观的实验室诊断措施。ADHD在很大程度上是遗传的。其潜在的病理生理学已被理论化为包括多巴胺能纹状体结构上的抑制性去甲肾上腺素能额皮质活动失调。有证据表明，ADHD对药物治疗具有高度反应性，从而导致整体功能改善。虽然药物治疗被认为是最有效的治疗方法，但优化ADHD管理的其他组成部分包括适当的教育安置，家长管理培训和社交技能发展。中枢神经系统兴奋剂，特别是哌醋甲酯和安非他明，仍然是一线药物治疗。托莫西汀是一种选择性去甲肾上腺素能再摄取抑制剂，是第一种获得FDA批准用于儿童和成人ADHD的非兴奋剂化合物。其他药物类别，包括α-激动剂抗高血压药，三环类抗抑郁药，其他抗抑郁药，如安非他酮，和唤醒促进剂莫达非尼，在标签外治疗处方。新的ADHD药物的持续开发预计将强调替代和缓释输送系统和非刺激性化合物。
Attention-deficit/hyperactivity disorder (ADHD) is the most common neuropsychiatric disorder of childhood. Recent research indicates that ADHD most often persists into adolescence and adulthood, and is associated with impairments in academic, social and occupational functioning. The ADHD diagnosis is based on history and clinical examination. There are no objective laboratory measures for diagnosis. ADHD is largely heritable. Its underlying pathophysiology has been theorised to include dysregulation of inhibitory noradrenergic frontocortical activity on dopaminergic striatal structures. Evidence shows that ADHD is highly responsive to pharmacological treatments resulting in global functional improvements. Although pharmacotherapy is recognised as the most effective treatment, additional components to optimise ADHD management include proper educational placement, parent management training and social skills development. Central nervous system stimulants, specifically methylphenidate and amphetamine, remain first-line pharmacological treatments. Atomoxetine, a selective noradrenergic re-uptake inhibitor, is the first non-stimulant compound to receive FDA approval for paediatric and adult ADHD. Other medication classes, including alpha-agonist antihypertensives, tricyclic antidepressants, other antidepressants such as buproprion, and the wake-promoting agent modafinil, are prescribed in off-label therapy. Ongoing development of new ADHD medications is expected to emphasise alternative and extended-release delivery systems and non-stimulant compounds.