Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial
Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial
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DOI：
10.1016/j.euroneuro.2017.05.005
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发表时间：
2017-08-01
影响因子：
5.6
通讯作者：
Asherson, Philip
中科院分区：
文献类型：
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作者：
Cooper, Ruth E.;Williams, Emma;Asherson, Philip
患有ADHD的成年人描述了大麻的自我治疗，有些人报告说大麻比ADHD药物更受欢迎。在美国，少数精神科医生为ADHD开大麻药物，尽管没有来自随机对照研究的证据。EMA-C试验（ADHD-大麻素的实验医学）是一项在30名ADHD成人中进行的大麻素药物Sativex口腔粘膜喷雾剂的试点随机安慰剂对照实验研究。主要结局是使用Qb测试的认知表现和活动水平。次要结局包括ADHD和情绪不稳定（EL）症状。从2014年7月17日至2015年6月18日，30名受试者被随机分配到活性药物组（n=15）或安慰剂组（n=15）。对于主要结局，ITT分析中未发现显著差异，尽管总体评分模式是活性药物组的评分通常优于安慰剂组（Est=-0.17，95% CI-0.40至0.07，p=0.16，n=15/11活性药物/安慰剂）。对于次要结局，Sativex与多动/冲动（p=0.03）和抑制的认知测量（p=0.05）的名义上显著改善相关，并且有改善注意力不集中（p=0.10）和EL（p=0.11）的趋势。按方案效果更高。调整多重检验后，结果不符合显著性要求。活性药物组发生了1起严重（肌肉癫痫发作/痉挛）和3起轻度不良事件，安慰剂组发生了1起严重（心血管问题）不良事件。患有ADHD的成年人可能代表了一个亚组，他们在使用大麻素后症状减轻，没有认知障碍。虽然不是确定的，但这项研究提供了初步证据，支持ADHD使用大麻的自我药物理论，以及进一步研究ADHD内源性大麻素系统的必要性。(C)2017 Elsevier B.V.和ECNP。All rights reserved.
Adults with ADHD describe self-medicating with cannabis, with some reporting a preference for cannabis over ADHD medications. A small number of psychiatrists in the US prescribe cannabis medication for ADHD, despite there being no evidence from randomised controlled studies. The EMA-C trial (Experimental Medicine in ADHD-Cannabinoids) was a pilot randomised placebo-controlled experimental study of a cannabinoid medication, Sativex Oromucosal Spray, in 30 adults with ADHD. The primary outcome was cognitive performance and activity level using the QbTest. Secondary outcomes included ADHD and emotional lability (EL) symptoms. From 17.07.14 to 18.06.15, 30 participants were randomly assigned to the active (n=15) or placebo (n=15) group. For the primary outcome, no significant difference was found in the ITT analysis although the overall pattern of scores was such that the active group usually had scores that were better than the placebo group (Est=-0.17, 95%CI-0.40 to 0.07, p=0.16, n=15/11 active/placebo). For secondary outcomes Sativex was associated with a nominally significant improvement in hyperactivity/impulsivity (p=0.03) and a cognitive measure of inhibition (p=0.05), and a trend towards improvement for inattention (p=0.10) and EL (p=0.11). Per-protocol effects were higher. Results did not meet significance following adjustment for multiple testing. One serious (muscular seizures/spasms) and three mild adverse events occurred in the active group and one serious (cardiovascular problems) adverse event in the placebo group. Adults with ADHD may represent a subgroup of individuals who experience a reduction of symptoms and no cognitive impairments following cannabinoid use. While not definitive, this study provides preliminary evidence supporting the self-medication theory of cannabis use in ADHD and the need for further studies of the endocannabinoid system in ADHD. (C) 2017 Elsevier B.V. and ECNP. All rights reserved.