成人的ADHD常見於至焦慮異常診所求診病患


  March 17, 2008(喬治亞州訊)-一項針對至焦慮異常專門診所求診病患的研究結果顯示,這些病患中有33%符合成人注意力缺乏/過度異常(ADHD)的診斷標準,這比美國一般大眾發生成人ADHD盛行率的4.4%要來得高。
  
  這些發現,由Michael Van Ameringen醫師與其來自安大略漢米爾敦曼徹斯特大學醫學中心的同事,研究結果在美國焦慮異常學會第28屆年會中發表。
  
  Van Ameringen醫師向Medscape精神醫學表示,當我們針對至焦慮異常門診求診的病患進行研究,我們發現這些病患中有33%符合成人ADHD診斷標準,但他們並未尋求醫療協助。
  
  他附帶表示,大約有50%罹患ADHD的兒童到最後演變成成人ADHD,這是非常重要的,然而,這通常未被發現,因為與其他精神異常共同發生;他指出,即使成人ADHD並未在精神異常診斷與統計手冊第四版(DSM-IV)中詳細描述,美國食品藥物管理局(FDA)已經核准新的、長效的治療兒童、青少年與成人ADHD的中樞神經刺激藥物。
  
  他向聽眾表示,ADHD是兒童精神異常中最常見的一種,大約佔了兒童精神科求診50%的病例數;兒童ADHD的盛行率據報導為3%至10%之間,且經常與行為異常、反向挑戰異常、焦慮異常與雙極性異常共同發生。
  
  他指出,在DSM-IV中並沒有對成人ADHD的特定診斷條件,因此臨床醫師必須應用兒童的ADHD診斷條件(例如在七歲以前發生),雖然這將在第五版的手冊中更新。
  
  雖然兒童的ADHD經常會自行緩解,但仍有36%至55%的兒童維持該症狀直到成人。
  
  ADHD的症狀在成人身上並沒有相同的形式:
  * 兒童ADHD的過動症狀(扭動、煩躁、坐立難安、奔跑或爬行、無法安全地玩耍或工作、拼命地講話)在成人身上將會轉化成不同的症狀(工作狂、傾向將行程排得滿滿的、自我選擇非常活耀的工作、持續地活耀、拼命地講話)。
  * 同樣的,兒童的衝動症狀(脫口而出的答案、等不到輪到他的時候、打擾或介入他人),與在成人時的表現不同(對於挫折忍耐度低、耐性不佳、突然辭去工作、結束關係、開快車、容易上癮的人格)。
  * 最終,罹患ADHD兒童無法專注的症狀(無法維持專心、不聽他人說話、不能夠追隨他人指示、無法組織思考、常常遺漏重要的部份、容易分心、健忘),成人ADHD病患(表現出無法置信的延遲、緩慢、無法安排時間、非常缺乏組織能力)。
  
  他附帶表示,ADHD兒童病患經常是男性,且在臨床上男性與女性的比例為10:1,在社區中為3:1,在成人該比例接近3:2。
  
  大部分的兒童ADHD是綜合症狀型(注意力缺乏與衝動及過動症狀),但是更多的成人ADHD病例是注意力缺乏型;他表示,值得去注意的是,許多女孩因為罹患的是注意力缺乏亞型,可能因此未被發現。
  
  ADHD是一種會遺傳的病況,其遺傳比例大約為0.76,這比乳癌、氣喘、或是精神分裂症高。
  
  Van Ameringen醫師表示,從國家並存疾病調查回覆(NCS-R)研究中一項令人驚訝的發現是,對許多人來說,根據DSM-IV標準診斷的成人ADHD盛行率為4.4%,使得成人ADHD變成成人最常見的病況之一。
  
  該調查發現,成人ADHD盛行率的比例為5:3,且罹患成人ADHD的個體更可能有焦慮異常、情緒異常與社交恐慌(Kessler RC et al. Am J Psychiatry. 2006;163:716-23);僅有25%罹患ADHD的個體被發現曾經接受ADHD治療,僅有10%在過去的一個月內曾經接受治療。
  
  【ADHD與焦慮症的盛行率】
  Van Ameringen醫師與其同事的目的在於確認兒童與成人ADHD的盛行率,這些病患都來自於一家焦慮異常診所,他們針對97位被轉介到該診所的連續病患進行分析;這些病患完成一份成人ADHD自我報告指數第1.1版症狀確認清單,且同時接受一項以DSM-VI為基礎的臨床訪談,這其中包括了迷你神經精神面談(MINI)的ADHD部分清單。
  
  他們發現97位成人中有32位(33%)符合MINI診斷成人ADHD的標準,同樣的,88位完成成人ADHD自我報告清單的成人中有29位(33%)符合成人ADHD診斷標準。
  
  符合ADHD診斷標準的32位個體中,僅有9位(28%)曾經被確認罹患ADHD;9位僅有7位(22%)曾經接受該疾病治療,且僅有1位病患目前正在接受這些治療。
  
  Van Ameringen醫師表示,大部分被確認罹患ADHD病患知道他們有這些症狀,但是並沒有人正式診斷他們罹患這些疾病。
  
  他附帶表示,希望DSM-V將會有診斷這個疾病更好的標準。

Adult ADHD Is Common Among Pat

By Marlene Busko
Medscape Medical News

March 17, 2008 (Savannah, Georgia) — A study of consecutive patients seen in an anxiety-disorders clinic found that 33% met criteria for adult attention-deficit/hyperactivity disorder (ADHD), which is much higher than the 4.4% prevalence of adult ADHD in the US population.

These findings, by Michael Van Ameringen, MD, and colleagues from McMaster University Medical Center, in Hamilton, Ontario, were presented in a talk here at the Anxiety Disorders Association of America 28th Annual Meeting.

"When we looked at individuals who were walking in for treatment for their anxiety disorder, we found that 33% of them met criteria for ADHD in adults, and they were not seeking treatment for this," Dr. Van Ameringen told Medscape Psychiatry.

It is important to be aware that adult ADHD exists and that probably about 50% of children do not grow out of it, he added. Often it is often not picked up because it co-occurs with other psychiatric illness. Even though adult ADHD is not specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV), the US Food and Drug Administration (FDA) has given approval for the use of new long-acting stimulants for ADHD in children, adolescents, and adults, he noted.

ADHD is the most common psychiatric disorder of childhood, and it accounts for up to 50% of clinical cases in childhood psychiatry, he told the audience. The prevalence of childhood ADHD is reported to be 3% to 10%, and it is highly comorbid with conduct disorder, oppositional-defiance disorder, anxiety disorder, and bipolar disorder.

There are no specific criteria for adult ADHD in the DSM-IV, so clinicians must apply the criteria for childhood ADHD (such as onset before age 7 years), although this is expected to change with the DSM-V, he said.

Although childhood ADHD often resolves, 36% to 55% of children maintain symptoms in adulthood.

Symptoms of ADHD take on different forms in adults:

  • Symptoms of hyperactivity in children with ADHD (squirming, fidgeting, inability to stay seated, running and climbing excessively, inability to play and work quietly, talking excessively) translate into different symptoms in adults (workaholic tendencies, being overscheduled and overwhelmed, self-selecting very active jobs, constantly active, talking excessively).
  • Similarly, symptoms of impulsivity in children (blurting out answers, not waiting his or her turn, intruding on or interrupting others) manifest differently in adults (low frustration tolerance, short temper, quitting jobs abruptly, ending relationships, driving too fast, addictive" personality).
  • Finally, symptoms of inattention differ in children with ADHD (difficulty in sustaining attention, not listening, not following through, inability to organize, losing important items, easily distractible, forgetful) vs adults with ADHD (showing incredible procrastination, slow, inefficient, very poor time-management skills, very disorganized)

Childhood ADHD is more common in boys, with a male:female prevalence ratio of 10:1 in clinical samples and 3:1 in community samples, he added, noting that, in adults, this ratio is closer to 3:2.

Most cases of childhood ADHD are the combined (inattentive and impulsive/hyperactive) type, but more cases of adult ADHD are the inattentive type. It is interesting to note that ADHD might not be detected in girls because they have the inattentive subtype, he said.

ADHD is a highly heritable condition, with a heritability factor of 0.76, which is greater than that for breast cancer, asthma, or schizophrenia.

"One of the surprising findings from the National Comorbidity Survey-Replication [NCS-R] study, for many people, was that the prevalence of adult ADHD meeting strict DSM-IV criteria was 4.4%, which makes adult ADHD 1 of the most common conditions in adulthood," said Dr. Van Ameringen.

The survey found a 5:3 male:female prevalence of adult ADHD, and individuals with adult ADHD were more likely to also have anxiety disorders, mood disorders, and social phobia (Kessler RC et al. Am J Psychiatry. 2006;163:716-23). Only 25% of the individuals found to have adult ADHD had ever had treatment for ADHD, and only 10% had treatment in the past month.

Prevalence of ADHD with Anxiety

Dr. Van Ameringen and colleagues aimed to determine the prevalence of childhood and adult ADHD in a sample of patients seen in an anxiety-disorders clinic. They looked at 97 consecutive patients referred to their clinic. The patients completed an Adult ADHD Self-Report Scale version 1.1 symptom checklist and were also assessed with a structured clinical interview for DSM-IV, which included the ADHD module of the Mini International Neuropsychiatric Interview (MINI).

They found that 32 of the 97 adults (33%) met the MINI criteria for adult ADHD, and similarly, 29 of the 88 adults (33%) who completed the self-report checklist met criteria for adult ADHD.

Only 9 of the 32 individuals (28%) who met the criteria for adult ADHD had previously been identified as having ADHD; only 7 of these 9 individuals (22%) had ever been treated for this disorder, and only 1 person was currently receiving treatment for this.

Most individuals identified as having adult ADHD "know they've had these symptoms, but no one has made the formal diagnosis," said Dr. Van Ameringen.

It is hoped that the DSM V will have better criteria to diagnose this condition, he added.

Anxiety Disorders Association of America 28th Annual Meeting: Oral Presentation 6R. March 6-9, 2007.

    
相關報導
躁鬱症並不是「匆促隨意」的診斷
2011/6/27 下午 03:41:38
嗜睡與所有年齡層類ADHD症狀有關
2010/6/22 下午 05:38:00
太極拳可以改善某些ADHD症狀
2010/6/1 下午 04:58:00

上一頁
   1   2   3   4   5   6   7   8   9   10  




回上一頁