成人注意缺陷多动障碍常见于焦虑病人

hren2008

Adult ADHD Is Common Among Patients in Anxiety-Disorders Clinic
Marlene Busko
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.
2008年3月17日（萨凡纳，佐治亚州），一项看过焦虑门诊的连续病例研究结果发现，33%的人符合成人注意缺陷多动障碍（ADHD）诊断标准，远高于美国ADHD的4.4%的平均发病率。
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.
来自安大略省哈密尔顿市麦克马斯特大学医学中心的Michael Van Ameringen博士及其同事开展了该项研究，发表在美国焦虑障碍协会（ADAA）第28届年会的论坛上。
\"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.
Van Ameringen告诉精神病学网站：当我们看到寻求治愈焦虑症的患者时，发现他们当中有33%符合成人ADHD诊断标准，并且他们并不打算治疗该病。
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.
他补充道，意识到成人ADHD的存在以及大约50%的患病儿童在成长过程中不能摆脱，这很重要。通常情况下，很难辨别该病是因为经常伴随有其他精神疾病。他指出，尽管在第4版《精神疾病诊断和统计手册》（DSM-IV）中没有成人ADHD的定义，但是FDA已经批准了新的长效治疗ADHD的药物，适用于儿童、青年和成人。
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.
他告诉听众，ADHD是儿童期最常见的一种精神疾病，约占儿童精神病例的50%。据报道，儿童ADHD的发病率约为3%-10%，经常伴随有品行障碍、对立性反抗障碍、焦虑症和躁郁症
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.
他说，由于在DSM-IV中没有针对成人ADHD的诊断标准，因此医师只能使用儿童ADHD的标准（比如发病年龄在7岁以前），期望在DSM-V中有所改变。
Although childhood ADHD often resolves, 36% to 55% of children maintain symptoms in adulthood.
虽然儿童ADHD往往能得到解决，但是35%~55%的儿童在长大成人时仍有症状。
Symptoms of ADHD take on different forms in adults:
成年ADHD的症状表现形式：
——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).
——ADHD儿童中的多动障碍症状（辗转不安、烦躁不安、不能保持坐态、过度跑动和攀爬、不能安静地玩和工作，话特别多）与成人的不同症状（工作狂、超负荷的或不知所措的、自选非常积极的工作、活跃不断、话特别多）相对应。
——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).
——同样的，儿童中的冲动症状（回答问题脱口而出、迫不及待、打断或中断别人）在成人中也有所不同（低的挫折承受力，急性子，突然辞职、断绝交往、开车太快、成瘾人格）
——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)
——最后，ADHD儿童中的注意障碍症状（难以精力集中、似听非听、半途而废、无组织、丢三落四、心不在焉、健忘的）VS 成年ADHD 的症状（拖拖拉拉、迟钝、效率低下、时间管理技巧差、无组织的）
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.
儿童期ADHD在男孩中比较常见，临床样本男女比例为10：1，社区样本比例为3：1，他补充道，需要指出的是，在成人中，患病比例接近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.
许多儿童ADHD的情况是混合型的（注意障碍和冲动/多动）而成人ADHD中以注意障碍型为多见。他说，有趣的是，ADHD在女孩中很难检测，因为她们中存在不注意亚型。
ADHD is a highly heritable condition, with a heritability factor of 0.76, which is greater than that for breast cancer, asthma, or schizophrenia.
ADHD是高度遗传的，遗传因子为0.76，高于乳腺癌，哮喘和精神分裂症。
\"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.
对于多数人而言，在NCS-R（国家并发症调查-再研究）研究中，令人惊奇的是，严格符合DSM-IV标准的成人ADHD的发病率为4.4%，使得ADHD成为成人常见病之一。
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.
调查发现，男女成年ADHD发病比例为5：3，并且往往伴随焦虑症、情绪失控和社会恐惧症。仅有25%的成年ADHD病人曾经接受过治疗，在过去的一个月里仅有10%的人进行了治疗。

Prevalence of ADHD with Anxiety
伴有焦虑症的ADHD流行病学
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).
Van Ameringen博士和他的同事的研究目的在于确定看过焦虑症门诊的病人样本中儿童和成年ADHD的流行病学情况。
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.
他们发现，97人中有32人（33%）符合成年ADHD最低标准，同样的，完成自测报告表的88人中有29人（33%）符合成年ADHD标准。
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.
符合成年ADHD标准的33人中有9人（28%）先前被诊断为ADHD，而9人中仅有7人曾经接受过该病的治疗，只有1人现在仍在接受治疗。
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.
Van Ameringen博士表示，许多被诊断为成年ADHD的病人知道他们有这些症状，但是没人接受正规治疗。
It is hoped that the DSM V will have better criteria to diagnose this condition, he added.
希望DSM-V能完善该病的诊断标准，他补充道。
Anxiety Disorders Association of America 28th Annual Meeting: Oral Presentation 6R. March 6-9, 2007.
美国焦虑症协会28届年会：口述报告，6R，3月6-9，2007