注意缺陷多动障碍患儿的成人早期精神状况随访研究

目的 了解注意缺陷多动障碍(ADHD)患儿在成人早期罹患精神障碍的状况.方法 采用前瞻性设计方法,对就诊于北京大学精神卫生研究所精神科门诊的300例ADHD患儿进行随访,同意参加随访者116例(随访率38.7%),基线至随访为2.0～13.5年;患儿基线年龄为7.5～17.0岁,随访时年龄为18.0～23.5岁;采用以美国精神障碍诊断与统计手册第4版为诊断标准制订的定式会谈工具确定诊断,包括Conners成人ADHD诊断会谈量表(Conners Adult ADHD Diagnostic Interview for DSM-Ⅳ,CAADID)、DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查(SCID-Ⅰ)和DSM-Ⅳ轴Ⅱ障碍定式临床检查(SCID-Ⅱ)工具.结果 随访时116例中符合成人ADHD诊断者共59例(50.9%),其中单纯符合成人ADHD诊断标准者18例(15.5%),同时符合成人ADHD及精神障碍/人格障碍者41例(35.3%);不符合成人ADHD诊断,但符合精神障碍/人格障碍者17例(14.7%);不符合任何精神疾病诊断者40例(34.5%),其中功能缓解29例(25.0%),功能未缓解11例(9.5%).116例中,40例(34.5%)至少共患1种DSM-Ⅳ轴Ⅰ障碍,其中21例(18.1%)共患情感障碍,12例(10.3%)共患焦虑障碍,6例(5.2%)共患物质滥用;38例(32.8%)符合DSM-Ⅳ轴Ⅱ人格障碍诊断,其中6例(5.2%)符合A组人格障碍诊断,23例(19.8%)符合B组人格障碍诊断,包括20例(17.2%)反社会型人格障碍,18例(15.5%)符合C组人格障碍诊断,6例(6.0%)符合其他人格障碍诊断.结论 ADHD患儿至成人早期预后较差,2/3左右罹患成人ADHD、精神障碍或人格障碍,其中50.9%符合成人ADHD.

Young adult follow-up of children with attention deficit hyperactivity disorder: psychiatric status

Objective To investigate the psychiatric status in their young adulthood of children with attention deficit hyperactivity disorder (ADHD).Methods This was a prospedive study.The follow-up study of a cohort of clinic-referred ADHD children was conducted.At baseline, The consecutively referred children (n = 300) with DSM-Ⅳ ADHD, aged 7.5 - 17.0 years were assessed.At the 2.0 - 13.5-year follow-up, 116 ( 38.7% ) of them were reassessed ( aged 18.0 - 23.5 years ) using the structured psychiatric interviews to make DSM-Ⅳ diagnoses by trained clinicians, including the Conners Adult ADHD Diagnostic Interview for DSM-Ⅳ (CAADID), Structured Clinical Interview for DSM-Ⅳ Axis Ⅰ Disorders, Non-Patient Version ( SCID- Ⅰ/NP), and Structured Clinical Interview for DSM-Ⅳ Personality Disorders (SCID-Ⅱ).Results In the former 116 ADHD children, 50.9% (n =59) still met the ADHD criteria, in which 15.5% (n = 18) with pure ADHD, and 35.3% (n =41 ) fulfilled both ADHD and psychiatric/ personality disorders, 14.7% ( n = 17) met the criteria of psychiatric/personality disorders, but not ADHD,34.5% (n = 40) fulfilled none of the psychiatric/personality diagnoses at follow-up.Among 116 former ADHD children, 34.5% (n=40) had at least one DSM-Ⅳ axis Ⅰ disorders, in which 18.1% comorbid mood disorders, 10.3% anxiety disorders, 5.2% abuse disorders; and 32.8% (n=38) had at least one DSM-Ⅳ axis Ⅱ personality disorders, in which 5.2% type A personality disorders, 19.8% type B ( 17.2%anti-social personality disorders), 15.5% type C, and 6.0% others.Conclusion It indicates that ADHD youth be at high risk for a wide range of adverse psychiatric outcomes, and 2/3 of them have diagnoses of adult ADHD and/or psychiatric/personality disorders.