成人注意缺陷多动障碍临床特点的初步分析

目的初步分析我国成人注意缺陷多动障碍(ADHD)患者的症状特点、共病及社会功能情况。方法对6～16岁曾就诊于我院的88例符合美国精神障碍诊断与统计手册第4版(DSM-IV)的ADHD患儿在≥18岁时采用DSM-IV配套的定式会谈工具进行再评估,以满足成人ADHD诊断标准者59例为研究组,对照组为29例不满足ADHD诊断标准且GAF评分70分者,比较两组临床特点的不同。结果成人ADHD临床分型以ADHD-I为主,占86.4%(51/59);"经常"出现的症状依次是:"组织事情有困难"(98.3%)、"逃避需要大量持续用脑的任务"(96.6%)、"不能注意细节"(94.9%)、"很难遵从指令且完不成工作"(96.6%)、"注意持续时间短"(88.1%)和"因外界刺激而分心"(72.9%)。成人ADHD中共患任何一种DSM-Ⅳ轴Ⅰ或轴Ⅱ障碍者66.1%(39/59),其中39.0%(23/59)至少共患一种轴Ⅰ精神障碍,49.2%(29/59)至少共患一种轴Ⅱ障碍。成人ADHD组功能大体评定量表得分明显低于对照组(t=12.96,P0.001),74.6%(44/59)出现轻或中度社会功能损害。结论成人ADHD的临床表现以注意缺陷型为主,共患其他精神障碍及人格障碍较多,总体社会功能相对较差。

An exploratory clinical study of attention deficit hyperactivity disorder in young adulthood

Objective The exploratory study aimed to characterize the clinical features and the patterns of comorbidity and psychosocial functioning of adult attention deficit hyperactivity disorder (ADHD). Methods The study initially recruited 88 children who diagnosed with ADHD at age 6～16 years. They were reevaluated and administered structured psychiatric interviews for DSM-IV when they were at least 18 years old. A total of 59 adults with ADHD and 29 controls with GAF>70 were included in the study. Results Fifty-one(86.4%)of the adult ADHD were diagnosed as predominantly inattentive subtype of ADHD. The most common adult ADHD symptoms included "often has difficulty organizing tasks and activities (98.3%); often avoiding doing work projects where effort at thinking a lot is required (96.6%); often has trouble paying close attention to details (94.9%); often has problems following through on instructions and finishing job tasks (96.6%); often has difficulty sustaining attention (88.1%); often is distracted easily by extraneous stimuli (72.9%)". The majority (66.1%) of the adult ADHD had one or more psychiatric axis-I/axis-II comorbidity. Among them, 39.0% had psychiatric axis-I comorbidity and 49.2% had personality axis-II comorbidity. The average GAF score was significant lower in adult ADHD than in controls ( t =12.96, P <0.001). The majority (74.6%) of the adult ADHD had mild or moderate impairment or distress of overall functioning. Conclusions The main feature of adult ADHD is attention deficit. Patients with adult ADHD usually have comorbid conditions such as other psychiatric disorders and personality disorders and their psychosocial functioning is relatively poor.