注意缺陷多动障碍患儿的成人早期精神状况随访研究

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

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 Interiew 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。

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% comorbidmood 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.