Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Erwachsenenalter

 

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Zusammenfassung

Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen (ADHS) sind die häufigsten psychischen Erkrankungen im Kindes- und Jugendalter. Bei 30 - 50 % persistiert ADHS im Erwachsenenalter, wobei insbesondere die Aufmerksamkeitsstörungen bestehen bleiben. Die Symptome der Aufmerksamkeitsstörung einer ADHS sind meist Beeinträchtigungen durch gestörte exekutive Funktionen. Schwierigkeiten ergeben sich manchmal in der Abgrenzung des Erwachsenen ADS/ADHS zu anderen Störungen und in der Erfassung einer komorbide vorliegenden ADS/ADHS. Der Artikel gibt einen Überblick über die Beeinträchtigungen durch die Aufmerksamkeitsstörung, das klinische Bild, die Problematik der Diagnostik, die Pharmako- und Psychotherapie und Komorbidität bei ADHS im Erwachsenenalter.

Abstract

The attention-deficit-/hyperactivity disorders (ADHD) are the most common psychiatric disorders in children and adolescents. ADHD persists in 30 - 50 % into the adulthood. Attention problems were found to be more persistent than hyperactivity and impulsivity. Many of the symptoms classified as ADHD symptoms of inattention are actually symptoms of executive function impairments. Assessment and differential diagnosis of adult ADD/ADHD may be difficult, because of a high rate of comorbidity. This article gives an overview about the impairments caused by attention-deficits, the clinical picture, the problems of diagnosis, the pharmacotherapy, the psychotherapy and comorbidity of ADHD in adults.

Literatur

• 1 Arnold L E. Sex differences in ADHD: conference summary.  J Abnorm Child Psychol. 1996;  24 555-569
  CrossrefPubMedGoogle Scholar
• 2 Biederman J, Faraone S V, Mick E. et al . Clinical correlates of ADHD in females: findings from a large group of girls ascertained from pediatric and psychiatric referral sources.  J Acad Am Child Adolesc Psychiatry. 1999;  38 966-975
  PubMedGoogle Scholar
• 3 Biederman J, Faraone S V, Milberger S. et al . Patterns of psychiatric comorbidity, cognition and psychosocial functioning in adults with attention deficit hyperactivity disorder.  Am J Psychiatry. 1993;  150 1792-1798
  PubMedGoogle Scholar
• 4 Goldman L S, Genel M, Bezman R. et al . Diagnosis and treatment of attention-deficit/hyperactive disorder in children and adolescents.  JAMA. 1998;  279 1100-1107
  CrossrefPubMedGoogle Scholar
• 5 Anderson J R, Williams S, McGee R. et al . DSM-III disorders in preadolescent children: prevalence in a large sample from the general population.  Arch Gen Psychiatry. 1987;  44 69-76
  PubMedGoogle Scholar
• 6 Gallucci F, Bird H R, Berarni C. et al . Symptoms of attentino deficit hyperactivity disorder in an Italian school sample: findings of a pilot study.  J Acad Am Child Adolesc Psychiatry. 1993;  32 1051-1058
  PubMedGoogle Scholar
• 7 Leung P WL, Luk S L, Ho T P. et al . The diagnosis and prevalence of hyperactivity in Chinese schoolboys.  Br J Psychiatry. 1996;  168 486-496
  PubMedGoogle Scholar
• 8 Kanbayashi Y, Nakata Y, Fujii K. et al . ADHD-related behavior among non-referred children: parents ratings of DSM-III-R symptoms.  Child Psychiatry Hum Dev. 1994;  25 13-29
  PubMedGoogle Scholar
• 9 Bhatia M S, Nigam V R, Bohra N. et al . Attention deficit disorder with hyperactivity among pediatric outpatients.  J Child Psychol Psychiatry. 1991;  32 297-306
  PubMedGoogle Scholar
• 10 Bird H R, Canino G, Rubio-Supec M. et al . Estimates of prevalence of childhood maladjustment in a community survey in Puerto Rico.  Arch Gen Psychiatry. 1988;  45 1120-1126
  PubMedGoogle Scholar
• 11 Baumgaertel A, Wolraich M L, Dietrich M. Comparison of diagnostic criteria for attention deficit disorders in a German elementary school sample.  J Acad Am Child Adolesc Psychiatry. 1995;  34 629-638
  PubMedGoogle Scholar
• 12 Gomez R, Harvey J, Quick C, Scharer I, Harris G. DSM-IV AD/HD: Confirmatory factor models, prevalence and gender and age differences based on parent and teacher ratings of Australian primary school children.  J Child Psychol Psychiatry. 1999;  40 265-274
  CrossrefPubMedGoogle Scholar
• 13 American Psychiatric Association (APA) .Diagnostic and Statistical Manual of Mental Disorders, 3^rd Edition. Washington, DC; APA 1980
  Google Scholar
• 14 American Psychiatric Association (APA) .Diagnostic and Statistical Manual of Mental Disorders, 3^rd Edition, Revised. Washington, DC; APA 1987
  Google Scholar
• 15 American Psychiatric Association (APA) .Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition. Washington, DC; APA 1994
  Google Scholar
• 16 Lahey B B, Carlson C L. Validity of diagnostic category for attetion deficit disorder without hyperactivity: a review of literature.  J Learning Disabilities. 1991;  24 110-120
  PubMedGoogle Scholar
• 17 Lahey B B, Applegate B, McBurnett K. et al . DSM-IV field trials for attention deficit hyperactivity disorder in children and adolescents.  Am J Psychiatry. 1994;  151 1673-1685
  CrossrefPubMedGoogle Scholar
• 18 Eiraldi R B, Power T J, Nezu C M. Patterns of comorbidity associated with subtypes of attention-deficit/hyperactivity disorder among 6 to12 year-old children.  J Acad Am Child Adolesc Psychiatry. 1997;  36 503-514
  PubMedGoogle Scholar
• 19 Faraone S V, Biederman J, Weber W. et al . Psychiatric, Neuropsychological, and psychosocial features of DSM-IV subtypes of ADHD: results from a clinically referred sample.  J Acad Am Child Adolesc Psychiatry. 1998;  37 185-193
  PubMedGoogle Scholar
• 20 Gaub M, Carlson C L. Gender differences in ADHD: a metaanalysis and critical review.  J Acad Am Child Adolesc Psychiatry. 1997;  36 1036-1045
  PubMedGoogle Scholar
• 21 Hart E L, Lahey B B, Loeber R. et al . Developmental Change in ADHD in boys: a four-year longitudinal study.  J Abnorm Child Psychol. 1995;  23 729-749
  CrossrefPubMedGoogle Scholar
• 22 Levy F, Hay D A, McStephen M. et al . ADHD: a category or a continuum? Genetic analysis of a large-scale twin study.  J Am Acad Child Adolesc Psychiatry. 1997;  36 734-744
  PubMedGoogle Scholar
• 23 Achenbach T M, Howell C T, McConaughy S H. et al . Six-year predictors of problems in a national sample, III: transitions to young adult syndromes.  J Am Acad Child Adolesc Psychiatry. 1995;  34 658-669
  PubMedGoogle Scholar
• 24 Brown T E. Differential diagnosis of ADD vs. ADHD in adults. In: Nadeau KG (ed) A Comprehensive Guide to ADD in Adults. New York; Brunner/Mazel 1995: 93-108
  Google Scholar
• 25 Brown T E. Brown Attention Deficit Disorder Scales. San Antonio, TX; Psychological Corporation 1996
  Google Scholar
• 26 Lyon G R, Krasnegor N A. Attention, Memory, and Executive Function. Baltimore, MD; Paul H Books 1996
  Google Scholar
• 27 Quinlan D M. Asssessment of ADHD and Comorbidities. In: Brown TE (ed) ADD and Comorbidities in Children, Adolescents and Adults. Washington; APA Press 2000
  Google Scholar
• 28 Ward M F, Wender P H, Reimherr F W. The Wender Utah Rating Scale: an aid in retrospective diagnosis of childhood ADHD.  Am J Psychiatry. 1993;  150 885-890
  PubMedGoogle Scholar
• 29 Wilens T EA, Spencer T J, Biederman J. Pharmacotherapy of ADHD. In: Brown TE (ed) ADD and Comorbidities in Children, Adolescents and Adults. Washington; APA Press 2000
  Google Scholar
• 30 Taylor J R, Jentsch D. Stimulant Effects on Striatal and Cortical Dopamine Systems Involved in Reward-Related Behavior and Impulsivity. In: Solanto M, Arnsten AFT, Castellanos FX (eds) Stimulant drugs and ADHD. Oxford; University Press Oxford 2001
  Google Scholar
• 31 Wilens T E, Biederman J, Spencer T J. Pharmacotherapy of ADHD in adults.  CNS Drugs. 1998;  3 347-356
  PubMedGoogle Scholar
• 32 Michelson D. et al .Nonstimulant Treatments for ADHD. Strattera Global Medical Conference 2002
  Google Scholar
• 33 Casat C D, Pleasants D Z, Wyck Fleet J van. A double-blind trial of bupropion in children with attention deficit disorder.  Psychopharmacol Bull. 1987;  23 120-122
  PubMedGoogle Scholar
• 34 Conners C K, Casat C D, Gualtieri C T. et al . Bupropion hydrochloride in attention deficit disorder with hyperactivity.  J Am Acad Child Adolesc Psychiatry. 1996;  35 1314-1321
  PubMedGoogle Scholar
• 35 Barrickman L, Perry P, Allen A. et al . Bupropion versus methylphenidate in the treatment of ADHD.  J Am Acad Child Adolesc Psychiatry. 1995;  34 649-657
  PubMedGoogle Scholar
• 36 Hunt R D, Minderaa R B, Cohen D J. The therapeutic effect of clonidine and attention deficit disorder with hyperactivity: a comparison with placebo and methylphenidate.  Psychopharmacol Bull. 1986;  22 229-236
  PubMedGoogle Scholar
• 37 MTA Cooperative Group . Fourteen-month randomised clinical trial of treatment strategies for AD/HD.  Arch Gen Psychiatry. 1999;  56 (12) 1073-1086
  Google Scholar
• 38 Wilens T, McDermott S, Biedermann J. et al .Cognitive therapy for adults with ADHD: a systematic chart review of 26 cases. J Cognitive Psychoth (in press)
  Google Scholar
• 39 Beck A T, Rush A J, Shaw B F. et al .Cognitive Therapy of Depression; A Treatment Manual. New York; Guilford 1979
  Google Scholar
• 40 Beck A T, Freeman A. et al .Cognitive Therapy of Personality Disorder. New York; Guildford 1990
  Google Scholar
• 41 Linehan M. Cognitive-behavioral Treatment of Borderline Personality Disorder. New York; The Guildford Press 1993a
  Google Scholar
• 42 Linehan M. Skills Training Manual for Treating Borderline Personality Disorder. New York; The Guildford Press 1993b
  Google Scholar
• 43 Hesslinger B, Tebartz van Eltz L, Nyberg E. et al . Psychotherapy of ADHD in adults. A pilot study using a structured skills training program.  Eur Arch Psychiatry Clin Neurosci. 2002;  252 177-184
  Google Scholar
• 44 McDermott S P. Cognitive Therapy for Adults with AD/HD. In: Brown TE (ed) ADD and Comorbidities in Children, Adolescents and Adults. Washington; APA Press 2000
  Google Scholar
• 45 Biederman J, Faraone S V, Mick E. et al . Familial association between attention deficit disorder and anxiety disorders.  Am J Psychiatry. 1991;  148 251-256
  PubMedGoogle Scholar
• 46 Biederman J, Wilens M, Mick E A. et al . Psychoactive substance use disorders in adults with attentione deficit hyperactivity disorder (ADHD): Effects of ADHD and comorbidity.  Am J Psychiatry. 1995;  152 1652-1658
  PubMedGoogle Scholar
• 47 Borland B L, Heckmann H K. Hyperactive boys and their brothers: A 25-year follow-up study.  Arch Gen Psychiatry. 1976;  33 669-675
  PubMedGoogle Scholar
• 48 Murphy K R, Barkley R A. Prevalence of DSM-IV symptoms of ADHD in adult licenced drivers.  Journal of attention disorders. 1976;  1 147-162
  PubMedGoogle Scholar
• 49 Faraone S V, Biederman J. Do attention deficit hyperactivity disorder and major depression share familial risk factors?.  J Nerv Ment Dis. 1997;  185 463-469
  CrossrefPubMedGoogle Scholar
• 50 Spencer T. Adult ADHD. Paper presented at the Annual Meeting of the American Academy of Child and Adolescent Psychiatry. New Orleans; 1995
  Google Scholar
• 51 Geller B, Craney J L, Bolhofner K, DelBello M P, Williams M, Zimerman B. One-year recovery and relapse rate of children with a prepubertal and early adolescent bipolar disorder phenotype.  Am J Psychiatry. 2001;  158 303-305
  CrossrefPubMedGoogle Scholar
• 52 Schmahl C, Bohus M. Symptomorientierte Pharmakotherapie bei Borderline-Persönlichkeitsstörung.  Fortschr Neurol Psychiat. 2001;  69 310-321
  Article in Thieme ConnectPubMedGoogle Scholar
• 53 Pomerleau O, Downey K, Stelson F. et al . Cigarette smoking in adult patients with attention deficit hyperactivity disorder.  J Subst Abuse. 1995;  7 373-378
  CrossrefPubMedGoogle Scholar
• 54 Biederman J, Wilens M, Mick E A. et al . Is ADHD a risk factor for psychoactive substance use disorders? Findings from a four-year prospective follow-up study.  J Am Acad Child Adolesc Psychiatry. 1997;  34 464-471
  PubMedGoogle Scholar
• 55 Biederman J. ADHD and Comorbidities. Philadelphia; APA 5/2002
  Google Scholar

Dr. med. Andreas Kordon

Klinik für Psychiatrie und Psychotherapie · Universitätsklinikum Schleswig-Holstein · Campus Lübeck

Ratzeburger Allee 160

23538 Lübeck

Email: Kordon.a@psychiatry.mu-luebeck.de