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首页> 外文期刊>The journal of clinical psychiatry >Treating nicotine dependence by targeting attention-deficit/hyperactivity disorder (ADHD) with OROS methylphenidate: The role of baseline ADHD severity and treatment response
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Treating nicotine dependence by targeting attention-deficit/hyperactivity disorder (ADHD) with OROS methylphenidate: The role of baseline ADHD severity and treatment response

机译：通过用OROS哌醋甲酯靶向治疗注意力不足/多动障碍（ADHD）治疗尼古丁依赖性：基线ADHD严重程度和治疗反应的作用

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Objective: To determine whether treatment of attentiondeficit/hyperactivity disorder (ADHD) with osmotic-release oral system (OROS) methylphenidate promotes abstinence from smoking among smokers with ADHD who have greater severity of ADHD symptoms at baseline or greater improvement in ADHD during treatment. Method: This is a secondary analysis of data from a randomized, double-blind, 11-week trial conducted between December 2005 and January 2008 at 6 clinical sites; the original trial was sponsored by the National Drug Abuse Clinical Trials Network. Adult cigarette smokers (aged 18-55 years) who met DSM-IV criteria for ADHD were randomly assigned to OROS methylphenidate (72 mg/d) (n = 127) or matching placebo (n = 128). All participants received nicotine patches (21 mg/d) and weekly individual smoking cessation counseling. Logistic regression was used to model prolonged abstinence from smoking (ascertained by self-report and breath carbon monoxide testing) as a function of treatment, baseline ADHD Rating Scale-IV (ADHD-RS) score, change in ADHD-RS score during treatment, and their interactions. Results: Treatment interacted with both ADHD-RS score at baseline (P = .01) and change in ADHD-RS score during treatment (P = .008). Among patients with higher ADHDRS scores (> 36) at baseline and the most improvement in ADHD during treatment (ADHD-RS change score ≥ 24), 70.0% of those who took OROS methylphenidate achieved abstinence from smoking compared to 36.8% of those who took placebo (P = .02). In contrast, among patients with the lowest ADHD-RS baseline scores (≤ 30), 30.3% of those who took OROS methylphenidate achieved abstinence from smoking compared to 60.7% of those who took placebo (P = .02). Conclusions: OROS methylphenidate, in combination with nicotine patch, may be an effective treatment for nicotine dependence among smokers with more severe ADHD and more robust response of ADHD symptoms to medication. OROS methylphenidate may be counterproductive among smokers with lower severity of ADHD.
机译：目的：确定渗透释放口服系统（OROS）哌醋甲酯治疗注意力缺陷/多动障碍（ADHD）是否能促进基线时ADHD症状严重程度较高或治疗期间ADHD改善的ADHD吸烟者戒烟。方法：这是对2005年12月至2008年1月之间在6个临床场所进行的随机，双盲，为期11周的试验数据的二次分析;原始试验由国家药物滥用临床试验网络赞助。符合DSM-IV ADHD标准的成年吸烟者（18-55岁）被随机分配到OROS哌醋甲酯（72 mg / d）（n = 127）或相匹配的安慰剂（n = 128）。所有参与者均接受尼古丁贴剂（21 mg / d）和每周个人戒烟咨询。使用Logistic回归模型来模拟长期戒烟（通过自我报告和呼吸一氧化碳测试确定）与治疗，基线ADHD等级量表IV（ADHD-RS）得分，治疗期间ADHD-RS得分的变化之间的关系，及其互动。结果：治疗与基线时的ADHD-RS得分（P = .01）和治疗期间ADHD-RS得分的变化（P = .008）都存在相互作用。在基线时ADHDRS评分较高（> 36）且治疗期间ADHD改善最大的患者（ADHD-RS变化评分≥24）中，服用OROS哌醋甲酯的人中有70.0％戒烟，而服用烟酒的患者中则有36.8％安慰剂（P = .02）。相比之下，在ADHD-RS基线评分最低的患者（≤30）中，服用OROS哌醋甲酯的人中有30.3％戒烟，而服用安慰剂的人中有60.7％的人戒烟（P = .02）。结论：OROS哌醋甲酯与尼古丁贴剂联合使用可能是治疗烟瘾较重的ADHD和ADHD症状对药物反应更强的烟民的有效方法。 OROS哌醋甲酯可能对适度多动症严重程度较低的吸烟者起反作用。

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