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首页> 外文期刊>The journal of clinical psychiatry >A randomized double-blind trial of paroxetine and/or dextroamphetamine and problem-focused therapy for attention-deficit/hyperactivity disorder in adults.
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A randomized double-blind trial of paroxetine and/or dextroamphetamine and problem-focused therapy for attention-deficit/hyperactivity disorder in adults.

机译：帕罗西汀和/或右旋苯丙胺的随机双盲试验和针对成年人的注意力不足/多动障碍的针对性治疗。

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OBJECTIVE: To determine the effect of psychotherapy, dextroamphetamine, and/or paroxetine on attention-deficit/hyperactivity-disorder (ADHD) in adults. METHOD: Ninety-eight adults with DSM-IV ADHD were randomly assigned to receive psychotherapy and dextroamphetamine, paroxetine, both, or placebo for 20 weeks. A 2 x 2 factorial design compared patients who received dextroamphetamine versus no dextroamphetamine with patients who received paroxetine versus no paroxetine. Data were collected from August 2000 until May 2002. RESULTS: One half of the 98 enrolled subjects were found to have at least 1 lifetime mood or anxiety disorder on the Structured Clinical Interview for DSM-IV. Sixty percent of patients who received medication and 80% of those who received placebo completed the 5-month trial. ADHD symptoms were significantly (p = .012) lower in patients in the completer group who received dextroamphetamine. Paroxetine had no effect on ADHD. Hamilton Rating Scales for Anxiety (HAM-A) and Depression (HAM-D) scores were low to start, and no treatment differences were evident at endpoint. Significantly (p < .001) more patients in the completer group were rated by clinicians as ADHD responders if they received dextroamphetamine (85.7%) or combined treatment (66.7%) versus paroxetine (20.0%) or placebo (21.1%). Significantly (p = .003) more patients in the completer group were rated by clinicians as mood/anxiety responders if they received paroxetine (100%) or combined treatment (73.3%) versus those receiving dextroamphetamine (57.15%) or placebo (47.4%). Clinicians rated any patient who received medication and psychological therapy as significantly more improved overall than those who received placebo and psychological therapy (intent to treat: p = .033; completers: p = .001). CONCLUSION: ADHD symptoms improved with dextroamphetamine. Mood and internalizing symptoms were seen as improved with paroxetine by clinicians, despite absence of response on the HAM-A and HAM-D. The presence of a lifetime internalizing disorder attenuated the response to dextroamphetamine. Patients who received both dextroamphetamine and paroxetine had more severe adverse events but did not show greater improvement overall than patients treated with 1 medication. Clinical Trials Registry #GSK707.
机译：目的：确定心理治疗，右旋苯丙胺和/或帕罗西汀对成人注意缺陷/多动障碍（ADHD）的影响。方法：将98名患有DSM-IV ADHD的成年人随机分配接受心理治疗和右旋苯丙胺，帕罗西汀，两者或安慰剂治疗20周。 2 x 2析因设计比较接受右旋苯丙胺与不右旋苯丙胺的患者与接受帕罗西汀与不接受帕罗西汀的患者。从2000年8月至2002年5月收集了数据。结果：在结构化的DSM-IV访谈中，在98名登记受试者中，有一半患有至少一种终生的情绪或焦虑症。接受药物治疗的患者中有60％，接受安慰剂的患者中有80％完成了为期5个月的试验。接受右旋苯丙胺的完全治疗组患者的ADHD症状显着降低（p = 0.012）。帕罗西汀对多动症无影响。汉密尔顿焦虑量表（HAM-A）和抑郁症（HAM-D）评分开始时较低，在终点时无明显治疗差异。如果接受右旋苯丙胺（85.7％）或联合治疗（66.7％）对比帕罗西汀（20.0％）或安慰剂（21.1％），则完成组中有更多（p <.001）患者被临床医生评价为ADHD应答者。与接受右旋苯丙胺（57.15％）或安慰剂（47.4％）的接受帕罗西汀（100％）或联合治疗（73.3％）的患者相比，完成者组中有显着（p = .003）的患者被临床医生评为情绪/焦虑反应者）。临床医生对接受药物和心理治疗的患者的总体改善程度均高于接受安慰剂和心理治疗的患者（治疗意向：p = .033;完成者：p = .001）。结论：右旋苯丙胺可改善多动症症状。尽管对HAM-A和HAM-D没有反应，但临床医生认为帕罗西汀可以改善情绪和内在症状。一生的内在化障碍的存在减弱了对右旋苯丙胺的反应。同时接受右旋苯丙胺和帕罗西汀的患者有较严重的不良事件，但总体上没有显示出比用一种药物治疗的患者更大的改善。临床试验注册中心＃GSK707。

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