질병개념및진단분류 임상진단의난제점들 933

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1 KISEP Original Articles J Korean Neuropsychiatr Assoc Vol 37, No 5 청소년, 성인의주의력결핍과다활동장애 이영식 * 방양원 ** Attention-Deficit Hyperactivity Disorder in Adolescents and Adults Young-Sik Lee, M.D.,* Yang-Won Bang, M.D.** 중심단어 국문초록 서 론 1. 성인 ADHD 는고아진단인가? Department of Neuropsychiatry, College of Medicine, Chung-Ang University, Seoul Keyo Hospital, Uiwang Corresponding author 932

2 질병개념및진단분류 임상진단의난제점들 933

3 Table 1. Natural course of ADHD from child to adult with comorbid disorders Preschool age School age Adolescence Adult Irritable, aggressive ADHD ADHD/ADD ADD/ADHD hyperkinetic, difficult child Learning disorder Learning disorder ODD/CD CD Antisocial P Drug abuse Drug abuse Anxiety/Fear Anxiety disorder Anxiety disorder Mood disorder Mood disorder ADHDattention deficit hyperactivity disorder ADDattention deficit disorder ODDoppositional defiant disorder CDconduct disorder PDpersonality disorder 1. 소아 ADHD 병력확인의어려움 2. 나이를불문하고 ADHD 공존질환이많다는어려움 3. ADHD와타질환과증상감별의어려움 역 학 934

4 유전적인연구 질병의발달학적진행과정 1. 청소년기의증상및일상생활의문제점들 2. 성인기의증상및일상생활의문제점들 935

5 약물치료 1. 정신자극제 (Psychostimulant) 936

6 2. 항우울제 3. α-adrenergic agonist 4. Carbamazepine 약물투약공휴일 정신사회적중재 1. 행동인지치료 937

7 2. 개인상담 3. 집단치료 ( 가족, 부부치료 ) 참고문헌 1) Anderson JC, Williams S, McGee R, Silva PA (1987):DSM-Ⅲ disorders in preadolescent children:prevalence in a large sample from the general population. Arch Gen Psychiatry 24: ) Bird HR, Canino G, Rubino-Stipec M, Gould MS, Ribera J, Sesman M, Woodburry M, Huertas- Goldman S, Pagan A, Sanchez-Lacay A, Moscoso M(1988):Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. Arch Gen Psychiatry 45: ) Paul J(1995):History and overview of adulthood ADHD. In:A comprehensive guide to attention deficit disorder in adults. Ed by Kathleen G, Nadeau, New York, Brunner/Mazel publishers, pp3-17 4) David S(1994):Attention deficit hyperactivity disorder in adults. Am J Psychiatry 151: ) Wood DR, Reimherr FW, Wender PH, Johnson GE(1976):Diagnosis and treatment of minimal brain dysfunction in adults:a preliminary report. Arch Gen Psychiatry 33: ) Ward MF, Wender PH, Reimherr FW(1993): The Wender Utah Rating Scale:An aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry 150: ) Mannuzza S, Kein RG, Bessler A, Malloy P, Lapadula M(1993):Adult outcome of hyperactive boys:educational achievement, occupational rank and psychiatric status. Arch Gen Psychiatry 50: ) Wender PH, Reimherr FW, Wood DR(1981): Attention deficit disorde( minimal brain dysfunction ) in adults:a replication study of diagnosis and drug treatment. Arch Gen Psychiatry 38: ) Biederman J, Fararone SV, Mike E, Spencer T, Wilens T, Kiley K, Guite J, Ablon JS, Reed E, Warburton R(1995):High risk for attention deficit 938

8 hyperactivity disorder among children of parents with childhood onset of the disorder:a pilot study. Am J Psychiatry 152: ) Weiss G, Hechtman L, Milroy T, Perlman T(1985): Psychiatric status of hyperactives as adults:a controlled prospective 15-year follow-up of 63 hyperactive children. J Am Acad Child Psychiatry 24: ) Feehan M, McGee R, Williams S(1993):Mental health disorders from age 15 to age 18 years. J Am Acad Child Adolesc Psychiatry 32: ) Barkley(1989):Hyperactivity. In:The practice of child therapy. Ed by RJ Morris, TR Kratochwill, New York, Pergamon press, pp ) Bierdrman J, Munir K, Knee D, Habelow W, Amentano M, Autor S, Hoge SK, Waternox, C (1986):A family study of patients with attention deficit disorder and normal controls. J Psychiatr Research 20: ) Deutsch CK, Matthyses S, Swanson JM, Farkas LG(1990):Genetic latent structure analysis of Dysmorpholgy of attention deficit disorder. J Am Acad Child Adolesc Psychiatry 29: ) Goodman R, Stevenson J(1989):A twin study of hyperactivity-Ⅱ. The aetiological role of genes, family relationships and perinatal adversity. J Child Psychol Psychiatry 30: ) Faraone SV, Biederman J, Keenan K, Tsuang MT (1991):A family genetic study of girls with DSM- Ⅲ Attention deficit disorder. Am J Psychiatry 148: ) Manshadi M, Lippmann S, O Daniel RG, Blackman A(1983):Alcohol abuse and Attention deficit disorder. J Clin Psychiatry 44: ) Barkely RA(1990):Primary symptoms and conceptualization, in Attention Deficit Hyperactivity Disorder;A Handbook for Diagnosis and Treatment. New York, Guilford, pp ) Coleman WL, Levin MD(1988):Attention-deficit in adolescents:description, evaluation and management. Pediatr Rev 9: ) Ratey JJ, Greenberg MS, Lindem KJ(1991): Combination of treatments for attention deficit hyperactivity disorder in adults. J Nerv Ment Dis 179: ) Klein RG, Mannuzza S(1991):Long-term outcome of hyperactive children:a review. J Am Acad Child Adolesc Psychiatry 30: ) Hechtman L, Weiss G(1986):Controlled prospective fifteen year followup of hyperactives as adults: Nonmedical drug and alcohol use and antisocial behavior. Can J Psychiatry 31: ) Silver LB(1991):Attention Deficit Hyperactivity Disorder:A clinical guide to diagnosis and treatment. Washington, DC:American Psychiatric Press. Cited from Harris CF, et al. (1995):Attention deficit disorder during adolescence. Journal of Adolescent Health 16: ) Dulcan MK, Benson RS(1997):AACAP Official Action. Summary of the practice parameters for the assessment and treatment of children, adolescents, and adults with ADHD. J Am Acad Child Adolesc Psychiatry 36: ) Klorman R, Bruamaghim JT, Fitzpatrick PA, Borgstedt AD(1990):Clinical effects of a controlled trial of methylphenidate on adolescents with attention deficit disorder. J Am Acad Child Adolesc Psychiatry 29: ) Funk JB, Chessare JB, Weaver MT, Exley A (1993) : Attention deficit hyperactivity disorder, creativity and the effects of methylphenidate. Pediatrics 91: ) Vincent J, Varley CK, Legar P(1990):Effects of methylphenidate on early adolescent growth. Am J Psychatry 147: ) Kaplan SL, Busner J, Kupietz S, Wassermann E, Segal B(1990):Effects of methylphenidate on adolescents with aggressive conduct disorder and AD- HD:A preliminary report. J Am Acad Child Adolesc Psychiatry 29: ) Barkley RA, McMurray MB, Edelbrock CS, Robbins K(1989):The response of aggressive and nonaggressive ADHD children to two doses of methylphenidate J am Acad Child Adolesc Psychiatry 28: ) Barkley RA, McMurray MB, Edelbrock CS, Robbins K(1990):Side effects on methylphenidate in children with attention deficit hyperactivity disorder:a systemic, placebo-controlled evaluation. Pediatrics 86: ) Leimkuhler ME(1994):Attention deficit disorder in adults and adolescents:cognitive behavioral and personality styles. In:The psychotherapist s guide to neuropsychiatry. Ed by James ME, Cheryl SW, Teresa HM, Washington DC, American Psychiatric Press, 939

9 pp ) Baldessarini RJ(1989):Current status of antidepressants:clinical pharmacology and theory. J Clin Psychiatry 50: ) Spencer T, Bierderman J, Steingard R, Wilens T(1993):Buproprion exacerbates tics in children with attention-deficit hyperactivity disorder and Tourette s syndrome. J Am Acad Child Adolesc Psychiatry 32: ) Wender PH, Reimherr FW(1990) : Bupropion treatment of attention-deficit hyperactivity disorder in adults. Am J Psychiatry 147: ) Steingard R, Bierderman J, Spencer T, Wilens T, Gonzalez A(1993):Comparison of clonidine response in the treatment of attention-deficit hyperactivity disorder with and without cormorbid tic disorders. J Am Acad Child Adolesc Psychiatry 32: ) Brown CS, Wells BG, Cold JA, Froemming JH, Self TH, Jabbour JT(1990):Possible influence of carbamazepine on plasma imipramine concentrations in children with attention deficit hyperactivity disorder. J Clin Psychopharmacol 10: ) Bowen J, Fenton T, Rappaport L(1991):Stimulant medication and attention deficit-hyperactivity disorder. The child s perspective. Am J Dis Child 145: ) Bierderman J, Faraone SV, Keenan K, Tsuang MT(1991):Evidence of familial association between attention deficit disorder and major affective disorders Arch Gen Psychiatry 48: ) Liu C, Robin AL, Brenner S, Eastman J (1991): Social acceptability of methylphenidate and behavior modification for treating attention deficit hyperactivity disorder. Pediatrics 88: ) Klein RG, Mannuza S(1991):Long-term outcome of hyperactive children:a review. J Am Acad Child Adoesc Psychiatry 30: ) Ronan KR, Kendall PC(1990):Non-self-controlled adolescents:applications of cognitive-behavioral therapy. Adolesc Psychiatry ) Brown RT, Wynne ME, Borden KA, Clingerman SR, Geniesse R, Spunt AL(1986):Methylphenidate and cognitive therapy in children with attention deficit disorder. J Dev Behav Pediatr 7: ) Schneider S(1992):Separation and Individuation issues in psychosocial rehabilitation. Adolescence 27: ) Weiss G, Hechtman LT, Perlman T, Hopkins J, Wehar T(1979):Hyperactives as young adults:a controlled prospective 10-year follow-up of the psychiatric status of 75 children. Arch Gen Psychiatry 36: ) Pope AW, Bierman KL, Mumma GH(1989):Relations between hyperactive and aggressive behavior and peer relations at three elementary grade levels. J Abnorm Child Psychol 17: ) Jensen PS, Xenakis SN, Shervette RE, Bain MW, Davis H(1989):Diagnosis and treatment of attention deficit disorder in two general hospital clinics. Hosp Community Psychiatry 40:

10 ABSTRACT J Korean Neuropsychiatr Assoc Vol 37, No 5, September, 1998 Attention-Deficit Hyperactivity Disorder in Adolescents and Adults Youn-Sik Lee, M.D., Yang-Won Bang, M.D. Department of Neuropsychiatry, College of Medicine, Chung-Ang University, Seoul It seems best to view ADHD as a developmental disability that comprises impairments in persistence of effortsustained attention, the ability to delay responding and inhibit behaviorimpusivity, and the regulation of excessive activity level or responding in situationshyperactivity. These problems tend to arise early in childhood, often during the preschool years, and persist in over half the cases into adulthood as adult ADHD. ADHD in adolescents and adults responds to treatment with stimulants, tricyclic antidepressants, etc. Nonpharmacologic modalities such as behavior modification, individual and family therapy and cognitive therapy are useful adjuncts to psychopharmacologic management. Without effective treatment, ADHD often results in increased risk of trauma, substance abuse, conduct disorder, marital disharmony, family dysfunction, divorce, and incarceration in adolesence and adulthood. Lifelong treatment with proper medication and counselling are important to ADHD. KEY WORDSAdolescence Adult ADHD Pharmacotherapy Psychosocial Intervention. 941

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A 617 Special Issue Diabetic Retinopathy Won Ki Lee, M.D. Department of Ophthalmology The Catholic University of Korea College of Medicine Kangnam St. Mary s Hospital E mail : wklee@catholic.ac.kr Abstract R