過度活躍症

(由過度活躍跳轉過嚟)

過度活躍症attention deficit hyperactivity disorder,簡稱「ADHD」)係一種精神障礙精神疾患[1][2]。患者專注力不足,容易分心。患者特性包括好難專注、過度活躍、做嘢唔考慮後果等。除此之外,仲有不合年紀嘅行為,過度活躍症患者亦可能表現出情緒調節困難或者執行功能方面嘅問題[3][4]

過度活躍症
分類同外部資源
Patient UK英文Patient UK注意力不足過動症(ADHD)
attention deficit hyperactivity disorder

症狀同體徵 編輯

ADHD嘅症狀[5]
專注力失調 過動-衝動
  • 好難注意事情嘅細節
  • 唔容易專注喺同一件事情上面
  • 唔容易針對事物或者係活動進行規劃組織
  • 好容易遺忘一啲需要嘅物品
  • 喺日常活動入面比較健忘
  • 注意力持續時間較短,比較容易分心
  • 唔容易處理有結構性嘅工作
  • 難以完成繁瑣或者需要花時間嘅任務
  • 無辦法好好坐好
  • 喺座位上坐立不安、郁嚟郁去
  • 會喺唔適當嘅時間離開座位
  • 從事具風險性嘅事物,唔會太考慮後果
  • 經常處於活躍狀態、精力充沛、停唔到落嚟
  • 說話頻率同時間會比其他人多
  • 問題未講完就搶住講答案
  • 唔容易輪流等候
  • 喺對話入面成日插嘴或者打斷其他人對話

過度活躍症常見情況有唔專心、過動(成人會以不安嚟表現)、破壞行為同衝動[6][7]。喺人際關係同埋學業方面都容易出現問題[6],不過呢種症狀唔容易定義,因為好難介定一般情形入面唔專心、過動同衝動會有咩程度,喺咩情況入面先需要介入治療[8]

依照《精神疾病診斷與統計手冊》(DSM)第五版(DSM-5)嘅定義, 過度活躍症嘅症狀需要出現超過6個月,或者患者情形比同年齡明顯多好多[4],同埋患者症狀已經造成至少兩個情境(例如社交、學校/工作、家庭)嘅問題[4],呢啲條件需要喺12歲之前就出現[4],若果係17歲以下,喺專注力失調或者係過動/衝動上嘅症狀,至少需要有5項符合[4]

子類型 編輯

過度活躍症可以分做3個子類型[4][8]:

若果以注意力不足(專注力失調)為主嘅細路或者青少年,會有以下大部份甚至全部嘅症狀,同時唔係由其他醫學疾病或者藥物直接造成[4][9]

  • 容易分心、粗心、唔記得事情、成日由一件事情切換去另一件事情。
  • 好難持續專注喺同一件事情度。
  • 除非做緊自己有興趣嘅事務,唔係嘅話做咗幾分鐘後就會覺得無聊。
  • 難以對組織(規劃)事情、完成一個任務保持專注。
  • 好難完成功課,或者如期繳交,成日會唔見一啲要完成作業或者係其他活動需要嘅嘢(例如鉛筆、玩具、作業等)*
  • 當其他人同患者講嘢時,似乎無喺度聽對方講嘢。
  • 成日發白日夢、成日覺得困惑、動作緩慢。
  • 唔容易好似其他非過度活躍症患者一樣,快速同準確處理資訊。
  • 好難遵從指示
  • 唔容易認知細節,成日忽略細節。

若果係以過動為主嘅細路或者青少年,會有以下大部份甚至全部嘅症狀,而且唔係由其他醫學疾病或者藥物直接造成[4][9]

  • 成日煩躁同坐立不安
  • 係咁冇停咀講嘢
  • 周圍東奔西跑、碰觸或者玩弄視野入面任何一個或者每一個物體。
  • 好難喺上堂時間、食飯時間、做功課時間乖乖坐好。
  • 一直郁嚟郁去。
  • 唔容易進行安靜嘅活動或者工作。
  • 好無耐心
  • 脫口講出唔恰當嘅話語、毫無掩飾咁流露內心嘅諗法,同埋行事唔理後果。
  • 好難耐在遊戲中因輪流所產生嘅等待時間。
  • 成日打斷其他人對話或者活動。

若果過度活躍症患者症狀符合上述兩類,就屬於合併型嘅注意力不足過動症

ADHD嘅女性比較唔會有過動同衝動症狀,比較會有注意力唔集中同分心嘅症狀[10]。過度活躍症入面有關過動嘅症狀,可能會隨住年齡增長而漸漸消退,而轉變為青少年同成人階段嘅「內在唔安寧」[11]

注意力不足過動症嘅細路、青少年同成年比較容易有社交技巧英文social skills上嘅問題,例如社交互動、發展友誼同建立友誼。有半數嘅注意力不足過動症患者曾經受到同儕社會排斥情形,而無注意力不足過動症嘅人被社會排斥比例大約係10%至15%。患有注意力不足過動症嘅人比較唔容易處理口語同非語言訊息,比較容易喺社交互動方面有負面影響,亦比較容易喺對話入面離題、忽略到一啲社交資訊、又比較唔容易學習社交技能[12]

過度活躍症嘅細路比較容易有唔容易控制情緒嘅問題[13],佢哋嘅寫字英文handwriting能力亦比較弱[14],喺語言講嘢運動方面嘅發展都比較遲[15][16]。即使過度活躍症會造成好多不便,不過若果細路患者針對有興趣嘅主題同事物,佢哋嘅專注力持續時間會同其他細路一樣,甚至好過其他細路[17]

可能有關嘅疾病 編輯

過度活躍症患者入面,大約會有三分之二機率會伴隨其他疾病或者特徵[17]。常見嘅共病或者特徵有以下:

有一個2016年嘅系統回顧發現過度活躍症同肥胖哮喘睡眠障礙有直接關係,同乳糜瀉以及偏頭痛亦有一部分關聯[38]。不過同一年嘅另一篇系統回顧覺得過度活躍症同乳糜瀉無明確關係[39]

智力 編輯

有研究發現患有過度活躍症嘅人佢哋嘅智商(IQ)測試結果會比無過度活躍症嘅人低[40]。不過有關研究結果嘅重要性,依家依然存有爭議,因為好難區分影響係因為ADHD嘅症狀(例如分心)所造成,定係ADHD本身對於智力有影響[40]

有一份成人ADHD嘅研究指出有關ADHD患者喺智力上嘅差異,無統計上嘅意義,亦可以用其他相關疾病嚟解釋[41]

有一份最新嘅研究報告指出,智能障礙嘅患者患ADHD機率相比其他人高;而若果親屬入面有人為智能障礙者嘅話,家族入面其他成員患ADHD嘅機率(相比起親屬入面無智能障礙者)為高。根據擬和模型嘅分析,造成呢種情況嘅原因有91%可能性同基因有關[42]

治療 編輯

過度活躍症嘅治療方式包括心理治療行為治療藥物,亦有可能係用幾種方法一齊進行。治療對病症會有長期嘅改善,但係無法完全根除病症嘅影響[43]。藥物包括有興奮劑阿托莫西汀腎上腺素受體α2英文alpha-2 adrenergic receptor刺激劑,有時亦會包括抗抑鬱藥物[19][44]。若果無法專注喺長期獎勵入面嘅人,有好多正增強方式可以提升患者工作表現[45]。ADHD藥物入面嘅興奮劑亦可以提升患者嘅毅力同工作表現[46][45]

行為治療 編輯

有關行為治療喺ADHD嘅應用,有好多良好嘅實證,若果係針對學齡前,或者係症狀輕微嘅患者,一般會建議用行為治療為第一線療法[47][48]。心理療法包括有心理教育、行為治療、認知行為療法(CBT)、人際取向心理治療家庭治療英文family therapy學校介入、社交技巧訓練、行為方面嘅同儕介入、機構培訓[49]父母管理訓練[50]神經反饋訓練[51]。父母管理訓練可以改善包括反對行為以及唔合常規行為在內嘅一啲行為問題[52]。依家仲未清楚神經反饋訓練係咪有效[53]

研究有關家庭治療效果嘅高質素調查重係好少,不過有證據認為家庭治療嘅效果同社區照顧(community care)差唔多,而又好過用安慰劑[54]。有好多過度活躍症組織可以提供相關資訊,同埋協助家庭適應ADHD嘅情形[55]

有關社交技巧訓練、行為調整同藥物對病患嘅好處可能有限。要減少後續心理同精神問題(例如重度抑鬱症犯罪、學校學習失敗、物質使用疾患)嘅主要因素係同無從事偏差行為嘅人建立友誼[56]

規律嘅體能鍛煉,特別係帶氧運動,對於患有ADHD嘅細路成人嚟講一種有效嘅副加療法英文adjunct therapy,特別係配合興奮劑藥物治療時更加係咁,不過針對改善症狀,最理想嘅運動種類同強度仲未清楚[57][58][59]。長期規律有氧運動對ADHD患者嘅好處係提升行為同運動能力、提升管控功能(包括專注、抑制控制、計劃等)、較快嘅資訊處理速度記憶力亦會比較好[57][58][59]。家長同老師針對ADHD細路規律有氧運動對行為同社交-情緒上嘅改善有:全身整體機能較佳、減少ADHD症狀、自尊感較好、減少焦慮同抑鬱嘅程度、較少身體症狀、課業成績同校內行為較好,社交行為亦有所改善[57]。若果喺有使用興奮劑治療時進行運動,會增加興奮劑藥物對執行功能嘅影響[57],一般認為運動嘅短期效果係因為運動時大腦突觸多巴胺同去甲腎上腺素濃度嘅增加所造成[57]

藥物 編輯

針對過度活躍症,可以用中樞神經刺激劑(亦叫興奮劑)藥物嚟治療[60][61]Template:Update inline,對於症狀至少會有一啲效果,短期嚟講,大約有80%會有效果[62][63][61]。家長同老師反應哌甲酯比較可以改善患者症狀[63][62][64],中樞神經刺激劑亦可以減少ADHD細路意外事故嘅風險[65]。針對ADHD嘅中樞神經刺激劑藥物除咗哌甲酯之外,仲有苯丙胺甲基苯丙胺等。

針對ADHD嘅非中樞神經刺激劑藥物有好多種,包括阿托莫西汀安非他酮胍法辛英文guanfacine可樂定,呢啲可以作為主要藥物治療,或者配合中樞神經刺激劑藥物一齊用[60][66]。依家有關各種藥物之間嘅比較,仲未有足夠說服力嘅研究結果可以佐證,不過喺副作用入面似乎差唔多[67]。中樞神經刺激劑藥物比較可以提升課業表現,阿托莫西汀就無呢種效果[68]。阿托莫西汀冇咁易有成癮問題,所以若果有娛樂性藥物或者係強迫性藥物使用風險嘅人,比較建議使用阿托莫西汀[11]。有關藥物對社交行為上嘅影響,依家仲未有充足資料[67]。截至2015年6月,仲未完全確定ADHD藥物嘅長期影響[69][70]核磁共振成像研究推測長期用苯丙胺或者哌甲酯治療,會減少因為ADHD造成嘅大腦功能同結構異常[71][72][73]。2018年嘅文獻回顧發現若果考慮短期效果,哌甲酯對細路最有效,苯丙胺對成人最有效[74]

胍法辛英文guanfacine治療會依唔同國家有所唔同,英國國家健康照護專業組織英文National Institute for Health and Care Excellence(NICE)針對成人係第一線藥物,若果針對細路,只會建議喺病情嚴重時先使用,而大部份美國嘅醫學指南會建議可以針對各個年齡層使用[75][76]。針對學齡前嘅細路,一般唔建議用藥物治療[50][77]。若果治療用嘅中樞神經刺激劑劑量唔夠,可能會出現無藥效嘅情形[78],呢個尤其係成日出現喺青少年同成人身上,因為核可嘅劑量係針對學齡細路,所以有啲醫療人員會依據體重或者係依照其他因素畀藥[79][80][81]

一般嚟講,正常治療劑量嘅哌甲酯中樞神經刺激劑係安全,不過有佢嘅副作用同禁忌症[60]。若果哌甲酯畀細路同青少年使用,有研究發現呢個同一啲嚴重或者唔嚴重嘅有害副作用有關,不過證據品質仲未充份[82]。若果針對細路開呢類藥物,需要仔細監測細路服用情形[82]。若果ADHD嘅中樞神經刺激劑嚴重過量,可能會同興奮性精神病英文stimulant psychosis或者係狂躁嘅症狀[83]。若果係治療用嘅劑量,出現類似情形機會好低,只有0.1%,會喺開始用中樞神經刺激劑藥物治療後嘅前幾星期出現[83][84][85],若果用埋抗精神病藥,可以有效緩解急性苯丙胺精神病嘅症狀[83],若長期治療,需要作定期監測[86]。興奮劑嘅藥物治療需要定期停藥,評估係咪仲需要食藥、減少發育遲緩情形,同埋減低抗藥性[87][88]。若果係長期使用超過ADHD治療劑量嘅興奮劑藥物濫用,一般會同成癮以及物質依賴有關[89][90]。不過未治療嘅ADHD,會提高物質濫用以及行為規範障礙嘅風險[89]。興奮劑藥物嘅使用,可能可以降低風險,但係亦有可能無呢種效果[11][69][89]。仲未清楚懷孕時服用呢啲藥物係咪安全[91]

飲食 編輯

飲食嘅調整可能對少部份ADHD細路有幫助[92]2013年一份統合分析針對有ADHD症狀,同埋有補充遊離脂肪酸或者係減少食用有人工色素食品嘅細路一個相關研究發現,只有唔到三分之一嘅細路喺症狀上有所改善[93]。呢方面嘅助益有可能只係對有食物敏感嘅細路有幫助,亦有可能係因為呢啲細路同時亦接受緊ADHD治療[93]。呢啲發表咗嘅文獻亦表明依家已知嘅證據唔可以証實減少食用特定食物嚟治療ADHD嘅療法[93]。2014年發表嘅文獻亦發現排除飲食喺治療ADHD入面嘅成效有限[94]。另一篇2016年嘅文獻回顧指出,根據研究結果,「無麩質飲食喺未來成為ADHD嘅標準療法」機率係微乎其微[39]

2017嘅文獻回顧指出有一啲排除飲食嘅方式對於好細、唔食得藥嘅幼童同埋對藥物無反應嘅患者可能有用,不過唔鼓勵用補充遊離脂肪酸或者係減少食用有人工色素食品作為ADHD嘅正規治療方式[95] 。長期礦物質不足可能會令ADHD症狀加劇[96],亦有少數證據指出組織入面嘅含量過低同ADHD有關[97]。不過除非證實有鋅不足英文zinc deficiency嘅情形(依家多數係發展中國家先會有鋅不足情形),一般唔建議用鋅補充劑英文zinc supplementation治療[98]。不過若果鋅礦物質同苯丙胺類藥物同時使用嘅話,可以減低苯丙胺藥物嘅最細有效劑量,亦就係可以服用較少藥物而達到相同效果[99]。另外亦有證據指出Ω-3脂肪酸對於病情會有些少改善,不過唔建議取代醫學治療[100][101]

睇埋 編輯

參考 編輯

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