Die Psychopharmakotherapie der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung im Erwachsenenalter

Zusammenfassung

Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung zeichnet sich im Erwachsenenalter durch diagnostisch schwer greifbare, zum Teil abortive Symptome sowie eine Vielzahl von Komorbiditäten aus. Die Behandlung besteht neben der Berücksichtigung von Gesichtspunk ten der Sozialarbeit und der noch in den Anfängen stehenden Psychotherapie vornehmlich aus psychopharmakologischen Ansätzen. Die größte Bedeutung kommt hierbei der Behandlung mit Psychostimulanzien zu, deren Wirksamkeit nach den bisher vorliegenden Arbeiten genauso groß wie im Kindes- und Jugendalter zu sein scheint. Im Unterschied zur Behandlung bei Kindern beinhaltet das Spektrum der verwendeten Medikamente aber aufgrund der vielfältigen psychischen Begleitsymptome in höherem Ausmaß auch den Einsatz anderer Substanzklassen, v.a. von Antidepressiva. Die therapeutische Strategie sollte zum einen geleitet sein von einer symptomzentrierten Auswahl der zur Verfügung stehenden Substanzen. Zum anderen muss sie vom Prinzip einer individuell optimal zu ermittelnden Dosierung gekennzeichnet sein. Die vorliegende Übersichtsarbeit soll über die Grundprinzipien der Behandlung einen differenzierten Überblick geben unter Berücksichtigung von praktischen Gesichtspunkten der Behandlungsdurchführung.

Summary

Attention deficit-hyperactivity disorder is one of the most common child psychiatric disorders that continues in a considerable number of patients into adulthood. In adults diagnosis may be more difficult to establish because the core symptoms e.g. hyperactivity may be remitted or covered from various comorbidities that occur together with the disorder. Treatment in adults predominantely relies on pharmacotherapeutic approaches especially with psychostimulants. Empirical studies indicate that their clinical effectiveness may be as high as in children and adolescents. However due to the high prevalence of comorbidities, e.g. depression, the psychopharmacological treatment requires an extended use of other substance groups, especially antidepressants. An optimal treatment response necessitates the choice of an adequate substance, depends on the leading clinical symptoms and a procedure of an individual titration of different dosages. This article reviews the current empirical results in the pharmacological treatment of ADHD in adults and provides possible treatment strategies for clinical practice.

Schlüsselwörter

Aufmerksamkeitsdefizit-Hyperaktivitätsstörung - Erwachsene - Komorbiditäten - Psychostimulanzien - Antidepressiva

Keywords

Attention deficit-hyperactivity disorder - adults - comorbidities - psychostimulants - antidepressants

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