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Themenschwerpunkt/Theme Articles

Pharmakotherapie der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Erwachsenenalter

Allgemeine Grundlagen, Epidemiologie, Psychopathologie, Klassifikation, Verlauf, Neurobiologie und soziale Adaptation

Published Online:September 01, 2006https://doi.org/10.1024/1661-4747.54.2.99

Abstract

Zusammenfassung: Auch bei der ADHS im Erwachsenenalter sind - wie bei Kindern und Jugendlichen - die Stimulanzien Methylphenidat und Amphetamine unbestritten die Mittel erster Wahl. Mittlerweile belegen mehrere kontrollierte Studien die klinische Erfahrung hoher Responderraten, zuverlässiger Wirksamkeit und guter Verträglichkeit. Deshalb ist zu erwarten, dass die heutige, in vielen Ländern bei Erwachsenen noch notwendige Off-Label-Verordnung bald der Vergangenheit angehören wird. Ebenso ist aufgrund der neueren retardierten Präparate ein Wandel in der Verordnungspraxis abzusehen mit günstigen Auswirkungen auf Compliance und Befinden der Betroffenen. Von weit reichender Bedeutung ist die positive Wirkung der Stimulanzientherapie auf das Fahrverhalten im Straßenverkehr, welche bisher in Fachkreisen und in der Öffentlichkeit zu wenig Beachtung erfuhr. Neben den Stimulanzien erreichen aber auch andere Substanzen, wie zum Beispiel Mittel mit noradrenergem Angriffspunkt, zunehmend mehr Bedeutung in der ADHS-Therapie. Ihre wesentlichen Vorteile sind darin zu sehen, dass sie kein Abhängigkeitspotenzial aufweisen und komorbide affektive Störungen bessern, der Nachteil ist jedoch ihre gegenüber Stimulanzien initial geringer ausgeprägte Wirkung. Trotzdem stellen sie wichtige therapeutische Alternativen dar. Die Pharmakotherapie sollte stets eine ausführliche Aufklärung des Patienten über Nutzen und Gefahren der Behandlung beinhalten, ebenso wie psychische und somatische Begleiterkrankungen oder Komedikationen zu berücksichtigen sind. Bedeutsam ist außerdem die psychotherapeutische Unterstützung, um die Erfolge der Pharmakotherapie durch eine Veränderung im Denken, Fühlen und Verhalten zu untermauern.


Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder (ADHD) in Adults

Abstract: Stimulants like methylphenidate and amphetamines are drugs of first choice in the treatment of adult ADHD and effect sizes are comparable to those in children and adolescents. In the meantime a number of controlled studies offer clear evidence of high response rates, reliable efficacy and satisfactory tolerance. Therefore off-label-prescription for adult ADHD, which is still a necessity today, is expected to be replaced by drug administration approvals in the near future. In the same way there will be a change in clinical prescription habits towards the use of newly developed retarded formulations of stimulants, which will improve compliance and outcome in ADHD-patients. In addition stimulant therapy of ADHD exerts positive effects on driving performance, which has been neglected until recently by specialists and the public. Besides stimulants other substances like noradrenergic reuptake inhibitors become more important in the treatment of adult ADHD. Their major advantages are the lack of abuse potential and positive effects on affective disorders, yet their initial efficacy in treating ADHD symptoms has shown to be less than that of stimulants. However, they are important as an alternative treatment. Pharmacotherapy of ADHD should be initiated only after extensive information of the patient concerning benefits and risks of the treatment. Psychiatric and somatic comorbidity just as well as comedication has to be considered and evaluated. Adjuvant psychotherapy is of major importance to reinforce the effects of pharmacological treatment on cognition, emotions and behaviour.

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