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주의력결핍과잉행동장애에 동반된 틱장애의 신경생물학과 약물치료

Neurobiology and Pharmacologic Treatment of Attention Deficit Hyperactivity Disorder with Comorbid Tic Disorder

김지훈|우준범
한국정서행동장애학회 (The Korean Society of Emotional and Behavioral Disorders)|2018.06|정서·행동장애연구 (JOURNAL OF EMOTIONAL & BEHAVIORAL DISORDERS)|제34권 제2호|pp. 71-92|DOI 10.33770/JEBD.34.2.4

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주의력결핍과잉행동장애Attention Deficit Hyperactivity Disorder틱장애신경생물학약물치료.Tic DisorderNeurobiologyPharmacological Treatment.

초록

주의력결핍과잉행동장애는 소아청소년기 정신질환 중 가장 흔한 질환이며 약 70%에서 다른 정신과 질환을 동반한다. 동반질환 중 가장 흔한 질환은 틱장애로 전체 주의력결핍과잉행동장애가 있는 소아청소년의 약 60∼70%에서 틱장애를 동시에 가지고 있다. 이러한 높은 동반률은 주의력결핍과잉행동장애와 틱장애가 신경생물학적으로 유사한 양상을 가지고 있을 가능성을 시사한다. 주의력결핍과잉행동장의의 치료에 있어 약물치료는 매우 중요한 부분을 차지하며 여러 연구에서 핵심증상의 치료에 매우 효과적인 것으로 보고되고 있다. 주의력결핍과잉행동장애의 치료에 주로 사용되는 약물은 정신자극제인 메틸페니데이트 제재와 비정신자극제인 아토목세틴, 삼환계항우울제들, 그리고 알파 효현제들이다. 그러나 틱장애가 동반된 주의력결핍과잉행동장애에서 정신자극제의 사용시 약 10%에서는 틱증상을 악화시킬 수 있으므로 약물치료 시 주의가 필요하다. 따라서 본 연구에서는 주의력결핍과잉행동장애의 약물치료의 근간이 되는 신경생물학에 대해 알아보고 틱장애와 동반 시 효과적인 약물치료에 대해 논하고자 한다.

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) is the most prevalent disorder in children and adolescents, and about 70% of ADHD have other comorbid dirorders. The most common comorbid disorder of ADHD is tic disorder, and 60∼70% of ADHD have tic disorder simultaneously. Pharmacological treatment is very important in treatment of ADHD . and many researches reported that pharmacological treatment was effective to treat core symptoms of ADHD. The major drugs for treating ADHD are Methyphenidate as psychostimulant, Atomoxetine as non-stimulant, tricyclic antidepressants, and alpha agonists. However psychostimulant can make worse tic symptoms in 10% of those with case with ADHD and tic disorder simultaneously. Therefore, we discuss the neurobiology that is a basic knowledgy in the phamacological treatment of ADHD and also discuss the effective pharmacological treatment in ADHD and comorbid tic disorder.

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