Recognizing ADHD in Adults with Comorbid Mood Disorders: Implications for Identification and Management

Adult Attention Deficit Disorder Center of Maryland, Johns Hopkins at Green Spring Station, Lutherville, MD, USA.
Postgraduate Medicine (Impact Factor: 1.7). 09/2009; 121(5):20-30. DOI: 10.3810/pgm.2009.09.2049
Source: PubMed


The objective of this study was to assist those in psychiatric clinical practice in the identification and management of attention-deficit/hyperactivity disorder (ADHD) in adults, with an emphasis on ADHD in the presence of comorbid mood disorders in adults. PubMed was searched to identify relevant studies and critical reviews published in English between 1988 and 2008 on the prevalence, persistence, and consequences of ADHD in adults. Additionally, relevant studies and critical reviews pertaining to the treatment of adults with ADHD and the relationships between ADHD and mood disorders with regard to overlapping symptom profiles, comorbidity, and treatment options were identified. The symptoms of ADHD persist into adulthood for a high proportion of children with this disorder. Among adults, the estimated prevalence of clinician-assessed ADHD in the general population is 4% to 5%. Untreated ADHD can adversely affect school and work achievements, diminish self-esteem, damage interpersonal relationships, and significantly reduce quality of life for adults. A significant proportion of adults with mood disorders have comorbid ADHD, and a significant proportion of adults with ADHD have comorbid mood disorders. Few reports have described the outcome of treatment of individuals with ADHD and concurrent mood disorders and no controlled trials were identified. Attention-deficit/hyperactivity disorder in adults can be identified despite resembling, or coexisting with, other psychiatric disorders. The complexities of comorbid psychiatric conditions require careful diagnostic prioritization when developing a comprehensive sequential treatment plan. The current research literature offers little clinical guidance for constructing treatment algorithms.

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    • "Although it is mostly associated with childhood, the symptoms may persist, with certain modifications and BioMed Research International alternative expressions, into adult life, this being the case in up to 40% of cases [3] [4] [5]. Current prevalence rates for ADHD are in the range of 4-5% for adults and 6–9% for children [6] [7]. Studies have also shown that around 80% of individuals with ADHD present a comorbid psychiatric disorder [8]. "
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    ABSTRACT: Objectives . (1) To assess the current presence of ADHD symptoms among patients seeking treatment for gambling disorder; (2) to explore clinical and sociodemographic differences between patients who score high and low on the measure of ADHD symptoms; (3) to analyze whether the presence of ADHD symptoms is associated with more severe psychopathology and with specific personality traits; (4) to analyze the mediating role of ADHD symptoms in the relationship between novelty seeking and gambling severity. Method . A total of 354 consecutive patients were administered an extensive battery assessing gambling behavior, psychopathology, and personality traits. Results . Male and female gamblers did not differ significantly in their mean scores on the ADHD measure. However, younger participants aged 18–35 scored higher. Higher ADHD scores were also associated with greater severity of gambling disorder and more general psychopathology. Regarding personality traits, high persistence and self-directedness were negatively related to ADHD scores, while in women alone a positive correlation was found between ADHD scores and scores on harm avoidance and self-transcendence. Conclusion . The presence of ADHD symptoms in both male and female gambling disorder patients may act as an indicator of the severity of gambling, general psychopathology, and dysfunctional personality traits.
    BioMed Research International 06/2015; Volume 2015(Article ID 965303):11. DOI:10.1155/2015/965303 · 1.58 Impact Factor
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    • "ADHD is one of the most common disorders of childhood with a cumulative incidence of 7.5% by 19 years of age (Barbaresi et al., 2004). Furthermore, 30% to 65% of children with ADHD keep their symptoms into adulthood (Faraone, Biederman, & Mick, 2006), which is reflected in a 4% to 5% prevalence rate of adult ADHD in the population worldwide (Goodman & Thase, 2009). The primary symptoms of adult ADHD still include inattentiveness , impulsivity, and hyperactivity, although symptoms of hyperactivity diminish with increasing age (Barkley, 2002). "
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    ABSTRACT: Neurofeedback has been applied effectively in various areas, especially in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). This study protocol is designed to investigate the effect of slow cortical potential (SCP) feedback and a new form of neurofeedback using near-infrared spectroscopy (NIRS) on symptomatology and neurophysiological parameters in an adult ADHD population. A comparison of SCP and NIRS feedback therapy methods has not been previously conducted and may yield valuable findings about alternative treatments for adult ADHD. The outcome of both neurofeedback techniques will be assessed over 30 treatment sessions and after a 6-month follow-up period, and then will be compared to a nonspecific biofeedback treatment. Furthermore, to investigate if treatment effects in this proof-of-principle study can be predicted by specific neurophysiological baseline parameters, regression models will be applied. Finally, a comparison with healthy controls will be conducted to evaluate deviant pretraining neurophysiological parameters, stability of assessment measures, and treatment outcome. To date, an investigation and comparison of SCP and NIRS feedback training to an active control has not been conducted; therefore, we hope to gain valuable insights in effects and differences of these types of treatment for ADHD in adults. This study is registered with the German Registry of Clinical Trials: DRKS00006767 , date of registration: 8 October 2014.
    Trials 04/2015; 16(1):174. DOI:10.1186/s13063-015-0683-4 · 1.73 Impact Factor
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    • "For the above-mentioned reasons, studies of major depression may contain variable proportions of patients with atypical depression and bipolar II. Other confounding factors are comorbidity with ADHD, as ADHD may be common in individuals with major depression (Goodman and Thase, 2009), that atypical depression may be common in ADHD (Asherson, 2005), and that lifetime ADHD is a frequent comorbid condition in adults with bipolar disorder (Nierenberg et al., 2005). Among patients with ADHD plus bipolar disorder in one study, 88% had bipolar II (Wilens et al., 2003). "
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    ABSTRACT: For many years, a deficiency of monoamines including serotonin has been the prevailing hypothesis on depression, yet research has failed to confirm consistent relations between brain serotonin and depression. High degrees of overlapping comorbidities and common drug efficacies suggest that depression is one of a family of related conditions sometimes referred to as the "affective spectrum disorders", and variably including migraine, irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia and generalized anxiety disorder, among many others. Herein, we present data from many different experimental modalities that strongly suggest components of mitochondrial dysfunction and inflammation in the pathogenesis of depression and other affective spectrum disorders. The three concepts of monoamines, energy metabolism and inflammatory pathways are inter-related in many complex manners. For example, the major categories of drugs used to treat depression have been demonstrated to exert effects on mitochondria and inflammation, as well as on monoamines. Furthermore, commonly-used mitochondrial-targeted treatments exert effects on mitochondria and inflammation, and are increasingly being shown to demonstrate efficacy in the affective spectrum disorders. We propose that interactions among monoamines, mitochondrial dysfunction and inflammation can inspire explanatory, rather than mere descriptive, models of these disorders.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 04/2011; 35(3):730-43. DOI:10.1016/j.pnpbp.2010.07.030 · 3.69 Impact Factor
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