A Systematic Review of Rates and Diagnostic Validity of Comorbid Adult Attention-Deficit/Hyperactivity Disorder and Bipolar Disorder

Bipolar Disorder Research Program, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Ga. 30322, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 12/2007; 68(11):1776-84. DOI: 10.4088/JCP.v68n1118
Source: PubMed


Adult attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized and reported to frequently coexist with bipolar disorder. Concurrent diagnosis of adult ADHD and bipolar disorder remains controversial. In this study, we conducted a systematic review to examine the rates and diagnostic validity of the concept of comorbid adult ADHD and bipolar disorder.
MEDLINE, Embase, PsycInfo, and Cochrane databases were searched for articles published before March 30, 2007, using the keywords manic, bipolar, attention deficit hyperactivity, and adult. The computer search was supplemented with bibliographic cross-referencing.
Exclusion criteria were studies with only pediatric subjects, childhood ADHD only but not adult ADHD, and either bipolar disorder or ADHD only, but not both; review articles, case reports; letters to the editor; and book chapters. Of the 262 citations found, 12 studies met our inclusion criteria.
Specific diagnostic validating criteria examined were phenomenology, course of illness, heredity, biological markers, and treatment response. There were 6 studies on comorbid rates, 4 on phenomenology, 3 on course of illness, 2 on heredity, none on biological markers, and 1 on treatment response.
The proposed comorbid syndrome is fairly common (present in up to 47% of adult ADHD and 21% of bipolar disorder populations), with a more severe course of illness compared with that of bipolar disorder alone, and high rates of comorbidity with other psychiatric disorders. Its treatment appears to require initial mood stabilization.
Comorbid adult ADHD and bipolar disorder has been insufficiently studied, with more emphasis on comorbidity rates and few data on course, neurobiology, heredity, and treatment. The diagnostic validity of adult ADHD/ bipolar disorder as a true comorbidity is not well-established on the basis of this equivocal and insufficient literature. More studies are greatly needed to further clarify its diagnostic validity and treatment approach.

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    • "We are not certain of how clinicians determine ADHD and BP diagnoses, so some overlap between them is possible. Because ADHD and BD may have comparable neurocognitive profiles and risk genes (Frias et al., 2014b; Lotan et al., 2014), related research has increasingly emphasized the cooccurrence of these two psychiatric disorders (Galanter and Leibenluft, 2008; Kent and Craddock, 2003; Masi et al., 2006b; Pataki and Carlson, 2013; Skirrow et al., 2012; Wingo and Ghaemi, 2007). "
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    ABSTRACT: Controls: 0.4%; aHR: 7.85, 95% CI: 7.09-8.70), and had a younger mean age at the time of first diagnosis (ADHD: 12.0 years vs. Controls: 18.8 years). Compared to ADHD patients that had never taken methylphenidate, patients with long-term use of methylphenidate were less likely to be diagnosed with BD (aOR: 0.72, 95% CI: 0.65-0.80). However, the duration of exposure to atomoxetine did not have a significant relationship to a BD diagnosis. The results suggested that a previous diagnosis of ADHD was a powerful indicator of BD, particularly juvenile-onset BD. Nevertheless, the exact mechanisms of the relationships among ADHD, its pharmacotherapy, and BD require further clarification in the future.
    Journal of Psychiatric Research 10/2015; 72:6-14. DOI:10.1016/j.jpsychires.2015.10.014 · 3.96 Impact Factor
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    • "Instead, externalizing disorders with hypomania spectrum might predict subsequent cluster B personality disorders and other affective disorders, but not necessarily bipolar disorders [32,37,60,61]. Although hypomania spectrum and externalizing disorders coexist in adults [31,43,59,62], this seems to be considerably less common than in children and adolescents [20,21]. "
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    ABSTRACT: We investigated whether adolescents with hypomania spectrum episodes have an excess risk of mental and physical morbidity in adulthood, as compared with adolescents exclusively reporting major depressive disorder (MDD) and controls without a history of adolescent mood disorders. A community sample of adolescents (N = 2 300) in the town of Uppsala, Sweden, was screened for depressive symptoms. Both participants with positive screening and matched controls (in total 631) were diagnostically interviewed. Ninety participants reported hypomania spectrum episodes (40 full-syndromal, 18 with brief episode, and 32 subsyndromal), while another 197 fulfilled the criteria for MDD without a history of a hypomania spectrum episode. A follow up after 15 years included a blinded diagnostic interview, a self-assessment of personality disorders, and national register data on prescription drugs and health services use. The participation rate at the follow-up interview was 71 % (64/90) for the hypomania spectrum group, and 65.9 % (130/197) for the MDD group. Multiple imputation was used to handle missing data. The outcomes of the hypomania spectrum group and the MDD group were similar regarding subsequent non-mood Axis I disorders in adulthood (present in 53 vs. 57 %). A personality disorder was reported by 29 % of the hypomania spectrum group and by 20 % of the MDD group, but a statistically significant difference was reached only for obsessive-compulsive personality disorder (24 vs. 14 %). In both groups, the risk of Axis I disorders and personality disorders in adulthood correlated with continuation of mood disorder. Prescription drugs and health service use in adulthood was similar in the two groups. Compared with adolescents without mood disorders, both groups had a higher subsequent risk of psychiatric morbidity, used more mental health care, and received more psychotropic drugs. Although adolescents with hypomania spectrum episodes and adolescents with MDD do not differ substantially in health outcomes, both groups are at increased risk for subsequent mental health problems. Thus, it is important to identify and treat children and adolescents with mood disorders, and carefully follow the continuing course.
    BMC Psychiatry 01/2014; 14(1):9. DOI:10.1186/1471-244X-14-9 · 2.21 Impact Factor
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    • "Garrulousness, restlessness, loss of sustained attention, and inappropriate social behavior can be seen in both BPD and ADHD populations; however, in individuals diagnosed with BPD, these symptoms tend to be more episodic than chronic [5]. Wingo and Ghaemi conducted a literature review on the commonality of those diagnosed with both BPD and ADHD. "
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    ABSTRACT: The present study investigated whether premorbid psychopathological and cognitive impairment symptoms could be retrospectively identified during the childhood and adolescence of those later diagnosed with bipolar disorder (BPD). The present sample consisted of 30 adults diagnosed with BPD, 30 of their significant-others, a group-matched control group of 30 adults (without any reported psychological or cognitive disorders), and 30 of their significant-others. The adults diagnosed with BPD and the control group completed a self-report form of the retrospective version of the Coolidge Personality and Neuropsychological Inventory (CPNI-R) as they were before the age of 16 years. The significant-others reported on the adults diagnosed with BPD or upon their controls. Initial two-factor analyses of variance revealed that on a comprehensive measure of psychopathology and of cognitive impairment, those diagnosed with BPD scored significantly higher than the control group on the self-report and the significant-other forms, with large effects sizes. Overall, the overarching research hypothesis was confirmed: adults diagnosed with BPD and their significant-others could report salient prodromes during their childhood or adolescence.
    Comprehensive psychiatry 12/2013; 55(3). DOI:10.1016/j.comppsych.2013.11.014 · 2.25 Impact Factor
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