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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    • "However, it is acknowledged that there remains a lack of research into ADHD in females, particularly amoung adults (American Psychiatric Association, 2013). Meta-analysis examining comorbidity of ADHD and BD in adults identified rates ranging from 5% to 47% (Wingo and Ghaemi, 2007), and studies of familial co-variation indicate that the disorders co-occur at a higher rate than in the general population, suggesting a potential familial relationship between them (Larsson et al., 2013; Skirrow et al., 2012). The existence of juvenile bipolar disorder, now reconceptualised as severe mood dysregulation in DSM-5, and its overlap with ADHD has been hotly debated (Kent and Craddock, 2003; Skirrow et al., 2012). "
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    ABSTRACT: Objective: Overlapping symptoms can make the diagnostic differentiation of attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) challenging in adults using current clinical assessments. This study sought to determine if current clinical measures delineate ADHD from BD in adults, comparing relative levels of ADHD, BD and emotional lability (EL) symptoms. Methods: Sixty adult women with ADHD, BD or controls were compared on self-report and interview measures for ADHD symptoms, mania, depression, EL, and impairment. Results: ADHD interview measures and self-ratings of ADHD symptoms best discriminated between ADHD and BD. Self-report measures of EL and depression showed non-specific enhancement in both clinical groups. BD-specific items may distinguish BD from ADHD if a retrospective time-frame is adopted. Conclusions: Using measures which capture specific symptoms of ADHD and chronicity/episodicity of symptoms facilitates the delineation of ADHD from BD in adult women.
    Full-text · Article · Mar 2016 · Journal of Affective Disorders
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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.
    Full-text · Article · Oct 2015 · Journal of Psychiatric Research
    • "Several psychiatric disorders are characterized by EF deficits, including bipolar disorder (BD) and adult attention deficit/ hyperactivity disorder (ADHD), among others. These disorders usually share clinical symptoms, present high rates of comorbidity and are challenging to differentiate from one another clinically (Wingo and Ghaemi, 2007; Chang, 2010; Klassen et al., 2010). Besides these similarities, both BD (Bearden et al., 2001; Agarwal et al., 2008; Lin et al., 2011; Ibanez et al., 2012) and ADHD patients (Seidman et al., 2004; Depue et al., 2010; Ibanez et al., 2012) present abnormalities in brain regions relevant to EF tasks, such as the dorsolateral prefrontal cortex and the anterior cingulate cortex (Stuss and Benson, 1986; Fuster, 1997). "
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    ABSTRACT: Bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD) in adults share clinical symptoms. Both disorders present with executive functioning impairment. The detection of executive dysfunction usually requires the administration of an extensive neuropsychological battery. The Institute of Cognitive Neurology (INECO) Frontal Screening (IFS) is an efficient tool, which has been demonstrated to be useful for the detection of executive deficits in other diseases involving the prefrontal cortex. This study assessed the usefulness of the IFS in detecting the executive dysfunction of BD and ADHD adults, by means of a receiver-operating characteristic curve analysis and a multigroup discriminant function analysis. Twenty-four BD, 25 ADHD patients and 25 controls were assessed with a battery that included the IFS and other measures of executive functioning. Our results showed that both patient groups performed significantly lower than controls on the IFS total score. Using a 27.5 point cut-off score, the IFS showed good sensitivity and acceptable specificity to detect executive impairments in BD and ADHD patients. The IFS discriminated between controls and each patient group more reliably than other executive functions measures. Our results suggest that this tool could be a useful instrument to assess executive functions in BD and ADHD patients.
    No preview · Article · May 2014
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