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4. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication
Kessler RC et al.
Am J Psychiatry. 2006 Apr;163(4):716-23.
http://ajp.psychiatryonline.org/cgi/content/full/163/4/716
OBJECTIVE: Despite growing interest in adult attention deficit
hyperactivity disorder (ADHD), little is known about its prevalence or
correlates. METHOD: A screen for adult ADHD was included in a
probability subsample (N=3,199) of 18-44-year-old respondents in the
National Comorbidity Survey Replication, a nationally representative
household survey that used a lay-administered diagnostic interview to
assess a wide range of DSM-IV disorders. Blinded clinical follow-up
interviews of adult ADHD were carried out with 154 respondents,
oversampling those with positive screen results. Multiple imputation
was used to estimate prevalence and correlates of clinician-assessed
adult ADHD. RESULTS: The estimated prevalence of current adult ADHD was
4.4%. Significant correlates included being male, previously married,
unemployed, and non-Hispanic white. Adult ADHD was highly comorbid with
many other DSM-IV disorders assessed in the survey and was associated
with substantial role impairment. The majority of cases were untreated,
although many individuals had obtained treatment for other comorbid
mental and substance-related disorders. CONCLUSIONS: Efforts are needed
to increase the detection and treatment of adult ADHD. Research is
needed to determine whether effective treatment would reduce the onset,
persistence, and severity of disorders that co-occur with adult ADHD.
PMID: 16585449
5. Continuities between emotional and disruptive behavior disorders in adolescence and personality disorders in adulthood
Helgeland MI, Kjelsberg E, Torgersen S.
Am J Psychiatry. 2005 Oct;162(10):1941-7.
http://ajp.psychiatryonline.org/cgi/content/full/162/10/1941
OBJECTIVE: The purpose of this study was to quasiprospectively
investigate continuities between emotional and disruptive behavior
disorders in adolescence and personality disorders in adulthood.
METHOD: One hundred thirty subjects (age: mean=43.2 years) who had been
diagnosed with emotional and disruptive behavior disorders during
adolescence (age: mean=14.6 years) and rediagnosed based on hospital
records, according to DSM-IV, were interviewed with the Structured
Interview for DSM-IV Personality to establish whether they suffered
from personality disorders at the 28-year follow-up. RESULTS:
Adolescents with disruptive behavior disorders were not more likely to
have personality disorders in adulthood than adolescents with emotional
disorders. Adolescents with disruptive behavior disorders were
significantly more likely to have cluster B personality disorders at
follow-up than adolescents with emotional disorders. Logistic
regression analyses revealed that disruptive behavior disorders in
females were significantly more strongly associated with a high risk of
cluster B diagnoses at follow-up than in males. Emotional disorders
were significant and independent predictors of cluster C personality
disorders in women but not in men. Disruptive behavior disorders were a
significant and independent predictor of antisocial personality
disorders in men. CONCLUSIONS: These results support the view that
personality disorders can be traced back to adolescent emotional and
disruptive behavior disorders. The moderating effect of gender in
cluster B and cluster C personality disorders suggests that
sociocultural and biological factors may contribute to different adult
outcomes in men and women with similar adolescent psychiatric disorders.
PMID: 16199842
6. Psychiatric comorbidity in adult attention deficit hyperactivity disorder: findings from multiplex families
McGough JJ et al.
Am J Psychiatry. 2005 Sep;162(9):1621-7.
http://ajp.psychiatryonline.org/cgi/content/full/162/9/1621
OBJECTIVE: Patterns of psychiatric comorbidity were assessed in adults
with and without attention deficit hyperactivity disorder (ADHD)
identified through a genetic study of families containing multiple
children with ADHD. METHOD: Lifetime ADHD and comorbid psychopathology
were assessed in 435 parents of children with ADHD. Rates and mean ages
at onset of comorbid psychopathology were compared in parents with
lifetime ADHD, parents with persistent ADHD, and those without ADHD.
Age-adjusted rates of comorbidity were compared with Kaplan-Meier
survival curves. Logistic regression was used to assess additional risk
factors for conditions more frequent in ADHD subjects. RESULTS: The
parents with ADHD were significantly more likely to be unskilled
workers and less likely to have a college degree. ADHD subjects had
more lifetime psychopathology; 87% had at least one and 56% had at
least two other psychiatric disorders, compared with 64% and 27%,
respectively, in non-ADHD subjects. ADHD was associated with greater
disruptive behavior, substance use, and mood and anxiety disorders and
with earlier onset of major depression, dysthymia, oppositional defiant
disorder, and conduct disorder. Group differences based on Kaplan-Meier
age-corrected risks were consistent with those for raw frequency
distributions. Male sex added risk for disruptive behavior disorders.
Female sex and oppositional defiant disorder contributed to risk for
depression and anxiety. ADHD was not a significant risk factor for
substance use disorders when male sex, disruptive behavior disorders,
and socioeconomic status were controlled. CONCLUSIONS: Adult ADHD is
associated with significant lifetime psychiatric comorbidity that is
not explained by clinical referral bias.
PMID: 16135620
7. The hard work of growing up with ADHD
Martin A.
Am J Psychiatry. 2005 Sep;162(9):1575-7.
http://ajp.psychiatryonline.org/cgi/content/full/162/9/1575
PMID: 16135614
8. Psychiatric and medical comorbidities of bipolar disorder
Krishnan KR.
Psychosom Med. 2005 Jan-Feb;67(1):1-8.
http://www.psychosomaticmedicine.org/cgi/content/full/67/1/1
OBJECTIVES: This review summarizes the literature on psychiatric and
medical comorbidities in bipolar disorder. The coexistence of other
Axis I disorders with bipolar disorder complicates psychiatric
diagnosis and treatment. Conversely, symptom overlap in DSM-IV
diagnoses hinders definition and recognition of true comorbidity.
Psychiatric comorbidity is often associated with earlier onset of
bipolar symptoms, more severe course, poorer treatment compliance, and
worse outcomes related to suicide and other complications. Medical
comorbidity may be exacerbated or caused by pharmacotherapy of bipolar
symptoms. METHODS: Articles were obtained by searching MEDLINE from
1970 to present with the following search words: bipolar disorder AND,
comorbidity, anxiety disorders, eating disorder, alcohol abuse,
substance abuse, ADHD, personality disorders, borderline personality
disorder, medical disorders, hypothyroidism, obesity, diabetes
mellitus, multiple sclerosis, lithium, valproate, lamotrigine,
carbamazepine, atypical antipsychotics. Articles were prioritized for
inclusion based on the following considerations: sample size, use of
standardized diagnostic criteria and validated methods of assessment,
sequencing of disorders, quality of presentation. RESULTS: Although the
literature establishes a strong association between bipolar disorder
and substance abuse, the direction of causality is uncertain. An
association is also seen with anxiety disorders,
attention-deficit/hyperactivity disorder, and eating disorders, as well
as cyclothymia and other axis II personality disorders. Medical
disorders accompany bipolar disorder at rates greater than predicted by
chance. However, it is often unclear whether a medical disorder is
truly comorbid, a consequence of treatment, or a combination of both.
CONCLUSION: To ensure prompt, appropriate intervention while avoiding iatrogenic complications,
the clinician must evaluate and monitor patients with bipolar disorder
for the presence and the development of comorbid psychiatric and
medical conditions. Conversely, physicians should have a high index of
suspicion for underlying bipolar disorder when evaluating individuals
with other psychiatric diagnoses (not just unipolar depression) that
often coexist with bipolar disorder, such as alcohol and substance
abuse or anxiety disorders. Anticonvulsants and other mood stabilizers
may be especially helpful in treating bipolar disorder with significant
comorbidity.
PMID: 15673617
9. Managing ADHD in children, adolescents, and adults with comorbid anxiety in primary care
[No authors listed]
Prim Care Companion J Clin Psychiatry. 2007;9(2):129-38.
http://www.psychiatrist.com/pcc/pccpdf/v09n02/v09n0207.pdf
PMID: 17607335
10. Comorbidity of adult attention-deficit hyperactivity disorder and bipolar disorder: prevalence and clinical correlates
Tamam L, Karakus G, Ozpoyraz N.
Eur Arch Psychiatry Clin Neurosci. 2008 Apr 24.
The aim of this study was to determine the frequency of adult attention
deficit hyperactivity disorder (ADHD) comorbidity with lifetime bipolar
disorder, and the influence of this comorbidity on various demographic
and clinical variables in patients. Patients (n = 159) with a previous
diagnosis of bipolar disorder (79 female, 80 male) were included in
this study. All patients were interviewed for the presence of current
adult and childhood ADHD diagnosis and other axis I psychiatric
disorder comorbidities using the structured clinical interview for
DSM-IV (SCID) and the Schedule for Affective Disorders and
Schizophrenia for School Age Children-Present and Lifetime Version
(K-SADS-PL). The subjects also completed a Wender Utah rating scale
(WURS-25) and a Current Symptoms Scale for ADHD symptoms. In
particular, patients' clinical characteristics, the age of onset of
bipolar disorder, and the number of episodes were noted. Twenty-six of
the 159 bipolar patients (16.3%) were diagnosed with adult ADHD, while
another subgroup of patients (n = 17, 10.7%) received a diagnosis of
childhood ADHD but did not fulfill criteria for adult ADHD. Both of
these two subgroups (patients with adult ADHD, and patients with only
childhood ADHD) had an earlier age of onset of the disease and a higher
number of previous total affective or depressive episodes than those
without any lifetime ADHD comorbidity. However only bipolar patients
with adult ADHD comorbidity had higher lifetime comorbidity rates for
axis I psychiatric disorders, such as panic disorder and alcohol
abuse/dependence, compared to patients without lifetime ADHD. Bipolar
patients with comorbid adult ADHD did not differ from bipolar patients
with comorbid childhood ADHD in terms of any demographic or clinical
variables except for adult ADHD scale scores. In conclusion, ADHD is a
common comorbidity in bipolar patients, and it adversely affects the
course of the disease and disrupts the social adjustment of the
patients. Regular monitoring of ADHD will help to prevent problems and
complications that could arise in the course of the disease,
particularly in patients with early onset bipolar disorder.
PMID: 18437277
11. Untreated ADHD in Adults: Are There Sex Differences in Symptoms, Comorbidity, and Impairment?
Rasmussen K, Levander S.
J Atten Disord. 2008 Mar 26.
Objective: To analyze sex differences among adult, never-treated
patients referred for central stimulant treatment of ADHD. Method: Data
for 600 consecutive patients from northern Norway referred for
evaluation by an expert team during 7 years were analyzed. General
background information, diagnostic and social history, and symptom
profiles were compared between previously never-treated men and women.
Results: The sex ratio was skewed. Of the previously untreated
patients, more than 20% fell outside society's ordinary vocational
activities or social benefit system. Most patients had the combined
form, one third the inattentive type, and only 2% the
hyperactive/impulsive subtype. Abuse and criminality were more common
among men, and affective, eating, and somatization disorders were more
common among women. Otherwise few sex differences were found.
Conclusion: ADHD symptom intensity and subtypes did not differ between
the sexes and was unrelated to age. Symptom intensity was linked with
criminality, abuse, and other psychiatric problems, differentially for
the two sexes.
PMID: 18367759
12. A systematic review of rates and diagnostic validity of comorbid adult
attention-deficit/hyperactivity disorder and bipolar disorder
Wingo AP, Ghaemi SN.
J Clin Psychiatry. 2007 Nov;68(11):1776-84.
OBJECTIVE: 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. DATA SOURCES: 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. STUDY SELECTION: 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. DATA EXTRACTION: 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. DATA SYNTHESIS: 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. CONCLUSIONS:
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.
PMID: 18052572
13. The complexity of ADHD: diagnosis and treatment of the adult patient with comorbidities
Newcorn JH, Weiss M, Stein MA.
CNS Spectr. 2007 Aug;12(8 Suppl 12):1-14.
Attention-deficit/hyperactivity disorder (ADHD) is an impairing but
usually treatable condition. Popular culture propagates the myth that
ADHD recedes with age; this is not the case. Although it is common,
<20% of adults with ADHD are diagnosed or treated. Adults with ADHD
show significant comorbidities with depressive disorders, anxiety
disorders, substance use, oppositional defiant disorder, personality
disorders, sleep problems, and learning disabilities. However, symptoms
that result from ADHD, such as mood symptoms or lability, are often
mistaken for comorbid disorders. Comorbidity with ADHD impacts
treatment compliance, treatment response, and patient insight.
Insufficient data on the interaction between ADHD and comorbidities
impedes proper diagnosis and treatment. Better clinical tools for
assessing these conditions are needed. Food and Drug
Administration-approved pharmacologic treatments for adult ADHD include
stimulants, dexmethylphenidate, and the nonstimulant atomoxetine.
Effect sizes of approved medicines at approved doses are half those
seen in children. Adults may also need longer duration of medication
effects than children. Short-acting stimulants are likely to result in
poorer adherence and have a higher risk for diversion or abuse. Risk of
abuse is a major concern; stimulant treatments are controlled
substances, and children with ADHD show increased risk of substance
abuse. Psychosocial interventions may be beneficial in treating both
ADHD and comorbidities.In this expert roundtable supplement, Margaret
Weiss, MD, PhD, presents a comprehensive overview of complications
surrounding differential diagnosis in adults with ADHD. Next, Mark A.
Stein, PhD, reviews evaluation, comorbidity, and development of a
treatment plan in this population. Finally, Jeffrey H. Newcorn, MD,
provides a discussion on the pharmacologic options available for adults
with ADHD, considering dosages specific to adults and common
comorbidities.
PMID: 17667893
14. Subtype differences in adults with attention-deficit/hyperactivity
disorder (ADHD) with regard to ADHD-symptoms, psychiatric comorbidity
and psychosocial adjustment
Sobanski E et al.
Eur Psychiatry. 2008 Mar;23(2):142-9.
BACKGROUND: To date, nearly all research of subtype differences in ADHD
has been performed in children and only two studies, with conflicting
results, have covered this subject in adults with ADHD. OBJECTIVE: This
study examined subtype differences in the clinical presentation of
ADHD-symptoms, related psychopathological features, psychosocial
functioning and comorbid psychiatric disorders in adults with ADHD.
METHOD: One hundred and eighteen adults with ADHD, diagnosed according
to DSM-IV criteria, and a population based control group underwent
diagnostic evaluations with clinical interviews for ADHD, DSM-IV
disorders and demographic features. Comparisons were made between ADHD
combined type (n=64), predominantly inattentive type (n=30) and
predominantly inattentive type, anamnestically combined type (n=24),
relative to each other and to a community control group (n=70).
RESULTS: The four groups did not differ in age and gender composition.
All ADHD groups had significantly less education, were significantly
more often unemployed and reported significantly more lifetime
psychiatric comorbidity than controls. In comparison to each other, the
three ADHD groups differed mainly in core symptoms and the pattern of
comorbid psychiatric disorders, whereas no prominent differences in
associated psychopathological features and most of the assessed
psychosocial functions could be found. Patients with ADHD combined type
and inattentive, anamnestically combined type both presented with
significantly more hyperactive symptoms and also showed more impulsive
symptoms than those with the predominantly inattentive type. With a
similar overall lifetime psychiatric comorbidity in the three groups,
patients with ADHD combined type and inattentive, anamnestically
combined type suffered significantly more from lifetime substance use
disorders than patients with predominantly inattentive type.
CONCLUSION: Our results clearly show impaired psychosocial adjustment
and elevated risk for additional psychiatric disorders in adults with
all subtypes of ADHD, compared to healthy controls. They provide
preliminary evidence that in adult ADHD there might be a subgroup of
patients, which is classified as predominantly inattentive subtype
according to current diagnostic criteria, but which in its clinical
presentation is in between ADHD combined and inattentive type. Further
studies are needed to evaluate this finding and to gain a clear picture
of its validity.
PMID: 18024089
15. Psychiatric comorbidity in ADHD symptom subtypes in clinic and community adults
Sprafkin J, Gadow KD, Weiss MD, Schneider J, Nolan EE.
J Atten Disord. 2007 Sep;11(2):114-24.
OBJECTIVE: To compare psychiatric comorbidity between the three symptom
subtypes of Attention-Deficit/Hyperactivity Disorder (ADHD),
Inattentive (I), Hyperactive-Impulsive (H), and Combined (C), in
adults. METHOD: A clinic sample (N = 487) and a nonreferred community
sample (N = 900) completed a DSM-IV-referenced rating scale and a
questionnaire (social, educational, occupational, and treatment
variables). Participants were assigned to one of four groups: ADHD:I,
ADHD:H, ADHD:C, and NONE. RESULTS: All three ADHD symptom groups
reported more severe comorbid symptoms than the NONE group; the ADHD:C
and NONE groups were the most and least severe, respectively; and there
were clear differences between the ADHD:I and ADHD:H groups. The
pattern of group differences was similar in both samples. CONCLUSION:
ADHD symptom subtypes in adults are associated with distinct clinical
correlates. The diversity of self-reported psychopathology in adults
who meet symptom criteria for ADHD highlights the importance of
conducting broad-based evaluations.
PMID: 17494828
16. The role of comorbid major depressive disorder in the clinical presentation of adult ADHD
Fischer AG et al.
J Psychiatr Res. 2007 Dec;41(12):991-6.
Most adults with attention-deficit/hyperactivity disorder (ADHD) are
not recognized and remain untreated, although a large fraction of these
individuals are diagnosed and treated for other comorbid mental
disorders, such as major depressive disorder (MDD). The fact that MDD
is one of the most commonly occurring mental disorders with high
comorbidity with adult ADHD raises the question whether such
comorbidity is associated with differences in the clinical picture of
ADHD. Three hundred and twenty adult ADHD outpatients were evaluated.
Diagnoses followed DSM-IV criteria. Interviews to evaluate ADHD and
oppositional defiant disorder (ODD) were performed based on the
Portuguese version of K-SADS-E. Psychiatric comorbidities were
investigated using SCID-IV and MINI. Regression models were applied to
test MDD association with clinical and demographic outcomes. Subjects
presenting ADHD and MDD had a higher frequency of generalized anxiety
disorder and social phobia and a lower frequency of substance
dependence, grade repetition and school suspensions, when compared to
subjects with ADHD without MDD. Furthermore, adults presenting ADHD and
MDD reported higher demand for psychotherapy and pharmacological
treatment prior to enrollment in the study when compared to ADHD
subjects free of MDD. However, contrary to what could be expected based
on these data, the presence of MDD was not associated with an earlier
ADHD diagnosis. These results point to the need for research and
medical education into an earlier and more efficient ADHD diagnosis in
patients who search for mental health care.
PMID: 17098256
17. ADHD in adults: a study of clinical characteristics, impairment and comorbidity
Torgersen T, Gjervan B, Rasmussen K.
Nord J Psychiatry. 2006;60(1):38-43.
In this study, we explored the clinical characteristics, impairment and
comorbidity in a sample of 45 adult patients with
attention-deficit/hyperactivity disorder (ADHD). The collection of data
is based on a naturalistic, retrospective approach using medical
records documenting a comprehensive assessment of the patients. The
sample was severely impaired in terms of academic achievement,
employment and criminality, and had very high levels of comorbidity,
especially alcohol and drug abuse, antisocial personality disorder and
depression. Despite a high degree of contact with child psychiatric
services in childhood, very few were diagnosed with ADHD, and many had
a long period of psychiatric treatment as adults before the ADHD
diagnosis was made. ADHD is in this sample of adults associated with
severe impairment and comorbidity, and the connection between
impairment and lack of proper diagnosis and treatment is discussed.
PMID: 16500798
18. Clinical and diagnostic implications of lifetime
attention-deficit/hyperactivity disorder comorbidity in adults with
bipolar disorder: data from the first 1000 STEP-BD participants
Nierenberg AA et al.
Biol Psychiatry. 2005 Jun 1;57(11):1467-73.
BACKGROUND: Systematic studies of children and adolescents with a
diagnosis of bipolar disorder show that rates of
attention-deficit/hyperactivity disorder (ADHD) range from 60% to 90%,
but the prevalence and implications of ADHD in adults with bipolar
disorder are less clear. METHODS: The first consecutive 1000 adults
with bipolar disorder enrolled in the National Institute of Mental
Health's Systematic Treatment Enhancement Program for Bipolar Disorder
(STEP-BD) were assessed for lifetime ADHD. The retrospective course of
bipolar disorder, current mood state, and prevalence of other comorbid
psychiatric diagnoses were compared for the groups with and without
lifetime comorbid ADHD. RESULTS: The overall lifetime prevalence of
comorbid ADHD in this large cohort of bipolar patients was 9.5% (95%
confidence interval 7.6%-11.4%); 14.7% of male patients and 5.8% of
female patients with bipolar disorder had lifetime ADHD. Patients with
bipolar disorder and ADHD had the onset of their mood disorder
approximately 5 years earlier. After adjusting for age of onset, those
with ADHD comorbidity had shorter periods of wellness and were more
frequently depressed. We found that patients with bipolar disorder
comorbid with ADHD had a greater number of other comorbid psychiatric
diagnoses compared with those without comorbid ADHD, with substantially
higher rates of several anxiety disorders and alcohol and substance
abuse and dependence. CONCLUSIONS: Lifetime ADHD is a frequent comorbid
condition in adults with bipolar disorder, associated with a worse
course of bipolar disorder and greater burden of other psychiatric
comorbid conditions. Studies are needed that focus on the efficacy and
safety of treating ADHD comorbid with bipolar disorder.
PMID: 15950022
19. Impact of comorbidity in adults with attention-deficit/hyperactivity disorder
Biederman J.
J Clin Psychiatry. 2004;65 Suppl 3:3-7.
Persistence of attention-deficit/hyperactivity disorder (ADHD) into
adulthood and male-to-female ratios of this disorder in childhood and
adulthood have been controversial issues in the ADHD diagnosis in
adults. Research has resolved these controversies and in turn provided
support for the validity of the diagnosis in adults. Support for the
diagnosis can also be found in data that show the lifetime prevalence
rate for comorbid conditions such as antisocial disorders, mood and
anxiety disorders, and substance abuse disorders to be consistent
across pediatric and adult populations with ADHD. These coexisting
conditions add not only to the impairment associated with ADHD in
adults but also to the disorder's economic burden, the extent of which
is currently unknown. However, adults with the disorder, like children,
probably have higher health care use and costs than people without the
disorder. Little, too, is known about the social cost of ADHD, but if
left untreated, the impact may be substantial. Research to determine
the occupational costs associated with ADHD is ongoing, but until that
and other cost-of-illness data are available, studies on the economic
costs of the comorbid conditions depression, anxiety, and substance
abuse and dependence may be used to make suppositions about the
economic impact of ADHD in adults. More studies are needed on the
outcomes of adults with this disorder, especially cost-of-illness
studies.
PMID: 15046528
20. Can adults with attention-deficit/hyperactivity disorder be
distinguished from those with comorbid bipolar disorder? Findings from
a sample of clinically referred adults
Wilens TE et al.
Biol Psychiatry. 2003 Jul 1;54(1):1-8.
BACKGROUND: Despite data describing the overlap of attention deficit
hyperactivity disorder (ADHD) and bipolar disorder (BPD) in youth,
little is known about adults with these co-occurring disorders. We now
evaluate the clinical characteristics of referred adults with (n = 24)
and without BPD (n = 27). METHODS: Referred adults to clinical trials
of ADHD were evaluated by psychiatric evaluation using DSM-IV criteria.
Structured psychiatric interviews were used to systematically assess
adult and childhood disorders. RESULTS: The vast majority of patients
with ADHD plus BPD had bipolar II disorder (88%). Adults with ADHD plus
BPD had higher rates of the combined subtype of ADHD compared to ADHD
without BPD (chi(2) = 8.7, p =.003), a greater number of DSM-IV ADHD
symptoms (14.8 +/- 2.9 and 11.4 +/- 4.0; t = -3.4, p <.01), more
attentional symptoms of ADHD (8.1 +/- 1.4 and 6.8 +/- 2.1; t = -2.5, p
<.02; trend), poorer global functioning (47 +/- 5.9 and 52 +/- 7.4,
t = 2.6, p <.02; trend), and additional comorbid psychiatric
disorders (3.7 +/- 2.5 and 2.0 +/- 1.9; t = -2.9, p <.01).
CONCLUSIONS: These results suggest that adults with ADHD plus BPD have
prototypic symptoms of both disorders, suggesting that both disorders
are present and are distinguishable clinically.
PMID: 12842302
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