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Comorbidity of adult attention-deficit hyperactivity disorder and bipolar disorder: prevalence and clinical correlates

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Abstract

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.

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References

  1. Alpert JE, Maddocks A, Nierenberg AA, O’Sullivan R, Pava JA, Worthington JJ, Biederman J, Rosenbaum JF, Fava M (1996) Attention deficit hyperactivity disorder in children among adults with major depression. Psychiatry Res 62:213–219

    Article  PubMed  CAS  Google Scholar 

  2. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (DSM-IV-TR) 4th edition, text revision, American Psychiatric Association, Washington D.C.

  3. Aycicegi A, Dinn WM, Harris CL (2003) Assessing adult attention deficit/hyperactivity disorder: a Turkish version of the current symptoms scale. Psychopathology 36:160–167

    Article  PubMed  Google Scholar 

  4. Barkley RA, Murphy KA (1998) Attention-deficit hyperactivity disorder: a clinical workbook, 2nd edn. Guilford Press, New York

    Google Scholar 

  5. Biederman J (2004) Impact of comorbidity in adults with attention deficit/hyperactivity disorder. J Clin Psychiatry 65(suppl 3):3–7

    PubMed  Google Scholar 

  6. Biederman J, Faraone SV, Keenan K, Knee D, Tsuang MT (1990) Family-genetic and psychosocial risk factors in DSM-III attention deficit disorder. J Am Acad Child Adolesc Psychiatry 29:526–533

    PubMed  CAS  Google Scholar 

  7. Biederman J, Faraone SV, Mick E, Wozniak J, Chen L, Ouellette C, Marrs A, Moore P, Garcia J, Mennin D, Lelon E (1996) Attention deficit hyperactivity disorder and juvenile mania: an overlooked comorbidity? J Am Acad Child Adolesc Psychiatry 35:997–1008

    Article  PubMed  CAS  Google Scholar 

  8. Biederman J, Faraone SV, Spencer T, Wilens T, Norman D, Lapey KA, Mick E, Lehman BK, Doyle A (1993) Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. Am J Psychiatry 150:1792–1798

    PubMed  CAS  Google Scholar 

  9. Biederman J, Mick E, Faraone SV (2000) Age-dependent decline of symptoms of attention deficit disorder: impact of remission definition and symptom type. Am J Psychiatry 157:816–818

    Article  PubMed  CAS  Google Scholar 

  10. Biederman J, Mick E, Faraone SV, Van patent S, Burback M, Wozniak J (2004) A prospective follow-up study of pediatric bipolar disorder in boys with attention-deficit/hyperactivity disorder. J Affect Disord 82S:S17–S23

    Article  Google Scholar 

  11. Faraone SV, Biederman (1997) Do attention deficit hyperactivity disorder and major depression share familial risk factors? J Nerv Ment Dis 185:533–541

    Article  PubMed  CAS  Google Scholar 

  12. Faraone SV, Biederman J, Monuteaux MC (2001) Attention deficit hyperactivity disorder with bipolar disorder in girls: further evidence for a familial subtype. J Affect Disord 64:19–26

    Article  PubMed  CAS  Google Scholar 

  13. Faraone SV, Biederman J, Wozniak J, Mundy E, Mennin D, O’Donnell D (1997) Is comorbidity with ADHD a marker for juvenile-onset mania? J Am Acad Child Adolesc Psychiatry 36:1046–1055

    PubMed  CAS  Google Scholar 

  14. First M, Spitzer R, Gibbon M, Williams JB (1997) Structured clinical interview for DSM-IV axis I disorders. American Psychiatric Press, Washington

    Google Scholar 

  15. Geller B, Williams M, Zimerman B, Frazier J, Beringer L, Warner KL (1998) Prepubertal and early adolescent bipolarity differentiate from ADHD by manic symptoms, grandiose delusions, ultra-rapid or ultradian cycling. J Affect Disord 51:81–91

    Article  PubMed  CAS  Google Scholar 

  16. Gokler B, Unal F, Pehlivanturk B, Kultur EC, Akdemir D, Taner Y (2004) Okul Çağı Çocukları İçin Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi-Şimdi ve Yaşam Boyu Şekli-Türkçe Uyarlamasının Geçerlik ve Güvenirliği. Cocuk ve Genclik Ruh Sagligi Dergisi 11:109–116

    Google Scholar 

  17. Henin A, Biederman J, Mick E, Hirshfeld-Becker DR, Sachs GS, Wu Y, Yan L, Ogutha J, Nierenberg AA (2007) Childhood antecedent disorders to bipolar disorder in adults: a controlled study. J Affect Disord 99:51–57

    Article  PubMed  Google Scholar 

  18. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N. (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988

    Article  PubMed  CAS  Google Scholar 

  19. Kent L, Craddock N (2003) Is there a relationship between attention deficit hyperactivity disorder and bipolar disorder? J Affect Disord 73:211–221

    Article  PubMed  Google Scholar 

  20. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K, Spencer T, Ustun TB, Walters EE, Zaslavsky AM (2006) The prevalence and correlates of adult ADHD in the United States: results from the national comorbidity survey replication. Am J Psychiatry 163:716–723

    Article  PubMed  Google Scholar 

  21. Kessler RC, Adler LA, Barkley R, Biederman J, Conners CK, Faraone SV, Greenhill LL, Jaeger S, Secnik K, Spencer T, Ustun TB, Zaslavsky AM (2005) Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication. Biol Psychiatry 57:1442–1451

    Article  PubMed  Google Scholar 

  22. Mancini C, Van Ameringen M, Oakman JM, Figueiredo D (1999) Childhood attention deficit/hyperactivity disorder in adults with anxiety disorders. Psychol Med 29:515–525

    Article  PubMed  CAS  Google Scholar 

  23. Mannuzza S, Klein RG, Besler A, Malloy P, LaPadula M (1998) Adult psychiatric status of hyperactive boys grown up. Am J Psychiatry 155: 493–498

    PubMed  CAS  Google Scholar 

  24. Manuzza S, Klein RG, Klein DF, Besler A, Shrout P (2002) Accuracy of adult recall of childhood attention deficit hyperactivity disorder. Am J Psychiatry 159:1882–1888

    Article  Google Scholar 

  25. Marks DJ, Newcorn JH, Halperin JM (2001) Comorbidity in adults with attention-deficit/hyperactivity disorder. Ann NY Acad Sci 931:216–238

    PubMed  CAS  Google Scholar 

  26. Masi G, Perugi G, Toni C, Millepiedi S, Mucci M, Bertini N, Pfanner C (2006) Attention-deficit hyperactivity disorder—bipolar comorbidity in children and adolescents. Bipolar Disord 8:373–381

    Article  PubMed  Google Scholar 

  27. Milberger S, Biederman J, Faraone SV, Murphy J, Tsuang MT (1995) Attention deficit hyperactivity disorder and comorbid disorders: issues of overlapping symptoms. Am J Psychiatry 152:1793–1799

    PubMed  CAS  Google Scholar 

  28. Murphy P, Schachar R (2000) Use of self-ratings in the assessment of symptoms of attention deficit hyperactivity disorder in adults. Am J Psychiatry 157:1156–1159

    Article  PubMed  CAS  Google Scholar 

  29. Nierenberg AA, Miyahara S, Spencer T, Wisniewski SR, Otto MW, Simon N, Pollack MH, Ostacher MJ, Yan L, Siegel R, Sachs G (2005) Clinical and diagnostic implications of lifetime attention-deficit/hyperactivity disorder comorbidity in adults with bipolar disorder: data from the first 1,000 STEP-BD participants. Biol Psychiatry 57:1467–1473

    Article  PubMed  Google Scholar 

  30. Oncü B, Günay Ş, Şentürk V (2005) Wender-Utah Derecelendirme Ölçeği Türkçe Formunun Erişkin Dikkat Eksikliği ve Hiperaktivite Bozukluğu’nda Geçerlik ve Güvenilirlik Çalışması. Turk Psikiyatri Derg 16:252–259

    PubMed  Google Scholar 

  31. Ozkürkcügil A, Aydemir Ö, Yıldız M, Esen Danacı A, Köroglu E (1999) DSM-IV eksen I bozuklukları için yapılandırılmış klinik görüşmenin (SCID-I) Türkçeye uyarlanması ve güvenilirlik calismasi. Ilac ve Tedavi Dergisi 12:233–236

    Google Scholar 

  32. Pliszka SR (1998) Comorbidity of attention-deficit/hyperactivity disorder with psychiatric disorder: an overview. J Clin Psychiatry 59(suppl 7):50–58

    PubMed  Google Scholar 

  33. Sachs GS, Baldassano CF, Truman CJ, Guille C (2000) Comorbidity of attention deficit hyperactivity disorder with early- and late-onset bipolar disorder. Am J Psychiatry 157:466–468

    Article  PubMed  CAS  Google Scholar 

  34. State RC, Frye MA, Altshuler LL, Strober M, DeAntonio M, Hwang S, Mintz J (2004) Chart review of the impact of attention-deficit/hyperactivity disorder comorbidity on response to lithium or divalproex sodium in adolescent mania. J Clin Psychiatry 65:1057–1063

    Article  PubMed  CAS  Google Scholar 

  35. Tamam L, Özpoyraz N (2002) Comorbidity of anxiety disorders in patients with bipolar-I disorder. Psychopathology 35:203–209

    Article  PubMed  Google Scholar 

  36. Tamam L, Tuğlu C, Karataş G, Özcan S (2006) Adult attention hyperactivity disorder in patients with bipolar I disorder in remission: preliminary study. Psychiatr Clin Neurosci 60:480–485

    Article  Google Scholar 

  37. Ward MF, Wender PH, Reimherr FW (1993) The Wender Utah rating scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry 150:885–890

    PubMed  CAS  Google Scholar 

  38. Wender PH, Wolf LE, Wasserstein WS (2001) Adults with ADHD: an overview. Ann NY Acad Sci 931:1–16

    PubMed  CAS  Google Scholar 

  39. West SA, McElroy SL, Strakowski SM, Keck PE, McConville BJ (1995) Attention deficit hyperactivity disorder in adolescent mania. Am J Psychiatry 152:271–273

    PubMed  CAS  Google Scholar 

  40. Wilens T, Biederman J, Spencer T (2002) Pharmacotherapy for ADHD in adults: a review of the literature. J Atten Disord 4:189–202

    Google Scholar 

  41. Wilens TE, Biederman J, Wozniak J, Gunawardene S, Wong J, Monuteaux M (2003) Can adults with attention-deficit/hyperactivity disorder be distinguished from those with comorbid bipolar disorder? Findings form a sample of clinically referred adults. Biol Psychiatry 54:1–8

    Article  PubMed  Google Scholar 

  42. Wilens TE, Dodson W (2004) A clinical perspective of attention-deficit/hyperactivity disorder into adulthood. J Clin Psychiatry 65:1301–1313

    PubMed  Google Scholar 

  43. Winokur G, Coryell W, Endicott J, Akiskal H (1993) Further distinction between manic-depressive illness (bipolar disorder) and primary depressive disorder (unipolar depression). Am J Psychiatry 150:1176–1181

    PubMed  CAS  Google Scholar 

  44. Wozniak J, Biederman J, Kiely K, Ablon JS, Faraone SV, Mundy E, Mennin D (1995) Mania-like symptoms suggestive of childhood-onset bipolar disorder in clinically referred children. J Am Acad Child Adolesc Psychiatry 34:867–876

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, Cukurova University Faculty of Medicine, Adana, Turkey

    Lut Tamam MD, Gonca Karakus & Nurgul Ozpoyraz

  2. Department of Psychiatry, Cukurova University Faculty of Medicine, 01330, Adana, Turkey

    Lut Tamam MD

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  1. Lut Tamam MD
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Tamam, L., Karakus, G. & Ozpoyraz, N. Comorbidity of adult attention-deficit hyperactivity disorder and bipolar disorder: prevalence and clinical correlates. Eur Arch Psychiatry Clin Neurosc 258, 385–393 (2008). https://doi.org/10.1007/s00406-008-0807-x

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  • DOI: https://doi.org/10.1007/s00406-008-0807-x

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