Comorbid attention-deficit hyperactivity disorder (ADHD) is common in patients with bipolar disorder (BD), and is associated with more mixed states, more severe psychopathology, and more impaired family functioning, Italian researchers report.
Giulio Perugi (University of Pisa) and team also found increased levels of substance abuse in BD patients with ADHD.
"The great burden concerning the association of ADHD and BD indicates the importance of not only screening, but also further assessing ADHD in patients with BD," they comment in the Journal of Affective Disorders.
The findings come from a study of 96 outpatients (59.3% men), aged 18-65 years, with BD I or II who were evaluated over a 12-month period.
In total, 19 (19.8%) patients fulfilled current and lifetime Adult ADHD Self-report Scale criteria for ADHD, with similar rates in BD I and BD II patients, at 21.9% and 15.6%, respectively.
Compared with patients without ADHD, those with the comorbidity had a significantly higher rate of mixed states (52.6 vs 18.2%) and a lower rate of manic episodes (0.0 vs 16.9%).
Furthermore, none of the patients with ADHD were in BD remission at the time of evaluation compared with 31.2% of those without ADHD.
Consistent with these findings, patients with ADHD had significantly higher mean severity scores on the Clinical Global Impression Bipolar scale for mixed (2.4 vs 1.8), depressive (2.8 vs 2.4), and global (2.7 vs 2.2) symptoms.
In addition, patients with ADHD had higher rates of substance use disorder than those without (42.1 vs 18.2%), particularly regarding cocaine (31.5 vs 5.2%) and poly-drug (42.1 vs 13.0%) abuse.
The researchers also found that patients with ADHD had significantly poorer family adjustment scores on the Sheehan Disability Scale than those without, at 5.3 versus 4.0.
Perugi and team conclude: "Our findings suggest that ADHD symptoms in adults may influence clinical presentation, course and prognosis of BD."
They add: "Further prospective research is needed to confirm our findings and to explore treatment implications for the management of BD."
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