Use ADHD questionnaire ‘with caution’ in bipolar patients

By Sara Freeman, medwireNews Reporter

A questionnaire used to determine whether or not someone has attention-deficit hyperactivity disorder (ADHD) should be used with caution in patients with bipolar disorder, Swiss researchers suggest.

“More than 40% of the subjects who scored positively at the [Adults ADHD Self-Report Scale] ASRS-v1.1 did not suffer from ADHD”, observe Nader Perroud and colleagues, from University Hospitals of Geneva, in the Journal of Affective Disorders.

Perroud and team scrutinised the medical records of 138 patients with bipolar disorder seen at their specialised mood disorders outpatient clinic over a 3-year period. All patients completed the ASRS-v1.1 and the 63 (45.6%) patients with positive scores underwent clinical assessment. Just over half (55.1%) of those clinically assessed were diagnosed with ADHD.

In addition, ADHD was not mentioned in the medical records of 49.2% of the patients who scored positive on the ASRS-v1.1, which “highlights the crucial need for clinicians to search for symptoms of ADHD in [bipolar disorder] subjects”, say the researchers.

They note that clinicians need to look for specific symptoms to help distinguish between the two conditions, which can be tricky even for experienced psychiatrists due to overlapping symptoms.

Bipolar disorder patients with ADHD were younger at age of bipolar disorder onset than those without concomitant ADHD (20.0 vs 26.4 years). Those with both disorders also had a younger age of onset of the first depressive episode (19.7 vs 27.0 years) and more depressive episodes (8.4 vs 5.6) than patients with bipolar disorder only. There was also a higher percentage of patients with anxiety disorders if both conditions were present than if they were not (48.0 vs 25.0%).

Bipolar disorder plus ADHD patients also had more borderline personality traits (6.2 vs 3.9), a higher number of cyclothymic features (15.8 vs 10.9) and were more likely to be alcohol or substance dependent (24.0 vs 9.0%).

“Interestingly, ADHD subjects reported more childhood emotional abuse than [bipolar disorder] subjects without ADHD”, at 83% versus 69%, the researchers note.

Their findings agree with those from previous studies, which show the prevalence of ADHD in bipolar disorder patients is around 20% and that the combination of the two disorders is associated with a worse outcome.

“Our results have important implications for the clinicians and for the decision to treat a [bipolar disorder] subject with psychostimulants or other ADHD medication”, Perroud and team say.

They advise: “A specialist in ADHD should be consulted if any doubts about the existence of ADHD are raised.”

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