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Mishra VC, Solanki G, Singh D, Goyal MK. Prevalence and clinical correlates of co-morbid attention deficit hyperactivity disorder in euthymic adults with bipolar disorder: A cross-sectional study. Indian J Psychiatry 2023; 65:1129-1136. [PMID: 38249150 PMCID: PMC10795658 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_647_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 01/23/2024] Open
Abstract
Background Bipolar disorders (BDs) are co-morbid with attention deficit hyperactivity disorder (ADHD), making diagnosis and management more difficult and associated with poorer outcomes. So, this study was planned to find the prevalence and clinical implication of co-morbid ADHD in BD. Materials and Methods In this cross-sectional study, a total of 110 euthymic BD patients were taken. They were screened for childhood ADHD symptoms and adult ADHD symptoms using the Wender Utah Rating Scale for ADHD and Adult ADHD Self-Report Screening Scale for DSM-5. Those were divided into three groups: Group A included BD patients without ADHD, Group B included bipolar patients with co-morbid adult ADHD (BD-aADHD), and Group C included bipolar patients who had a diagnosis of childhood ADHD (BD-cADHD). Results The ADHD prevalence of 27% was found in bipolar patients. The age of onset of an episode of BD was significantly earlier and the total duration of illness was significantly higher in BD-aADHD and BD-cADHD compared to the BD without ADHD. The BD-aADHD and BD-cADHD groups showed a significantly higher number of total, manic and major depressive episodes as compared to the BD without ADHD group. BD-aADHD showed a significant greater number of hypomanic episodes as compared to BD without ADHD. Conclusions The present study concludes that ADHD is a lifetime co-morbid condition in adults with BD. These patients have a more chronic and disabling course of BD which underscores the need to understand the potential benefit of controlling ADHD symptoms in this population.
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Affiliation(s)
- Vikash C. Mishra
- Department of Psychiatry, Katihar Medical College, Katihar, Bihar, India
| | - Gunjan Solanki
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India
| | - Dharmdeep Singh
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India
| | - Manish K. Goyal
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India
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Sandstrom A, Perroud N, Alda M, Uher R, Pavlova B. Prevalence of attention-deficit/hyperactivity disorder in people with mood disorders: A systematic review and meta-analysis. Acta Psychiatr Scand 2021; 143:380-391. [PMID: 33528847 DOI: 10.1111/acps.13283] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/13/2021] [Accepted: 01/21/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) in mood disorders is associated with unfavorable outcomes, including more frequent mood episodes, and increased risk of suicide. The reported prevalence of ADHD in individuals with mood disorders varies widely. METHODS We searched PsycInfo and PubMed for articles published before September 21st , 2020, using search terms for ADHD and mood disorders. We included original data on the prevalence of ADHD in individuals with bipolar disorder (BD) or major depressive disorder (MDD). We estimated the prevalence of ADHD, by developmental period and disorder using random-effects meta-analyses. We also compared the rate of ADHD in people with MDD and BD, and with and without mood disorders. RESULTS Based on 92 studies including 17089 individuals, prevalence of ADHD in BD is 73% (95% CI 66-79) in childhood, 43% (95% CI 35-50) in adolescence, and 17% (95% CI 14-20) in adulthood. Data from 52 studies with 16897 individuals indicated that prevalence of ADHD in MDD is 28% (95% CI 19-39) in childhood, 17% (95% CI 12-24) in adolescence, and 7% (95% CI 4-11) in adulthood. ADHD was three times more common in people with mood disorders compared to those without and 1.7 times more common in BD compared to MDD. CONCLUSION People with mood disorders are at a significant risk for ADHD. ADHD should be assessed and treated in individuals with BD and MDD. Comprehensive assessment strategies are needed to address challenges of diagnosing ADHD alongside mood disorders.
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Affiliation(s)
- Andrea Sandstrom
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Nader Perroud
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
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Mucci F, Avella MT, Marazziti D. ADHD with Comorbid Bipolar Disorders: A Systematic Review of Neurobiological, Clinical and Pharmacological Aspects Across the Lifespan. Curr Med Chem 2020; 26:6942-6969. [PMID: 31385763 DOI: 10.2174/0929867326666190805153610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/05/2018] [Accepted: 11/15/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Attention deficit hyperactivity (ADHD) disorder is a neurodevelopmental disorder characterized by inattention, hyperactivity, disruptive behaviour, and impulsivity. Despite considered typical of children for a long time, the persistence of ADHD symptoms in adulthood gained increasing interest during the last decades. Indeed, its diagnosis, albeit controversial, is rarely carried out even because ADHD is often comorbid with several other psychiatric diosrders, in particular with bipolar disorders (BDs), a condition that complicates the clinical picture, assessment and treatment. AIMS The aim of this paper was to systematically review the scientific literature on the neurobiological, clinical features and current pharmacological management of ADHD comorbid with BDs across the entire lifespan, with a major focus on the adulthood. DISCUSSION The pharmacology of ADHD-BD in adults is still empirical and influenced by the individual experience of the clinicians. Stimulants are endowed of a prompt efficacy and safety, whilst non-stimulants are useful when a substance abuse history is detected, although they require some weeks in order to be fully effective. In any case, an in-depth diagnostic and clinical evaluation of the single individual is mandatory. CONCLUSION The comorbidity of ADHD with BD is still a controversial matter, as it is the notion of adult ADHD as a distinct nosological category. Indeed, some findings highlighted the presence of common neurobiological mechanisms and overlapping clinical features, although disagreement does exist. In any case, while expecting to disentangle this crucial question, a correct management of this comorbidity is essential, which requires the co-administration of mood stabilizers. Further controlled clinical studies in large samples of adult ADHD-BD patients appear extremely urgent in order to better define possible therapeutic guidelines, as well as alternative approaches for this potentially invalidating condition.
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Affiliation(s)
- Federico Mucci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Fondazione BRF, Istituto per la Ricerca Scientifica in Psichiatria e Neuroscienze, Lucca, Italy
| | - Maria Teresa Avella
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Fondazione BRF, Istituto per la Ricerca Scientifica in Psichiatria e Neuroscienze, Lucca, Italy
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Mardomingo Sanz MJ, Sancho Mateo C, Soler López B, Alcindor Huelva P, Artiles Pérez L, Bastardas Sardan J, Blanco Barca O, Casal Pena C, Casas Rivero J, de Burgos Marín R, de Santos Moreno T, Durán Forteza O, Fernández Jaén A, Filippidis Semino I, Fraguas Herráez D, García Sánchez FJ, García Téllez JM, Gómez Sánchez JA, Gómez Vicente B, Hernández Martínez M, Huertas Patón A, Joga Elvira ML, Lara Cabeza FJ, Luna Ibáñez MJ, Madruga Garrido M, Málaga Dieguez I, Matos Spohring C, Mayoral Moyano S, Mazaira Castro JA, Migliorelli Toppi RA, Montoliu Tamarit L, Muro Romero JJ, Ortega García E, Ortiz de Zárate Aguirresarube C, Pablos Sánchez T, Pavón Puey A, Payá Gonzaléz B, Peláez JC, Pérez Eguiagaray I, Piñeiro Dieguez B, Rodríguez Arrebola E, Rodríguez Sacristán Cascajo A, Romero Escobar H, Royo Moya J, Ruiz Lozano MJ, Salmerón Ruiz MA, Sánchez García del Castillo C, Sole Montserrat JM, Vacas Moreira R, Valverde Gómez M. Assessment of comorbidity and social anxiety in adolescents with attention deficit hyperactivity disorder: The SELFIE study. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Banerjee N, Liu SK, Sinha VK, Jayaswal M, Desarkar P. Attention Deficits in a Comorbidity-Free Sample of Euthymic Pediatric Bipolar Disorder. Front Psychiatry 2019; 10:148. [PMID: 30949082 PMCID: PMC6437072 DOI: 10.3389/fpsyt.2019.00148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 02/27/2019] [Indexed: 01/03/2023] Open
Abstract
Attention deficits are considered one of the potential endophenotypic markers of Bipolar Disorder (BD). Pediatric bipolar disorder (PBD) likely has stronger genetic underpinnings than adult onset BD; therefore, demonstrating attention deficits in PBD can be both strategic and convincing in attesting their status as one of the potential endophenotypic markers of BD. However, unlike adult literature, uncertainty exists regarding the magnitude of attention deficits in PBD. In this regard, one key unresolved question is the potential impact of attention deficit hyperactivity disorder (ADHD). The main goal of the study was to examine attention deficits in a comorbidity-free sample of euthymic PBD patients. Thirty (21 boys, 9 girls) remitted PBD patients without co-morbidity and thirty age (<17 years), sex, handedness, and Full-Scale IQ matched control subjects were compared on performance on attention tasks. Working memory (WM), which might potentially confound with the attention task performances, was also examined. Compared to controls, PBD patients performed poorly on various tests of attention, but not on any WM tasks. Further, it was found that observed attention deficits were independent of residual mood symptoms, medication effect or illness characteristics. Such attention deficits in this comorbidity-free PBD sample further endorses its status as an endophenotypic marker of bipolar disorders and establishes continuity with deficits found in adult bipolar patients.
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Affiliation(s)
| | - Shi-Kai Liu
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Meera Jayaswal
- Department of Psychology, Ranchi University, Ranchi, India
| | - Pushpal Desarkar
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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6
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Mardomingo Sanz MJ, Sancho Mateo C, Soler López B. [Assessment of comorbidity and social anxiety in adolescents with attention deficit hyperactivity disorder: the SELFIE study]. An Pediatr (Barc) 2018; 90:349-361. [PMID: 30463795 DOI: 10.1016/j.anpedi.2018.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Attention-deficit/hyperactivity disorder (ADHD) and its comorbidities have an impact on the social anxiety of children and adolescents, but there are practically no studies addressing this topic in adolescence. Our objective was to assess the degree of social anxiety and to analyse the presence of psychiatric comorbidities (PSCs) in adolescents with ADHD. METHODOLOGY We conducted a cross-sectional observational study in patients aged 12 to 18 years with a confirmed diagnosis of ADHD (DSM-5). We collected data on the presence and type of PSCs and assessed social anxiety by means of the Social Anxiety Scale for Adolescents (SAS-A). RESULTS Forty-six child and adolescent psychiatrists and paediatric neurologists participated in the study and recruited 234 patients. Of the total patients, 68.8% (159) were male and 31.2% (72) female, with a mean age in the sample of 14.9 years (95% CI, 14.6-15.1). The type of ADHD was combined type (C) in 51.7% (121), predominantly inattentive (PI) in 37.2% (87), and predominantly hyperactive-impulsive (PH) in 9% (21). Of all patients, 97.9% (229) received pharmacological therapy: 78.6% (184) methylphenidate, 15% (35) lisdexamfetamine and 4.3% (10) atomoxetine.We found PSCs in 50.4% of the patients (118), of which the most frequent were learning and communication disorders (20.1%, n=47) and anxiety disorders (19.2%, n=45). The patients scored significantly higher in the SAS-A compared to reference values in the healthy population. The scores in the SAS-A were less favourable in adolescents with the PI type compared to those with the PH type (P=.015). The presence of a comorbid anxiety disorder was associated with worst scores in SAS-A (P<.001) showing an increased social anxiety. CONCLUSION Adolescents with ADHD classified as PI and those with comorbid anxiety had a higher degree of social anxiety as measured by the SAS-A. This psychological aspect must be identified and controlled in adolescents with ADHD to promote their social adaptation.
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Affiliation(s)
- María Jesús Mardomingo Sanz
- Sección de Psiquiatría y Psicología Infantil, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España
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Azeredo A, Moreira D, Barbosa F. ADHD, CD, and ODD: Systematic review of genetic and environmental risk factors. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 82:10-19. [PMID: 29361339 DOI: 10.1016/j.ridd.2017.12.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 06/07/2023]
Abstract
This review aims to analyze the relationships between Attention-Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD), particularly regarding the relative importance of genetic and environmental factors in the development of these disorders. Studies that examined at least two of these disorders were obtained from multiple databases, following the procedures of the Cochrane Collaboration initiative. Of the 279 documents obtained, nine were retained for in-depth analysis and were considered eligible for inclusion. In addition, eight studies from the manual search were included. The objectives, methodological aspects (sample and instruments), and the main conclusions were extracted from each study. Overall, the results suggest that (a) the causes for the onset and maintenance of these disorders are more associated with genetic factors than environmental factors, although the importance of the latter is recognized, and (b) children with ADHD have a predisposition to manifest behaviors that are common to ODD and CD, including the antisocial behavior that these children often display.
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Affiliation(s)
| | - Diana Moreira
- Maia University Institute, Portugal; University of Porto, Portugal; Portucalense Institute of Neuropsychology and Cognitive and Behavioral Neurosciences, Portugal.
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8
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Jhanda S, Malhotra S, Grover S. Relationship between bipolar disorder and attention deficit hyperkinetic disorder: An exploratory study. Asian J Psychiatr 2018; 35:101-108. [PMID: 29859501 DOI: 10.1016/j.ajp.2018.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/29/2018] [Accepted: 05/13/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study aimed to evaluate the impact of comorbid attention deficit hyperkinetic disorder (ADHD) on Bipolar disorder (BD). METHODS Patients aged 13-40 years with diagnosis of BD with ADHD (N = 30) were compared to those with BD without ADHD (N = 69) for clinical course, functional outcome and quality of life. RESULTS Those with BD + ADHD had significantly lower age of onset of BD (p < 0.001), a significantly higher number of total lifetime episodes (p = 0.002), higher number of lifetime manic episodes (p = 0.008), higher number of hospitalizations (p = 0.004) and higher prevalence of family history of BD as compared to those with BD without ADHD (p = 0.043). BD + ADHD group had poor response to conventional mood stabilizers and significantly higher prescriptions of atypical antipsychotics (p = 0.001) and higher rates of antidepressant-induced switch. Also, BD + ADHD group had significantly lower level of functioning in personal, occupational and social domains and reduced quality of life. In the BD + ADHD group, 40% patients had persistence of ADHD into adulthood. Comorbid current ADHD had more negative impact on the course and outcome of BD, when compared with those with ADHD in the past. CONCLUSIONS Comorbid ADHD has negative impact on the course and outcome of BD.
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Affiliation(s)
- Soumya Jhanda
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Savita Malhotra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Piñeiro-Dieguez B, Balanzá-Martínez V, García-García P, Soler-López B. Psychiatric Comorbidity at the Time of Diagnosis in Adults With ADHD: The CAT Study. J Atten Disord 2016; 20:1066-1075. [PMID: 24464326 DOI: 10.1177/1087054713518240] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The CAT (Comorbilidad en Adultos con TDAH) study aimed to quantify and characterize the psychiatric comorbidity at the time of diagnosis of ADHD in adult outpatients. METHOD Cross-sectional, multicenter, observational register of adults with ADHD diagnosed for the first time. RESULTS In this large sample of adult ADHD (n = 367), psychiatric comorbidities were present in 66.2% of the sample, and were more prevalent in males and in the hyperactive-impulsive and combined subtypes. The most common comorbidities were substance use disorders (39.2%), anxiety disorders (23%), and mood disorders (18.1%). In all, 88.8% patients were prescribed pharmacological treatment for ADHD (in 93.4% of cases, modified release methylphenidate capsules 50:50). CONCLUSION A high proportion of psychiatric comorbidity was observed when adult outpatients received a first-time diagnosis of ADHD. The systematic registering of patients and comorbidities in clinical practice may help to better understand and manage the prognostic determinants in adult ADHD.
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Affiliation(s)
- Benjamín Piñeiro-Dieguez
- Hospital de Terrassa (Consorci Sanitari CST), Servicio de Psiquiatría, Terrassa (Barcelona), Spain
| | - Vicent Balanzá-Martínez
- Servicio de Psiquiatría, Hospital Universitari Doctor Peset, Universitat de València, FISABIO, CIBERSAM, Valencia, Spain
| | - Pilar García-García
- Department of Biomedical Science (Area of Pharmacology), University of Alcalá, Alcalá de Henares, Madrid, Spain
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Sivakumar T. Comorbidity of Bipolar Disorder (BPD) and ADHD in Children and Adolescents: Studies Outside the United States, Methodological Issues Inflating Comorbidity, Role of Behavioural Sensitization, and Concept of Temper Dysregulation Disorder With Dysphoria Proposed by DSM-5 Work Group. J Atten Disord 2016; 20:571-2. [PMID: 22956711 DOI: 10.1177/1087054712457990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- T Sivakumar
- All India Institute of Medical Sciences, New Delhi, India
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11
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Frías Á, Palma C, Farriols N. Comorbidity in pediatric bipolar disorder: prevalence, clinical impact, etiology and treatment. J Affect Disord 2015; 174:378-89. [PMID: 25545605 DOI: 10.1016/j.jad.2014.12.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Research on pediatric bipolar disorder (PBD) is providing a plethora of empirical findings regarding its comorbidity. We addressed this question through a systematic review concerning the prevalence, clinical impact, etiology and treatment of main comorbid disorders involved. METHOD A comprehensive database search was performed from 1990 to August 2014. Overall, 167 studies fulfilled the inclusion criteria. RESULTS Bipolar youth tend to suffer from comorbid disorders, with highest weighted mean prevalence rate arising from anxiety disorders (54%), followed by attention deficit hyperactivity disorder (ADHD) (48%), disruptive behavior disorders (31%), and substance use disorders (SUD) (31%). Furthermore, evidence indicates that ADHD and anxiety disorders negatively affect the symptomatology, neurocognitive profile, clinical course and the global functioning of PBD. Likewise, several theories have been posited to explain comorbidity rates in PBD, specifically common risk factors, one disorder being a risk factor for the other and nosological artefacts. Lastly, randomized controlled trials highlight a stronger therapeutic response to stimulants and atomoxetine (vs. placebo) as adjunctive interventions for comorbid ADHD symptoms. In addition, research focused on the treatment of other comorbid disorders postulates some benefits from mood stabilizers and/or SGA. LIMITATIONS Epidemiologic follow-up studies are needed to avoid the risk of nosological artefacts. Likewise, more research is needed on pervasive developmental disorders and anxiety disorders, especially regarding their etiology and treatment. CONCLUSIONS Psychiatric comorbidity is highly prevalent and is associated with a deleterious clinical effect on pediatric bipolarity. Different etiological pathways may explain the presence of these comorbid disorders among bipolar youth. Standardized treatments are providing ongoing data regarding their effectiveness for these comorbidities among bipolar youth.
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Affiliation(s)
- Álvaro Frías
- FPCEE Blanquerna, University of Ramon-Llull, Císterst 34, 08022 Barcelona, Spain; Adult Outpatient Mental Health Center, Hospital of Mataró, Mataró, Spain.
| | - Cárol Palma
- FPCEE Blanquerna, University of Ramon-Llull, Císterst 34, 08022 Barcelona, Spain; Adult Outpatient Mental Health Center, Hospital of Mataró, Mataró, Spain
| | - Núria Farriols
- FPCEE Blanquerna, University of Ramon-Llull, Císterst 34, 08022 Barcelona, Spain; Adult Outpatient Mental Health Center, Hospital of Mataró, Mataró, Spain
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Comparison of clinical characteristics of bipolar and depressive disorders in Korean clinical sample of youth: a retrospective chart review. Eur Child Adolesc Psychiatry 2014; 23:307-16. [PMID: 23963644 DOI: 10.1007/s00787-013-0461-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 08/03/2013] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to compare the clinical characteristics of bipolar disorder I, II (BD I and II) and not otherwise specified (BD NOS) to those of major depressive disorder (MDD) in a clinical sample of Korean children and adolescents. This study was a cross-sectional review of longitudinal observational data. Two psychiatrists retrospectively reviewed the medical records of 198 children and adolescents (age 6-18) that were diagnosed as having bipolar or depressive disorders from March 2010 to February 2012 at Department of Psychiatry of Asan Medical Center, Seoul, Korea. Every subject's diagnoses were reviewed and confirmed. BD I, II and MDD were assessed according to the Diagnostic and Statistical Manual-IV criteria. BD NOS was defined based on the criteria for the Course and Outcome of Bipolar Youth study. Comparisons were made in demographic information, clinical characteristics, family history, and psychiatric comorbidities at baseline and during observation. Among 198 subjects, 20 (10.1 %) subjects were diagnosed as having BD I, 10 (5.1 %) as BD II, 25 (12.6 %) as BD NOS and 143 (73.7 %) as MDD. BD depression was associated with mood change while taking an antidepressant, familial bipolarity, aggressive behaviors, and atypical features. Comorbid obsessive-compulsive disorder tended to be higher in BD NOS than in MDD. Presence of psychosocial stressors was more common in MDD than in BD depression. In children and adolescents, bipolar depression is distinct from unipolar depression in family history, comorbidity, and clinical characteristics.
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Sivakumar T, Agarwal V, Sitholey P. Comorbidity of attention-deficit/hyperactivity disorder and bipolar disorder in North Indian clinic children and adolescents. Asian J Psychiatr 2013; 6:235-42. [PMID: 23642982 DOI: 10.1016/j.ajp.2012.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 10/27/2012] [Accepted: 12/29/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study examined comorbidity between attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BPD) in children attending child and adolescent psychiatry (CAP) services in a Medical University in North India. METHODS Children attending CAP services, old or new, were assessed using unstructured clinical interview, kiddie-Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime Version (K-SADS-PL), Mental State Examination (MSE) for ADHD, Child Mania Rating Scale (CMRS) Parent Version and Children's Global Assessment Scale (C-GAS). Information was collected from both children and parents. All children were clinically evaluated, and prospectively followed up. The diagnosis was made by consensus. Subjects with DSM-IV-TR diagnosis of ADHD, BPD, and ADHD+BPD were compared with each other. Research criteria for broad phenotype BPD were applied in ADHD subjects without DSM-IV-TR diagnosis of BPD. RESULTS 45 subjects had ADHD; 21, BPD and; 7 had lifetime DSM-IV-TR diagnosis of ADHD+BPD. 13.5% of ADHD subjects had comorbid BPD and 25% of BPD subjects had comorbid ADHD. ADHD-CT was the most common subtype of ADHD. Nearly two third of BPD subjects had their first mood episode before 13 years of age. ADHD+BPD subjects were more likely to be mentally retarded and have longer duration of mood episode compared to BPD subjects. Three subjects with DSM-IV-TR diagnosis of ADHD without BPD were additionally diagnosed with broad phenotype of BPD. CONCLUSIONS Variable comorbidity rates of ADHD+BPD in different studies are most likely due to differences in study setting, study sample, conceptualization of BPD and assessment methods.
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Affiliation(s)
- Thanapal Sivakumar
- Psychosocial Rehabilitation Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560029, India.
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Marín-Méndez JJ, Patiño-García A, Segura V, Ortuño F, Gálvez MD, Soutullo CA. Differential expression of prostaglandin D2 synthase (PTGDS) in patients with attention deficit-hyperactivity disorder and bipolar disorder. J Affect Disord 2012; 138:479-84. [PMID: 22370065 DOI: 10.1016/j.jad.2012.01.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 01/30/2012] [Accepted: 01/30/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND As marker genes for bipolar disorder (BP) and attention deficit hyperactivity disorder (ADHD) are not fully identified, we carried out a complete genome analysis to search for genes differentially expressed in ADHD and BP. MATERIALS AND METHODS We recruited 39 patients (30 ADHD, 9 BP), aged 7 to 23 years. For evaluation of the psychiatric diagnosis, we used a semi-structured interview based on the K-SADS-PL (DSM-IV). RNA was extracted from peripheral blood and analyzed with the GeneChip® Human Genome U133-Plus 2.0 (Affymetrix). For the validation of differentially expressed genes, real-time PCR was used. RESULTS Hybridization and subsequent statistical analysis found 502 probe-sets with significant differences in expression in ADHD and BP patients. Of these, 82 had highly significant differences. Neuregulin (NRG1), cathepsins B and D (CTSB, CTSD) and prostaglandin-D2-synthase (PTGDS) were chosen for semi-quantitative mRNA determination. The expression of PTGDS was statistically increased in ADHD relative to BP patients (p=0.01). We found no such differential expression with NRG1, CTSB and CTSD genes (p>0.05). CONCLUSIONS The gene coding for PTGDS was found to be more expressed in patients with ADHD relative to patients with BP, indicating a possible link with the differential etiology of ADHD. The experimental approach we have used is, at least in part, validated by the detection of proteins directly concerned with brain functions, and shows a possible way forward for studies of the connection between brain function genes and psychiatric disorders. LIMITATIONS Confirmation of our findings requires a larger sample of patients with clearly-defined phenotypes.
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Ratheesh A, Srinath S, Reddy YCJ, Girimaji SC, Seshadri SP, Thennarasu K, Hutin Y. Are anxiety disorders associated with a more severe form of bipolar disorder in adolescents? Indian J Psychiatry 2011; 53:312-8. [PMID: 22303039 PMCID: PMC3267342 DOI: 10.4103/0019-5545.91904] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Anxiety disorders are common among children and adolescents with bipolar disorder. Among adults, anxiety disorder comorbidity is associated with a more severe form of bipolar disorder and a poorer outcome. There is limited data on the effect of comorbid anxiety disorder on bipolar disorder among children and adolescents. AIM To study the prevalence of anxiety disorders among adolescents with remitted bipolar disorder and examine their association with the course and severity of illness, global functioning, and quality of life. MATERIALS AND METHODS We evaluated 46 adolescents with DSM IV bipolar disorder (I and II) who were in remission, using the Schedule for Affective Disorders and Schizophrenia for School-Age Children. We measured quality of life using the Pediatric Quality of Life Inventory and global functioning using the Children's Global Assessment Scale, and then compared these parameters between adolescents with and without current anxiety disorders. We also compared the two groups on other indicators of severity such as number of episodes, suicidal ideation, presence of psychotic symptoms, and response to treatment. RESULTS Among the 46 subjects, the prevalence of current and lifetime anxiety disorders were 28% (n=13) and 41% (n=19), respectively. Compared with others, adolescents with anxiety had more lifetime suicidal ideation, more number of episodes, lower physical, psychosocial, and total subjective quality of life, and lower global functioning. CONCLUSIONS Among adolescents with bipolar disorder, anxiety disorders are associated with a poorer course, lower quality of life, and global functioning. In these subjects, anxiety disorders should be promptly recognized and treated.
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Affiliation(s)
- Aswin Ratheesh
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
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Neurocognitive performance in children and adolescents with bipolar disorder: a review. Eur Child Adolesc Psychiatry 2011; 20:433-50. [PMID: 21904806 DOI: 10.1007/s00787-011-0209-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 07/28/2011] [Indexed: 10/17/2022]
Abstract
A number of studies have reported the evidence of cognitive deficits in adult bipolar patients. Recently, there has been a shift in research on neurocognitive performance in bipolar disorder (BD) towards examining younger age groups. A review of the literature on neurocognitive impairments in BD in childhood and adolescence was conducted. We searched systematically for studies in samples of age groups younger than 18 years of age in average that included either a healthy control group or normative data for the cognitive tests used. Twenty-one original articles were found and reviewed. Children and adolescents with BD show deficits in a variety of cognitive areas. The most consistent results were found for impairments in verbal memory. A majority of studies also indicated impairments in working memory. Similar pattern of neurocognitive impairment was found in children and adolescents as compared to adults suffering from BD. The neurocognitive deficits need to be recognized and incorporated into individual treatment programs.
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Klassen LJ, Katzman MA, Chokka P. Adult ADHD and its comorbidities, with a focus on bipolar disorder. J Affect Disord 2010; 124:1-8. [PMID: 19683348 DOI: 10.1016/j.jad.2009.06.036] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 06/29/2009] [Accepted: 06/30/2009] [Indexed: 10/20/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a syndrome that most often presents in childhood. However, the condition is also relatively common in adults, with prevalence rates reaching 5% in the general population, with more than half the children affected by ADHD retaining the condition during their adult years. While the disorder in children is most often described as a disorder involving hyperactivity and impulsiveness, ADHD presents with very different characteristics in adulthood, notably with less externalizing symptoms and with a higher rate of psychiatric comorbidities, including major depressive disorder, bipolar disorder (BD), anxiety disorders and substance abuse. This review will focus on the evidence relating to bipolar disorder BD and its potential link with ADHD, looking at epidemiological, familial and neuroimaging studies. The comorbid presentation of people suffering with ADHD and BD (ADHD/BD) is associated with a more severe disease course, more severe mood disorder symptoms, and lower functional scores. Importantly, the co-segregation of these two conditions makes ADHD diagnosis challenging because its symptoms are often mistakenly assumed to be part of BD. As a result, patients with comorbid ADHD/BD are under-diagnosed and under-treated. Optimal diagnosis, understanding and treatment of the comorbid condition are important, as ADHD/BD has been associated with significant functional impairment and suboptimal treatment responses when compared to ADHD or BD populations alone.
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Affiliation(s)
- Larry J Klassen
- Department of Psychiatry, Faculty of Medicine, University of Manitoba, Canada.
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18
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Lus G, Mukaddes NM. Co-morbidity of bipolar disorder in children and adolescents with attention deficit/hyperactivity disorder (ADHD) in an outpatient Turkish sample. World J Biol Psychiatry 2010; 10:488-94. [PMID: 19401947 DOI: 10.1080/15622970902929876] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aimed to assess the prevalence of bipolar disorder (BPD) in children and adolescents with attention deficit hyperactivity disorder (ADHD), and to compare the clinical characteristics of a group with ADHD with a group with co-morbidity of ADHD and BPD. The study includes 121 individuals, aged 6-16 years, with a diagnosis of ADHD. Co-morbidity of BPD was evaluated using the Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime version (K-SADS-PL) and the Parent-Young Mania Rating Scale (P-YMRS). The Child Behavior Checklist (CBCL) was used to assess psychopathology in two groups. Ten children (8.3%) in the ADHD sample received the additional diagnosis of BPD. The ADHD + BPD group had significantly higher scores than the ADHD group on withdrawn, anxiety/depression, social problems, thought problems, attention problems, aggression, externalization, total score items of CBCL, and on the P-YMRS. It could be concluded that BPD is not a rare co-morbid condition in children with diagnosis of ADHD and subjects with this co-morbidity show more severe psychopathology than subjects with pure ADHD. Differential diagnosis of BPD disorder in subjects with ADHD seems crucial in establishing an effective treatment program, and therefore improving mental health outcomes.
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Affiliation(s)
- Gozde Lus
- Child Psychiatry Department, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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Sharp SI, McQuillin A, Gurling HMD. Genetics of attention-deficit hyperactivity disorder (ADHD). Neuropharmacology 2009; 57:590-600. [PMID: 19715710 DOI: 10.1016/j.neuropharm.2009.08.011] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 08/14/2009] [Accepted: 08/18/2009] [Indexed: 01/15/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a clinically and genetically heterogeneous syndrome which is comorbid with childhood conduct disorder, alcoholism, substance abuse, dis-social personality disorder, and affective disorders. A small but consistent overlap with autistic symptoms has also been established. Twin and family studies of ADHD show a substantial genetic heritability with little or no family environmental effect. Linkage and association studies have conclusively implicated the dopamine transporter gene (DAT1). DAT1 has also been confirmed as being associated with bipolar disorder. Remarkably, and for the first time in psychiatry, genetic markers at the DAT1 locus appear to be able to predict clinical heterogeneity because the non-conduct disordered subgroup of ADHD is associated with DAT1 whereas other subgroups do not appear to be associated. The second most well replicated susceptibility gene encodes the DRD4 dopamine receptor and many other dopamine related genes appear to be implicated. It is becoming increasingly clear that genes causing bipolar mania overlap with genes for a subtype of ADHD. The key to understanding the genetics of ADHD is to accept very considerable heterogeneity with different genes having effects in different families and in different individuals. It is too early to interpret the new wave of genome-wide association and copy number variant studies but preliminary data support the overlap with affective disorder genes and also with CNS connectivity genes likely to be involved in autism and affective disorders.
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Affiliation(s)
- Sally I Sharp
- Molecular Psychiatry Laboratory, Research Department of Mental Health Sciences, Windeyer Institute of Medical Sciences, University College London Medical School, 46 Cleveland Street, London W1T 4JF, UK
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Masi G, Milone A, Manfredi A, Pari C, Paziente A, Millepiedi S. Comorbidity of conduct disorder and bipolar disorder in clinically referred children and adolescents. J Child Adolesc Psychopharmacol 2008; 18:271-9. [PMID: 18582182 DOI: 10.1089/cap.2008.0051] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The co-occurrence of conduct disorder (CD) and bipolar disorder (BD) has been frequently reported in referred children and adolescents. We address the implications of this comorbidity in a naturalistic sample of youths with BD, CD, and CD+BD. METHODS The sample consisted of 307 patients (216 males and 91 females, age range 8-18 years, mean age 13.5 +/- 2.6 years) referred during a 5-year period and followed-up for at least 6 months, 106 with CD without BD, 109 with BD without CD, and 92 with CD+BD, diagnosed with a structured clinical interview (K-SADS-PL). RESULTS Patients with CD alone were more predominantly males and with the lowest socio-economic status. Patients with CD without BD were the least severe at the baseline, while patients with BD alone presented the greatest improvement during the follow-up, and those with CD+BD had the poorest response. Patients with CD+BD presented higher rates of global aggression at the baseline, namely impulsive aggression, compared with CD alone, and the highest risk of substance abuse. Patients with BD alone presented higher rates of comorbid panic disorder and obsessive compulsive disorder, while patients with CD, with or without BD, had higher rates of ADHD. CONCLUSIONS Bipolar-conduct disorder comorbidity may have meaningful implications in children and adolescents, in terms of presentation, course, and treatments.
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
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Galanter CA, Leibenluft E. Frontiers between attention deficit hyperactivity disorder and bipolar disorder. Child Adolesc Psychiatr Clin N Am 2008; 17:325-46, viii-ix. [PMID: 18295149 DOI: 10.1016/j.chc.2007.11.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The co-occurrence of attention deficit hyperactivity disorder (ADHD) and bipolar disorder has received much recent attention in the literature. The authors review the literature examining associations between ADHD and bipolar disorder in children, and data concerning severe irritability in youth with ADHD. This article focuses on (1) population-based studies examining ADHD and bipolar disorder or ADHD and co-occurring irritability, (2) the co-occurrence and prospective relationships of ADHD and bipolar disorder in clinical samples, (3) phenomenology and assessment of bipolar disorder and ADHD, (4) treatment of comorbid ADHD and bipolar disorder, (5) family and genetic studies of ADHD and bipolar disorder, and (6) pathophysiologic comparisons between children with ADHD and irritability and bipolar disorder. We draw on the research to make clinical recommendations and highlight important directions for future research.
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Affiliation(s)
- Cathryn A Galanter
- Division of Child and Adolescent Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, #78, New York, NY 10032, USA.
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Stefanatos GA, Baron IS. Attention-deficit/hyperactivity disorder: a neuropsychological perspective towards DSM-V. Neuropsychol Rev 2007; 17:5-38. [PMID: 17318413 DOI: 10.1007/s11065-007-9020-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Neuropsychological methods and techniques have much to offer in the evaluation of the individual suspected as having Attention-Deficit/Hyperactivity Disorder (ADHD). After a review of the historical evolution of the ADHD concept, incidence and prevalence, and DSM-IV criteria for diagnosis, especially as regards omission related to gender differences, and other associated cultural, familial, socioenvironmental, and subject influences, this paper describes a number of dilemmas and obstacles encountered in clinical practice. Included are the confounds associated with the wide range of possible comorbidities, the insufficiency of current DSM-IV criteria, the emergence of subtype differentiation and its impact on diagnosis and treatment. The complex relationship between neuropsychological constructs and ADHD, and obstacles to valid assessment are also addressed. The complexities associated with a thorough ADHD evaluation are viewed within an impressive and expansive existing scientific framework and recommendations are made for future directions.
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Affiliation(s)
- Gerry A Stefanatos
- Cognitive Neurophysiology Laboratory, Moss Rehabilitation Research Institute, Korman Research Pavilion, Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
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Abstract
Bipolar disorder is a chronic and often devastating illness that may go undiagnosed because of its complex and diverse presentation. Clinicians can provide psychological treatments, in conjunction with pharmacotherapy, that can reduce the frequency, severity, and duration of manic and depressive episodes. Because bipolar disorder is characterized by high degrees of comorbidity and high rates of medical complications, the clinician will frequently need to implement other treatments targeted to comorbid conditions, such as panic, generalized anxiety, substance abuse, and personality disorders. This article introduces the issue of Journal of Clinical Psychology: In Session devoted to the treatment of bipolar disorder. We describe the cognitive styles and personal vulnerabilities that pose greater risk for bipolar disorder. Three evidence-based psychological treatments (interpersonal social rhythm therapy, family-focused treatment, and cognitive-behavioral therapy) and current pharmacological treatments are examined and illustrated. Finally, we review the effectiveness and practice implications of a variety of treatments for this severe and underresearched disorder.
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Affiliation(s)
- Robert L Leahy
- American Institute for Cognitive Therapy, New York, NY 10022, USA.
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Abstract
OBJECTIVE To assess prospectively the psychiatric diagnostic status, psychosocial correlates, and short-term outcome of youngsters with school refusal. METHODS Thirty-three subjects (8-16 years) presenting with school refusal to a tertiary Child and Adolescent Psychiatry service were evaluated. Instruments administered at baseline and after 3 months (including an outcome measure at 3 months) were: The Missouri Assessment of Genetics Interview for Children (MAGIC) to ascertain psychiatric diagnoses, a modified version of Parent Interview Schedule (PIS), and the Children's Global Assessment Scale (CGAS). RESULTS Twenty-nine subjects (87.9%) had a psychiatric diagnosis at baseline. Depressive disorder (63.6%) was commonest followed by specific phobias (30.3%). Psycho-social factors influenced school refusal in a majority (87.9%). Twenty of the thirty subjects (66.6%) who could be followed-up had returned to school. Psychiatric diagnosis persisted in 16 subjects. Younger age, being last-born, no or one diagnosis, and good baseline functioning predicted a favorable outcome. CONCLUSIONS Psychiatric morbidity is high in a clinic population of youngsters with school refusal. It is associated with temperamental, family, and other environmental adversities. Short-term outcome in these children is largely favourable in terms of return to school and global functioning.
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Affiliation(s)
- Mukesh Prabhuswamy
- Child and Adolescent Psychiatry Services, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India.
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Berk M, Hallam K, Lucas N, Kader L, Macneil C, Hasty M, Dodd S, Malhi G, Conus P. Health-related quality of life and functioning in bipolar disorder: the impact of pharmacotherapy. Expert Rev Pharmacoecon Outcomes Res 2006; 6:509-23. [PMID: 20528499 DOI: 10.1586/14737167.6.5.509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bipolar disorder has a major deleterious impact on many aspects of a patient's functioning and health-related quality of life. Although the formal measurement of these deficits has been neglected until recently, many well-designed trials now include an assessment of functioning and health-related quality of life using one or more rating scales. This review describes recent developments in the measurement of functioning and health-related quality of life in bipolar disorder, and discusses the evidence that medications that improve symptoms in bipolar disorder also offer clinically relevant benefits in functioning and health-related quality of life. Direct comparisons of the benefits of medications including atypical antipsychotics are problematic due to differences in trial populations, study durations and rating scales. Data from quetiapine trials indicate that this medication offers prompt and sustained improvement of functioning in patients with mania and enhancement of health-related quality of life in patients with bipolar depression, to accompany the significant improvements in mood episodes.
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Affiliation(s)
- Michael Berk
- Professor, University of Melbourne and ORYGEN Youth Health, Melbourne, Victoria, Australia, Department of Clinical and Biomedical Sciences - Barwon Health, University of Melbourne, Geelong, Victoria 3220, Australia.
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