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Treatment Shows Promise for Adult Comorbid ADHD and Bipolar Disorder: Presented at APA

By Paula Moyer

SAN DIEGO, CA -- May 22, 2007 -- Adults with comorbid attention deficit hyperactivity disorder (ADHD) and bipolar disorder are underrepresented in research, but may profit from a combination of a mood stabilizer and bupropion (Wellbutrin), according to a team of investigators who presented their findings here at the American Psychiatric Association 2007 Annual Meeting (APA).

"The course of illness of adult ADHD and bipolar disorder is more severe than that of bipolar disorder alone," according to principal investigator Aliza P. Wingo, MD, psychiatry resident at Emory University, Atlanta, Georgia, United States. "It is associated with more episodes of mania, more suicide attempts, more violence, and more legal problems, as well as an earlier age of onset and a higher risk of substance addiction." Dr. Wingo collaborated in her research with S. Nassir Ghaemi, MD, MPH, assistant professor of psychiatry, Harvard Medical School, and director of the Bipolar Disorder Research Program at Cambridge Hospital, both in Boston, Massachusetts, United States.

The investigators conducted a systematic review of the comorbidity rate and the validity of the diagnosis, because the 2 conditions in adults are reported to be frequently comorbid. Therefore, they examined the validity and clinical implications of coexisting adult ADHD and bipolar disorder. They were particularly interested in the rate of comorbidity, the phenomenology, and the course of illness, as well as family history and treatment.

The investigators conducted a literature search with the keywords "manic," "bipolar," "attention deficit hyperactivity," and "adult." They excluded studies with paediatric-only subjects, review articles, case reports, and articles that only assessed bipolar disorder or ADHD, but not both.

Among the 13 qualifying articles, the studies that focused on bipolar disorder, which had population totals of 919, 3,199, and 44, respectively, had comorbid adult ADHD rates of 5.9% to 21.2%. In the studies focused on adult ADHD, which had populations of 51, 79, 3,199, and 127, respectively, investigators reported comorbid bipolar disorder rates ranging from 4.5% to 47%. Some of the overlapping symptoms included talkativeness, distractibility, physical restlessness, and lack of normal social inhibitions.

Patients with comorbid ADHD and bipolar disorder had a significantly higher rate of mania than those with bipolar disorder alone (P =.039) and 46% of such patients attempted suicide compared with 19% of those with bipolar disorder alone. Among those with these comorbidities, 40% had documented difficulties with physical violence compared with 19% of those with bipolar disorder alone (P <.001). Similarly, 42% of comorbid subjects had legal problems compared with 22% of those with bipolar disorder alone (P =.0007). Comorbid patients were an average of 13.9 years old when they developed bipolar disorder, compared with an average of 18.0 years old for those without ADHD (P =.0001). Substance addiction rates were 90% for those with both conditions, 38% for those with adult ADHD alone, 33% for those with bipolar disorder alone, and 30% for controls (P <.05).

One study of 30 comorbid subjects who were stable on mood stabilisers tested whether a trial of bupropion would cause a reduction in ADHD symptoms. In this 6-week trial, 82% of patients had a reduction of at least 30% on an ADHD symptom checklist scale without concurrent mania.


[Presentation title: Adult ADHD and Bipolar Disorder--A Systematic Review of Comorbidity Rate and Diagnostic Validity. Abstract #NR90]

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