Marco Pinna1, Caterina Visioli2, Carlo Mario Rago2, Mirko Manchia3, Leonardo Tondo4, Ross J Baldessarini5. 1. Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy; Department of General Psychology, University of Padua, Padua, Italy; Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy. Electronic address: marco87.pinna@gmail.com. 2. Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy; Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy. 3. Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada; Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy. 4. Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy; Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; McLean Hospital-Harvard Medical School, Boston, MA, USA. Electronic address: Ltondo@aol.com. 5. Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; McLean Hospital-Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND: It has long been recognized that bipolar disorder (BD) and attention deficit-hyperactivity disorder (ADHD) co-occur in an uncertain proportion of patients, recognized commonly in juvenile years. There is growing suspicion that such co-occurrence is associated with several clinically unfavorable characteristics. Accordingly, we compared 703 type I or II BD subjects with vs. without a lifetime diagnosis of ADHD. METHODS: We compared 173 BD patients with vs. 530 without co-occurring ADHD for selected demographic and clinical factors, using standard initial bivariate comparisons followed by multivariable logistic regression modeling. RESULTS: ADHD was found in 25% of BD subjects, more among men and with type I BD. Those with ADHD had higher scores at the Adult ADHD Self-Report Scale (ASRS), were more likely to have had less successful school performance, unemployment, lower socioeconomic status, less marriage and more divorce, as well as more substance abuse, suicide attempts, and [hypo]mania, but were less likely to have an anxiety disorder or a family history of mood disorder. Multivariable logistic regression modeling found six factors differing between BD subjects with versus without ADHD: less education after high school, higher ASRS score for inattention, ever separated or divorced, irritable temperament, male sex, and lower scores on the Hamilton Depression Rating Scale (HDRS) at intake. COMMENTS: Co-occurrence of ADHD with BD was identified at a moderate rate, and was associated with several unfavorable outcomes as well as a tendency toward [hypo]mania.
BACKGROUND: It has long been recognized that bipolar disorder (BD) and attention deficit-hyperactivity disorder (ADHD) co-occur in an uncertain proportion of patients, recognized commonly in juvenile years. There is growing suspicion that such co-occurrence is associated with several clinically unfavorable characteristics. Accordingly, we compared 703 type I or II BD subjects with vs. without a lifetime diagnosis of ADHD. METHODS: We compared 173 BD patients with vs. 530 without co-occurring ADHD for selected demographic and clinical factors, using standard initial bivariate comparisons followed by multivariable logistic regression modeling. RESULTS:ADHD was found in 25% of BD subjects, more among men and with type I BD. Those with ADHD had higher scores at the Adult ADHD Self-Report Scale (ASRS), were more likely to have had less successful school performance, unemployment, lower socioeconomic status, less marriage and more divorce, as well as more substance abuse, suicide attempts, and [hypo]mania, but were less likely to have an anxiety disorder or a family history of mood disorder. Multivariable logistic regression modeling found six factors differing between BD subjects with versus without ADHD: less education after high school, higher ASRS score for inattention, ever separated or divorced, irritable temperament, male sex, and lower scores on the Hamilton Depression Rating Scale (HDRS) at intake. COMMENTS: Co-occurrence of ADHD with BD was identified at a moderate rate, and was associated with several unfavorable outcomes as well as a tendency toward [hypo]mania.
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