Researchers Urge Caution When Using ADHD Questionnaire with Bipolar Disorder Patients

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Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder have been closely associated for quite some time, but Swiss researchers urge caution when using a common questionnaire used to diagnose ADHD in patients diagnosed with bipolar disorder.

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

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

The researchers also found that 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.”

These findings cause the researchers to note that clinicians need to look for specific symptoms to help distinguish between the two conditions, which is often difficult for even highly experienced psychiatrists due to overlapping symptoms.

Bipolar disorder patients with ADHD were younger at age of bipolar disorder onset than those without accompanying ADHD (20.0 vs 26.4 years). Those with both disorders also had a younger average age of onset of the first depressive episode (19.7 vs 27.0 years) and more depressive episodes (8.4 vs 5.6) compared to patients with isolated bipolar disorder. Individuals with both conditions also had a higher risk of anxiety disorders (49.0 vs 25.0%).

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

These findings support previous studies which put the prevalence of ADHD in bipolar disorder patients 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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