Attention deficit/hyperactivity disorder symptoms in Italian bipolar adult patients: a preliminary report

BACKGROUND

It has been recently suggested that bipolar disorder (BD) with comorbid ADHD represents a distinct clinical phenotype of BD. With the aim to assess the impact of ADHD symptoms, we investigated the prevalence, epidemiological and clinical features associated with such a comorbidity in a sample of adult BD patients.

METHODS

A total of 96 outpatients (aged 18-65 years) with BD were included. All patients were screened using the Adult ADHD Self-report Scale (ASRS) and the Diagnostic, Clinical and Therapeutic Checklist (DCTC), a semi-structured interview developed for systematic collection of familial, demographic, anamnestic and clinical informations and exploration of DSM-IV-TR diagnostic criteria for mood, anxiety, eating, impulse control and alcohol and substance use disorders. The DCTC also includes the Clinical Global Impression Bipolar scale (CGI-BP), the Global Assessment of Functioning scale (GAF) and the Sheehan Disability Scale (SDS).

RESULTS

In our sample, 19 (19.8%) out of 96 BD patients fulfilled ASRS criteria for current and lifetime (onset before 7 years of age) ADHD symptoms (ADHD+). Compared to BD probands without ADHD symptoms (ADHD-), ADHD+ patients showed higher rates of current mixed episode, and lower rates of mania. ADHD+ resulted in more severe mean scores on the CGI-BP mixed, depressive and global subscales. None of the ADHD+ patients were in remission of BD at the time of the evaluation, versus 24 (31.2%) of the ADHD- group. ADHD+ patients also reported higher rate of lifetime comorbidity with Substance Use Disorder (SUD) and Alcohol Abuse in comparison to ADHD- patients. In particular the different rate in substance abuse was related to cocaine and poly-drug abuse. The two groups did not report significant differences in functioning and social adjustment with the exception of familial adjustment that was more compromised in ADHD+ than in ADHD- patients.

LIMITATIONS

Retrospective design and limited sample size.

CONCLUSIONS

In ADHD+ patients, BD is associated with higher rate of mixed states, more severe psychopathology and more impaired familial functioning as well as higher rates of comorbid substance, alcohol and poly-drug abuse compared to BD patients without adult ADHD. Our findings suggest that ADHD symptoms in adults may influence clinical presentation, course and prognosis of BD. Further prospective research is needed to confirm our findings and to explore treatment implications for the management of BD.

Phase II study of irinotecan and docetaxel in patients with previously treated non-small cell lung cancer: an Alpe-Adria Thoracic Oncology Multidisciplinary group study (ATOM 007)

This study was designed to evaluate the activity and tolerability of irinotecan and docetaxel in patients with previously treated non-small cell lung cancer (NSCLC). Eligibility included recurrent or progressive NSCLC, previous chemotherapy, age > or = 18 years, ECOG PS < or = 2. Treatment consisted of irinotecan (160 mg/m2 i.v.), followed by docetaxel (65 mg/m2 i.v.) on day 1 of a 21-day cycle, for a maximum of 6 cycles. Forty patients were enrolled. Median age was 60 years and median ECOG PS was 1. All patients were evaluable for toxicity and 31 (78%) were evaluable for response. A total of 125 cycles was administered (median, 3; range, 1-6). Most common grade 3-4 toxicities were neutropenia (62%), neutropenic fever (22%), and diarrhea (32%). Response rate was 10%; a further 40% of patients achieved stable disease. All responses were observed in patients with ECOG PS < or = 1, age <70 years, and who had received only one prior chemotherapy regimen. Median time to progression was 2.8 months and median survival was 7.4 months. Because of significant toxicity and limited activity, further investigation of irinotecan plus docetaxel in second line NSCLC is not recommended.

Sequential chemotherapy with paclitaxel plus cisplatin, followed by vinorelbine, followed by gemcitabine in advanced non-small cell lung cancer: an Alpe-Adria Thoracic Oncology Multidisciplinary group study (ATOM 001)

Aim of this study was to determine the activity and toxicity of a sequential chemotherapy regimen in advanced non-small cell lung cancer (NSCLC). Fifty-one previously untreated stage IIIB/IV NSCLC patients were enrolled to receive two cycles of cisplatin plus paclitaxel (80/175 mg/m(2) every 21 days), followed by two cycles of vinorelbine (30 mg/m(2) on days 1 and 8 every 21 days), followed by two cycles of gemcitabine (1000 mg/m(2) on days 1, 8, and 15 every 28 days). Forty-one patients (82%) completed the planned six cycles. Grade 3-4 neutropenia was the major toxicity (41% of patients) and it was mainly associated with vinorelbine administration. Response rate after cisplatin plus paclitaxel was 18%; this percentage increased to 41% after vinorelbine, and it reached 43% upon completion of the entire six cycle treatment program. Median survival time was 14.4 months, 1-year survival rate was 53%, and 2-year survival rate was 18%. Median time to disease progression was 6.8 months. This sequential chemotherapy regimen is feasible and active in patients with advanced NSCLC. This pilot experience provides the basis for an ongoing randomized phase III trial comparing our sequential regimen versus cisplatin plus gemcitabine.