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Brancati GE, Cosentino V, Barbuti M, Weiss F, Calderone A, Fierabracci P, Salvetti G, Santini F, Perugi G. Prevalence and Correlates of Self-Reported ADHD Symptoms in Bariatric Patients: Focus on Mood and Anxiety Comorbidity, Disordered Eating, and Temperamental Traits. Obes Surg 2024; 34:3335-3347. [PMID: 39052175 PMCID: PMC11349801 DOI: 10.1007/s11695-024-07308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity. A positive association between ADHD and obesity has been observed, especially in adult samples. In this study, prevalence and correlates of self-reported symptoms indicative of a positive screening for ADHD were examined in patients seeking bariatric treatment. MATERIAL AND METHODS The study sample was composed of 260 adult patients with obesity referred for bariatric surgery to the Obesity Center of the Endocrinology Unit in Pisa University Hospital between January 2006 and November 2016 (BMI ≥ 30 kg/m2; mean ± standard deviation = 46.27 ± 7.45 kg/m2). ADHD symptoms were identified using ADHD Symptom Check-List-90-R Screening Scale. Night-eating, binge-eating/purging behaviors, and temperamental and character traits were assessed in a subsample of 95 patients. RESULTS Thirty participants had a positive screening for ADHD (11.5%, 95% CI = 7.9-16.1%). Patients with a positive screening showed significantly higher rates of anxiety disorders (40% vs. 16.5%, χ2 = 7.97, p = 0.005) panic disorder (40% vs. 14.3%, χ2 = 10.48, p = 0.001), and a higher severity of psychopathological symptoms and sleep disturbances than those without. In subsample analyses, ADHD symptoms severity was associated with more bulimic behaviors (r = 0.31-0.46), greater harm avoidance (r = 0.45-0.66), less self-directedness (r = - 0.44-0.63), and cooperativeness (r = - 0.26-0.42). CONCLUSION ADHD symptoms may be common in patients with obesity seeking bariatric treatment and are positively associated with disordered eating, internalizing features, and maladaptive character traits. LEVEL OF EVIDENCE V, cross sectional descriptive study.
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Affiliation(s)
- Giulio Emilio Brancati
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Viarda Cosentino
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Margherita Barbuti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Francesco Weiss
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Alba Calderone
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Paola Fierabracci
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Guido Salvetti
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Ferruccio Santini
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy.
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Sesso G, Mazzullo C, Valente E, Ditaranto F, Fantozzi P, Belmonti V, Berloffa S, Placini F, Tancredi R, Masi G, Milone A. Non-Suicidal Self-Injury in Eating and Feeding Disorder Patients: Characteristics and Clinical Implications in a Group of Referred Female Adolescents. CHILDREN (BASEL, SWITZERLAND) 2024; 11:947. [PMID: 39201882 PMCID: PMC11353179 DOI: 10.3390/children11080947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/25/2024] [Accepted: 08/04/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) and Feeding or Eating Disorders (FEDs) often coexist during adolescence with reciprocal influences on their clinical picture. The present study aimed to identify differences and similarities in the clinical presentation of young patients with both conditions compared to those with the two non-comorbid disorders. METHODS We consecutively recruited forty-five female patients aged between 11 and 18 at our third-level hospital and subdivided them into three groups (NSSI: n = 15; FED: n = 15; NSSI + FED: n = 15). Patients underwent a full clinical assessment. RESULTS Based on our results, the NSSI + FED group was characterized by higher rates of binging/purging behaviors, greater prevalence of Cyclothymic Disorder, and a more severe clinical presentation compared to the non-comorbid groups. Moreover, higher levels of suicidal ideation were found in the NSSI + FED group. Pharmacological treatment patterns also differed, with SSRI being prescribed more frequently to NSSI + FED patients while mood stabilizers were prescribed more frequently to NSSI ones. A Principal Component Analysis identified four main dimensions: "Body Image" impairment was more pronounced in NSSI + FED patients, indicating negative attitudes towards their own body; "Metacognition" deficits were higher in NSSI than FED. CONCLUSIONS The present study underscores distinctive clinical features in patients with comorbid NSSI and FED, emphasizing the urgent need for tailored intervention strategies focusing on specific symptom domains.
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Affiliation(s)
- Gianluca Sesso
- Social and Affective Neuroscience Group, Molecular Mind Lab, IMT School for Advanced Studies, Piazza San Francesco, 55100 Lucca, Italy
| | - Cristina Mazzullo
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Elena Valente
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Francesca Ditaranto
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Pamela Fantozzi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Vittorio Belmonti
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Stefano Berloffa
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Francesca Placini
- Clinica di Neuropsichiatria dell’Infanzia e dell’Adolescenza, Ospedale Pediatrico-Microcitemico, Via Jenner s.n.c., 09121 Cagliari, Italy
| | - Raffaella Tancredi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Gabriele Masi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Annarita Milone
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
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French B, Nalbant G, Wright H, Sayal K, Daley D, Groom MJ, Cassidy S, Hall CL. The impacts associated with having ADHD: an umbrella review. Front Psychiatry 2024; 15:1343314. [PMID: 38840946 PMCID: PMC11151783 DOI: 10.3389/fpsyt.2024.1343314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/14/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Attention Deficit Hyperactivity Disorder (ADHD) affects up to 5% of the population and is characterised by symptoms of impulsivity, hyperactivity and inattention. These symptoms are significantly impairing and carry additional risks for children and adults with ADHD, including negative mental health (e.g. depression), physical health (e.g. obesity) and societal outcomes (e.g. imprisonment, divorce). Very few studies have attempted to synthesise these risks in one publication due to the breadth of evidence published on the adverse outcomes of ADHD. Methods An umbrella review was performed to identify reviews (systematic, meta-analysis and narrative) that investigate the risks arising from having ADHD. We conducted a narrative synthesis of the findings and conducted a quality review of the included publications. Results Upon searching five databases, 16,675 records were identified. Of these, 125 reviews met the criteria for inclusion. A narrative synthesis of these findings highlighted three key domains of risks associated with ADHD: mental health, physical health, social and lifestyle. Most reviews were of good and moderate quality. Discussion This review highlights the many risks associated with having ADHD, beyond its three key symptom domains and the impact of the condition on daily functioning. Registration International Prospective Register of Systematic Reviews (PROSPERO CRD42023404073).
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Affiliation(s)
- Blandine French
- NIHR MindTech MedTech Cooperative, Nottingham National Institute of Health Research Biomedical Research Center (NIHR BRC), Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Gamze Nalbant
- Lifespan and Population Health Unit, University of Nottingham, Nottingham, United Kingdom
| | - Hannah Wright
- NIHR MindTech MedTech Cooperative, Nottingham National Institute of Health Research Biomedical Research Center (NIHR BRC), Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Kapil Sayal
- NIHR MindTech MedTech Cooperative, Nottingham National Institute of Health Research Biomedical Research Center (NIHR BRC), Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - David Daley
- Nottingham Trent University (NTU) Psychology, School of Social Science, Nottingham Trent University, Nottingham, United Kingdom
| | - Madeleine J. Groom
- NIHR MindTech MedTech Cooperative, Nottingham National Institute of Health Research Biomedical Research Center (NIHR BRC), Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte L. Hall
- NIHR MindTech MedTech Cooperative, Nottingham National Institute of Health Research Biomedical Research Center (NIHR BRC), Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Qin K, Lei D, Zhu Z, Li W, Tallman MJ, Rodrigo Patino L, Fleck DE, Aghera V, Gong Q, Sweeney JA, McNamara RK, DelBello MP. Different brain functional network abnormalities between attention-deficit/hyperactivity disorder youth with and without familial risk for bipolar disorder. Eur Child Adolesc Psychiatry 2024; 33:1395-1405. [PMID: 37336861 DOI: 10.1007/s00787-023-02245-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) commonly precedes the initial onset of mania in youth with familial risk for bipolar disorder (BD). Although ADHD youth with and without BD familial risk exhibit different clinical features, associated neuropathophysiological mechanisms remain poorly understood. This study aimed to identify brain functional network abnormalities associated with ADHD in youth with and without familial risk for BD. Resting-state functional magnetic resonance imaging scans were acquired from 37 ADHD youth with a family history of BD (high-risk), 45 ADHD youth without a family history of BD (low-risk), and 32 healthy controls (HC). Individual whole-brain functional networks were constructed, and graph theory analysis was applied to estimate network topological metrics. Topological metrics, including network efficiency, small-worldness and nodal centrality, were compared across groups, and associations between topological metrics and clinical ratings were evaluated. Compared to HC, low-risk ADHD youth exhibited weaker global integration (i.e., decreased global efficiency and increased characteristic path length), while high-risk ADHD youth showed a disruption of localized network components with decreased frontoparietal and frontolimbic connectivity. Common topological deficits were observed in the medial superior frontal gyrus between low- and high-risk ADHD. Distinct network deficits were found in the inferior parietal lobule and corticostriatal circuitry. Associations between global topological metrics and externalizing symptoms differed significantly between the two ADHD groups. Different patterns of functional network topological abnormalities were found in high- as compared to low-risk ADHD, suggesting that ADHD in youth with BD familial risk may represent a phenotype that is different from ADHD alone.
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Affiliation(s)
- Kun Qin
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
- Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Du Lei
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, China.
| | - Ziyu Zhu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Wenbin Li
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Maxwell J Tallman
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - L Rodrigo Patino
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - David E Fleck
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Veronica Aghera
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Robert K McNamara
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
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Straszek SPV, Straarup KMN, Hjerrild S, Vinberg M. Adults with both bipolar disorder and ADHD. Ugeskr Laeger 2024; 186:V10230620. [PMID: 38708700 DOI: 10.61409/v10230620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
ADHD and bipolar disorder (BP) commonly coexist, and both share key symptoms, depending on affective state and emotional dysregulation. The overlap poses diagnostic challenges and may lead to underdiagnoses. Comorbid cases exhibit worsened symptom burden, increased psychiatric morbidity, admissions, and suicide attempts. Treating BP before ADHD is recommended. Stimulant use combined with mood stabilisers may be effective and relatively safe; however, this review finds that well-designed randomised controlled studies in the area is warranted.
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Patino LR, Wilson AS, Tallman MJ, Blom TJ, DelBello MP, McNamara RK. Aberrant Neurofunctional Responses During Emotional and Attentional Processing Differentiate ADHD Youth With and Without a Family History of Bipolar I Disorder. J Atten Disord 2024; 28:820-833. [PMID: 38153098 DOI: 10.1177/10870547231215292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE To compare neurofunctional responses in emotional and attentional networks of psychostimulant-free ADHD youth with and without familial risk for bipolar I disorder (BD). METHODS ADHD youth with (high-risk, HR, n = 48) and without (low-risk, LR, n = 50) a first-degree relative with BD and healthy controls (n = 46) underwent functional magnetic resonance imaging while performing a continuous performance task with emotional distracters. Region-of-interest analyses were performed for bilateral amygdala (AMY), ventrolateral (VLPFC) and dorsolateral (DLPFC) prefrontal cortex, and anterior (ACC) and posterior cingulate cortex (PCC). RESULTS Compared with HC, HR, but not LR, exhibited predominantly left-lateralized AMY, VLPFC, DLPFC, PCC, and rostral ACC hyperactivation to emotional distractors, whereas LR exhibited right VLPFC and bilateral dorsal ACC hypoactivation to attentional targets. Regional responses correlated with emotional and attention symptoms. CONCLUSION Aberrant neurofunctional responses during emotional and attentional processing differentiate ADHD youth with and without a family history of BD and correlate with relevant symptoms ratings.
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Affiliation(s)
| | | | | | - Thomas J Blom
- University of Cincinnati College of Medicine, OH, USA
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7
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Cho WM, Hsu TW, Cheng CM, Chang WH, Tsai SJ, Bai YM, Su TP, Chen TJ, Chen MH, Liang CS. Cause-specific mortality and comorbid neurodevelopmental disorder in 167,515 patients with bipolar disorder: An entire population longitudinal study. J Affect Disord 2024; 347:463-468. [PMID: 38065473 DOI: 10.1016/j.jad.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/28/2023] [Accepted: 12/02/2023] [Indexed: 01/08/2024]
Abstract
OBJECTIVE Studies addressing premature mortality in bipolar disorder (BD) patients are limited by small sample sizes. Herein, we used almost 99 % of the population of Taiwan to address this issue, and its association with comorbid neurodevelopmental disorders and severe BD. METHODS Between 2003 and 2017, we enrolled 167,515 individuals with BD and controls matched 1:4 for sex and birth year from the National Health Insurance Database linked to the Database of National Death Registry in Taiwan. Time-dependent Cox regression models were used to examine cause-specific mortality (all-cause, natural, and unnatural causes [accidents or suicide]). RESULTS With adjustments of sex, age, income, urbanization, and physical conditions, suicide was associated with the highest risk of mortality (reported as hazard ratio with 95 % confidence interval: 9.15; 8.53-9.81) among BD patients, followed by unnatural (4.94; 4.72-5.17), accidental (2.15; 1.99-2.32), and natural causes (1.02; 1.00-1.05). Comorbid attention-deficiency hyperactivity disorder did not contribute to the increased risk of cause-specific mortality; however, comorbid autism spectrum disorder (ASD) increased such risks, particularly for natural (3.00; 1.85-4.88) and accidental causes (7.47; 1.80-31.1). Cause-specific mortality revealed a linear trend with the frequency of psychiatric hospitalization (all, p for trend <0.001), and BD patients hospitalized twice or more each year had 34.63-fold increased risk of suicide mortality (26.03-46.07). CONCLUSIONS BD patients with a higher frequency of psychiatric hospitalization have the highest risk of suicide mortality, and comorbid ASD was associated with an increased risk of natural and accidental causes of mortality.
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Affiliation(s)
- Wei-Min Cho
- Department of Pharmacy Administration, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Tien-Wei Hsu
- Department of Psychiatry, E-DA Dachang Hospital, I-Shou Univerisity, Kaohsiung, Taiwan; Department of Psychiatry, E-DA Hospital, I-Shou Univerisity, Kaohsiung, Taiwan.
| | - Chih-Ming Cheng
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Han Chang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan; Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
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Zhu Z, Lei D, Qin K, Tallman MJ, Patino LR, Fleck DE, Gong Q, Sweeney JA, DelBello MP, McNamara RK. Cortical and subcortical structural differences in psychostimulant-free ADHD youth with and without a family history of bipolar I disorder: a cross-sectional morphometric comparison. Transl Psychiatry 2023; 13:368. [PMID: 38036505 PMCID: PMC10689449 DOI: 10.1038/s41398-023-02667-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
Although attention-deficit/hyperactivity disorder (ADHD) and a family history of bipolar I disorder (BD) are associated with increased risk for developing BD, their neuroanatomical substrates remain poorly understood. This study compared cortical and subcortical gray matter morphology in psychostimulant-free ADHD youth with and without a first-degree relative with BD and typically developing healthy controls. ADHD youth (ages 10-18 years) with ('high-risk', HR) or without ('low-risk', LR) a first-degree relative with BD and healthy comparison youth (HC) were enrolled. High-resolution 3D T1-weighted images were acquired using a Philips 3.0 T MR scanner. The FreeSurfer image analysis suite was used to measure cortical thickness, surface area, and subcortical volumes. A general linear model evaluated group differences in MRI features with age and sex as covariates, and exploratory correlational analyses evaluated associations with symptom ratings. A total of n = 142 youth (mean age: 14.16 ± 2.54 years, 35.9% female) were included in the analysis (HC, n = 48; LR, n = 49; HR, n = 45). The HR group exhibited a more severe symptom profile, including higher mania and dysregulation scores, compared to the LR group. For subcortical volumes, the HR group exhibited smaller bilateral thalamic, hippocampal, and left caudate nucleus volumes compared to both LR and HC, and smaller right caudate nucleus compared with LR. No differences were found between LR and HC groups. For cortical surface area, the HR group exhibited lower parietal and temporal surface area compared with HC and LR, and lower orbitofrontal and superior frontal surface area compared to LR. The HR group exhibited lower left anterior cingulate surface area compared with HC. LR participants exhibited greater right pars opercularis surface area compared with the HC. Some cortical alterations correlated with symptom severity ratings. These findings suggest that ADHD in youth with a BD family history is associated with a more a severe symptom profile and a neuroanatomical phenotype that distinguishes it from ADHD without a BD family history.
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Affiliation(s)
- Ziyu Zhu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, PR China
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
| | - Du Lei
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, PR China.
| | - Kun Qin
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, PR China
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, PR China
- Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, 442012, PR China
| | - Maxwell J Tallman
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
| | - L Rodrigo Patino
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
| | - David E Fleck
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, PR China.
- Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, 361021, Fujian, PR China.
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, PR China
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
| | - Robert K McNamara
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
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Bartoli F, Nasti C, Palpella D, Piacenti S, Di Lella ME, Mauro S, Prestifilippo L, Crocamo C, Carrà G. Characterizing the clinical profile of mania without major depressive episodes: a systematic review and meta-analysis of factors associated with unipolar mania. Psychol Med 2023; 53:7277-7286. [PMID: 37016793 PMCID: PMC10719688 DOI: 10.1017/s0033291723000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND The diagnostic concept of unipolar mania (UM), i.e. the lifetime occurrence of mania without major depressive episodes, remains a topic of debate despite the evidence accumulated in the last few years. We carried out a systematic review and meta-analysis of observational studies testing factors associated with UM as compared to bipolar disorder with a manic-depressive course (md-BD). METHODS Studies indexed up to July 2022 in main electronic databases were searched. Random-effects meta-analyses of the association between UM and relevant correlates yielded odds ratio (OR) or standardized mean difference (SMD), with 95% confidence intervals (CIs). RESULTS Based on data from 21 studies, factors positively or negatively associated with UM, as compared to md-BD, were: male gender (OR 1.47; 95% CI 1.11-1.94); age at onset (SMD -0.25; 95% CI -0.46 to -0.04); number of hospitalizations (SMD 0.53; 95% CI 0.21-0.84); family history of depression (OR 0.55; 95% CI 0.36-0.85); suicide attempts (OR 0.25; 95% CI 0.19-0.34); comorbid anxiety disorders (OR 0.35; 95% CI 0.26-0.49); psychotic features (OR 2.16; 95% CI 1.55-3.00); hyperthymic temperament (OR 1.99; 95% CI 1.17-3.40). The quality of evidence for the association with previous suicide attempts was high, moderate for anxiety disorders and psychotic features, and low or very low for other correlates. CONCLUSIONS Despite the heterogeneous quality of evidence, this work supports the hypothesis that UM might represent a distinctive diagnostic construct, with peculiar clinical correlates. Additional research is needed to better differentiate UM in the context of affective disorders, favouring personalized care approaches.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Christian Nasti
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Dario Palpella
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Susanna Piacenti
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Maria Elisa Di Lella
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Stefano Mauro
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Luca Prestifilippo
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
- Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
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10
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Brancati GE, De Rosa U, De Dominicis F, Petrucci A, Nannini A, Medda P, Schiavi E, Perugi G. History of Childhood/Adolescence Referral to Speciality Care or Treatment in Adult Patients with Attention-Deficit/Hyperactivity Disorder: Mutual Relations with Clinical Presentation, Psychiatric Comorbidity and Emotional Dysregulation. Brain Sci 2023; 13:1251. [PMID: 37759852 PMCID: PMC10526193 DOI: 10.3390/brainsci13091251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/16/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that only rarely remits in adulthood. While several studies underlined differences between child and adult ADHD, the relationship between adult clinical presentation and early referral/treatment has been rarely investigated. In our study, 100 adults with ADHD were recruited and subdivided according to a history of referral to speciality care or treatment with methylphenidate (MPH) during childhood/adolescence. The early referral was associated with a history of disruptive behaviors during childhood/adolescence. Current ADHD symptoms were more pronounced in patients first referred during childhood/adolescence but never treated with MPH. Early MPH treatment was associated with lower rates of mood disorders and lower severity of emotional dysregulation at the time of assessment. Negative emotionality mediated the relationship between MPH treatment and mood disorders comorbidity. ADHD patients first referred during childhood/adolescence are characterized by more externalizing features than those first referred in adulthood. MPH treatment during the developmental age may have a role in preventing mood disorders in patients with ADHD, possibly by reducing emotional dysregulation.
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Affiliation(s)
- Giulio Emilio Brancati
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56100 Pisa, Italy (A.N.)
| | - Ugo De Rosa
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56100 Pisa, Italy (A.N.)
| | | | - Alessandra Petrucci
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56100 Pisa, Italy (A.N.)
| | - Alessandro Nannini
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56100 Pisa, Italy (A.N.)
| | - Pierpaolo Medda
- Psychiatry Unit 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (P.M.)
| | - Elisa Schiavi
- Psychiatry Unit 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (P.M.)
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56100 Pisa, Italy (A.N.)
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11
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Lei D, Qin K, Li W, Zhu Z, Tallman MJ, Patino LR, Fleck DE, Aghera V, Gong Q, Sweeney JA, DelBello MP, McNamara RK. Regional microstructural differences in ADHD youth with and without a family history of bipolar I disorder. J Affect Disord 2023; 334:238-245. [PMID: 37149051 PMCID: PMC10228372 DOI: 10.1016/j.jad.2023.04.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/21/2023] [Accepted: 04/29/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Having a first-degree relative with bipolar I disorder (BD) in conjunction with prodromal attention deficit/hyperactivity disorder (ADHD) may represent a unique phenotype that confers greater risk for developing BD than ADHD alone. However, underlying neuropathoetiological mechanisms remain poorly understood. This cross-sectional study compared regional microstructure in psychostimulant-free ADHD youth with ('high-risk', HR) and without ('low-risk', LR) a first-degree relative with BD, and healthy controls (HC). METHODS A total of 140 (high-risk, n = 44; low-risk, n = 49; and HC, n = 47) youth (mean age: 14.1 ± 2.5 years, 65 % male) were included in the analysis. Diffusion tensor images were collected and fractional anisotropy (FA) and mean diffusivity (MD) maps were calculated. Both tract-based and voxel-based analyses were performed. Correlations between clinical ratings and microstructural metrics that differed among groups were examined. RESULTS No significant group differences in major long-distance fiber tracts were observed. The high-risk ADHD group exhibited predominantly higher FA and lower MD in frontal, limbic, and striatal subregions compared with the low-risk ADHD group. Both low-risk and high-risk ADHD groups exhibited higher FA in unique and overlapping regions compared with HC subjects. Significant correlations between regional microstructural metrics and clinical ratings were observed in ADHD groups. LIMITATIONS Prospective longitudinal studies will be required to determine the relevance of these findings to BD risk progression. CONCLUSIONS Psychostimulant-free ADHD youth with a BD family history exhibit different microstructure alterations in frontal, limbic, and striatal regions compared with ADHD youth without a BD family history, and may therefore represent a unique phenotype relevant to BD risk progression.
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Affiliation(s)
- Du Lei
- College of Medical Informatics, Chongqing Medical University, Chongqing 400016, China; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati 45219, OH, USA.
| | - Kun Qin
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati 45219, OH, USA; Huaxi MR Research Center (HMRRC), Department of Radiology, The Center for Medical Imaging, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Wenbin Li
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati 45219, OH, USA; Huaxi MR Research Center (HMRRC), Department of Radiology, The Center for Medical Imaging, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Ziyu Zhu
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati 45219, OH, USA; Huaxi MR Research Center (HMRRC), Department of Radiology, The Center for Medical Imaging, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Maxwell J Tallman
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati 45219, OH, USA
| | - L Rodrigo Patino
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati 45219, OH, USA
| | - David E Fleck
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati 45219, OH, USA
| | - Veronica Aghera
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati 45219, OH, USA
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, The Center for Medical Imaging, West China Hospital of Sichuan University, Chengdu 610041, China.
| | - John A Sweeney
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati 45219, OH, USA; Huaxi MR Research Center (HMRRC), Department of Radiology, The Center for Medical Imaging, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati 45219, OH, USA
| | - Robert K McNamara
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati 45219, OH, USA
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12
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Brancati GE, Nunes A, Scott K, O'Donovan C, Cervantes P, Grof P, Alda M. Differential characteristics of bipolar I and II disorders: a retrospective, cross-sectional evaluation of clinical features, illness course, and response to treatment. Int J Bipolar Disord 2023; 11:25. [PMID: 37452256 PMCID: PMC10349025 DOI: 10.1186/s40345-023-00304-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The distinction between bipolar I and bipolar II disorder and its treatment implications have been a matter of ongoing debate. The aim of this study was to examine differences between patients with bipolar I and II disorders with particular emphasis on the early phases of the disorders. METHODS 808 subjects diagnosed with bipolar I (N = 587) or bipolar II disorder (N = 221) according to DSM-IV criteria were recruited between April 1994 and March 2022 from tertiary-level mood disorder clinics. Sociodemographic and clinical variables concerning psychiatric and medical comorbidities, family history, illness course, suicidal behavior, and response to treatment were compared between the bipolar disorder types. RESULTS Bipolar II disorder patients were more frequently women, older, married or widowed. Bipolar II disorder was associated with later "bipolar" presentation, higher age at first (hypo)mania and treatment, less frequent referral after a single episode, and more episodes before lithium treatment. A higher proportion of first-degree relatives of bipolar II patients were affected by major depression and anxiety disorders. The course of bipolar II disorder was typically characterized by depressive onset, early depressive episodes, multiple depressive recurrences, and depressive predominant polarity; less often by (hypo)mania or (hypo)mania-depression cycles at onset or during the early course. The lifetime clinical course was more frequently rated as chronic fluctuating than episodic. More patients with bipolar II disorder had a history of rapid cycling and/or high number of episodes. Mood stabilizers and antipsychotics were prescribed less frequently during the early course of bipolar II disorder, while antidepressants were more common. We found no differences in global functioning, lifetime suicide attempts, family history of suicide, age at onset of mood disorders and depressive episodes, and lithium response. CONCLUSIONS Differences between bipolar I and II disorders are not limited to the severity of (hypo)manic syndromes but include patterns of clinical course and family history. Caution in the use of potentially mood-destabilizing agents is warranted during the early course of bipolar II disorder.
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Affiliation(s)
- Giulio Emilio Brancati
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Abraham Nunes
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Memorial Building (room 3088), Halifax, NS, B3H 2E2, Canada
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Katie Scott
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Memorial Building (room 3088), Halifax, NS, B3H 2E2, Canada
| | - Claire O'Donovan
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Memorial Building (room 3088), Halifax, NS, B3H 2E2, Canada
| | - Pablo Cervantes
- Department of Psychiatry, McGill University Health Centre, Montreal, QC, Canada
| | - Paul Grof
- Mood Disorders Center of Ottawa, Ottawa, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Martin Alda
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Memorial Building (room 3088), Halifax, NS, B3H 2E2, Canada.
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Meisinger C, Freuer D. Understanding the causal relationships of attention-deficit/hyperactivity disorder with mental disorders and suicide attempt: a network Mendelian randomisation study. BMJ MENTAL HEALTH 2023; 26:e300642. [PMID: 37669871 PMCID: PMC11146378 DOI: 10.1136/bmjment-2022-300642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 07/09/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a lifespan neurodevelopmental condition resulting from complex interactions between genetic and environmental risk factors. There is evidence that ADHD is associated with other mental disorders, but it remains unclear whether and in what way a causal relationship exists. OBJECTIVE To investigate the direct and indirect causal paths between ADHD and seven common mental disorders. METHODS Two-sample network Mendelian randomisation analysis was performed to identify psychiatric disorders causally related to ADHD. Total and direct effects were estimated in an univariable and multivariable setting, respectively. Robustness of results was ensured in three ways: a range of pleiotropy-robust methods, an iterative approach identifying and excluding outliers, and use of up to two genome-wide association studies per outcome to replicate results and calculate subsequently pooled meta-estimates. RESULTS Genetic liability to ADHD was independently associated with the risk of anorexia nervosa (OR 1.28 (95% CI 1.11 to 1.47); p=0.001). A bidirectional association was found with major depressive disorder (OR 1.09 (95% CI 1.03 to 1.15); p=0.003 in the forward direction and OR 1.76 (95% CI 1.50 to 2.06); p=4×10-12 in the reverse direction). Moreover, after adjustment for major depression disorder, a direct association with both suicide attempt (OR 1.30 (95% CI 1.16 to 1.547); p=2×10-5) and post-traumatic stress disorder (OR 1.18 (95% CI 1.05 to 1.33); p=0.007) was observed. There was no evidence of a relationship with anxiety, bipolar disorder or schizophrenia. CONCLUSIONS This study suggests that ADHD is an independent risk factor for a number of common psychiatric disorders. CLINICAL IMPLICATIONS The risk of comorbid psychiatric disorders in individuals with ADHD needs to be considered both in diagnosis and treatment.
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Affiliation(s)
- Christa Meisinger
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Dennis Freuer
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
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14
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Brancati GE, Acierno D, Barbuti M, Elefante C, Gemignani S, Raia A, Perugi G. Revisiting stimulant use for emotional dysregulation in attention-deficit/hyperactivity disorder (ADHD). Expert Rev Neurother 2023; 23:981-994. [PMID: 37747111 DOI: 10.1080/14737175.2023.2263645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/22/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Emotional dysregulation (ED) symptoms are present in a considerable portion of patients with attention-deficit/hyperactivity disorder (ADHD). In recent years, an increasing number of studies investigated the effects of stimulant medications on ED in patients with ADHD. AREAS COVERED A narrative review of the literature on stimulant treatment for ED is provided, including controlled and observational clinical studies conducted on pediatric and adult samples and neurobiological investigations. Positive effects of stimulants on irritability have been demonstrated in children. Comorbidity with disruptive behavior disorders (DBD) and disruptive mood dysregulation disorder does not prevent stimulant effectiveness. Methylphenidate has also been found to reduce temper problems, affective instability, and emotional over-reactivity in adults with ADHD, although with variable effect sizes. A variety of adverse emotional effects have been reported, especially at high doses and in special populations. However, several possible confounders of treatment-emergent ED have been highlighted. Finally, according to neuroimaging studies, stimulants may mitigate emotional processing anomalies associated with ADHD. EXPERT OPINION The findings are consistent with models including ED within the core features of ADHD. Stimulant treatment should be prioritized over antipsychotics in ADHD-DBD. It remains to be elucidated whether other medications may be more effective in specific populations with ADHD and/or ED.
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Affiliation(s)
- Giulio Emilio Brancati
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Donatella Acierno
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Margherita Barbuti
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Camilla Elefante
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Samuele Gemignani
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Accursio Raia
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giulio Perugi
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
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15
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Salazar de Pablo G, Cabras A, Pereira J, Castro Santos H, de Diego H, Catalan A, González-Pinto A, Birmaher B, Correll CU, Fusar-Poli P. Predicting bipolar disorder I/II in individuals at clinical high-risk: Results from a systematic review. J Affect Disord 2023; 325:778-786. [PMID: 36657494 DOI: 10.1016/j.jad.2023.01.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION No systematic review has estimated the consistency and the magnitude of the risk of developing bipolar disorder I-II (BD-I/II) in individuals at clinical high risk for bipolar disorder (CHR-BD). METHODS PubMed and Web of Science databases were searched until April 2022 in this pre-registered (PROSPERO CRD42022346515) PRISMA-compliant systematic review to identify longitudinal studies in individuals meeting pre-defined CHR-BD criteria. The risk of bias was assessed using the Newcastle-Ottawa Scale, and results were systematically synthesized around CHR-BD criteria across follow-up periods and different subgroups. RESULTS Altogether, 13 studies were included reporting on nine prospective independent cohorts (n = 678 individuals at CHR-BD). The mean age of participants was 15.7 years (range 10.1-22.6 years), and 54.2 % were females. The most common CHR-BD subgroup was subthreshold mania (55.5 %), followed by BD-Not Otherwise Specified (BD-NOS: 33.3 %). Development of BD I/II ranged from 7.1 % to 23.4 % after 2 years. Development of BD-I ranged from 3.4 % at 4 years to 23 % at 8 years. Development of BD-II ranged from 10 % at 2 years to 63.8 % at 4 years. The risk of developing BD-I appeared highest in those meeting BD-NOS criteria (23 % at eight years). Predictors of development of BD were identified but remained mostly unreplicated. The quality of the included studies was moderate (NOS = 5.2 ± 1.1). CONCLUSIONS Emerging data from research studies point towards the promising utility of CHR-BD criteria. These studies may pave the way to the next generation of research, implementing detection, prognostication, and preventive interventions in individuals at CHR-BD identified and followed in clinical practice.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK; Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain.
| | - Anna Cabras
- Department of Neurology and Psychiatry, University of Rome La Sapienza, Rome, Italy
| | - Joana Pereira
- Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | | | - Héctor de Diego
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Ana Catalan
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Psychiatry Department, Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto, Facultad de Medicina y Odontología, University of the Basque Country UPV/EHU, Centro de Investigación en Red de Salud Mental, (CIBERSAM), Instituto de Salud Carlos III, Plaza de Cruces 12, 48903 Barakaldo, Bizkaia, Spain
| | - Ana González-Pinto
- Departmennt of Psychiatry, Araba University Hospital, Bioaraba Research Institute, CIBER-ISCIII-Salud Mental, Vitoria, Spain; Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
| | - Boris Birmaher
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, PA, USA
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; OASIS service, South London and Maudsley NHS Foundation Trust, London, UK; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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16
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Khoury E, Acquaviva E, Purper-Ouakil D, Delorme R, Ellul P. Meta-analysis of personal and familial co-occurrence of Attention Deficit/Hyperactivity Disorder and Bipolar Disorder. Neurosci Biobehav Rev 2023; 146:105050. [PMID: 36657649 DOI: 10.1016/j.neubiorev.2023.105050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Attention Deficit Disorder / Hyperactivity (ADHD) and Bipolar Disorder (BD) are highly comorbid disorders. Studies have raised the hypothesis of shared genetic, neurobiological, and clinical factors. This would entail an excess risk of co-occurrence of both disorders. OBJECTIVE We present the first meta-analysis of individual and familial associations between ADHD and BD. METHODS From 2688 references, 59 were included, with a total of 550,379 ADHD patients, 57,799 BD patients and 12,608,137 controls. RESULTS Personal history of ADHD increased the risk of BD (OR = 6.06), and conversely individuals with BD had an increased risk of ADHD (OR = 8.94). First-degree relatives of ADHD patients had an increased risk of BD (OR = 1.94). Offspring of individuals with BD had a higher risk for ADHD (OR = 2.33). Finally, first-degree relatives of BD patients had an increased risk of ADHD (OR = 2.71). CONCLUSION We show a clear epidemiological overlap between ADHD and BD, as well as a strong familial association which advocates in favor of a more systematic screening.
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Affiliation(s)
- Elie Khoury
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, APHP, 48 boulevard Sérurier, 75019 Paris, France.
| | - Eric Acquaviva
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, APHP, 48 boulevard Sérurier, 75019 Paris, France.
| | - Diane Purper-Ouakil
- CHU Montpellier-Saint Eloi Hospital, University of Montpellier, Unit of Child and Adolescent Psychiatry (MPEA1), 80 Av. Augustin Fliche, 34090 Montpellier, France; INSERM CESP U 1018 Psychiatry, Development and Trajectories, France.
| | - Richard Delorme
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, APHP, 48 boulevard Sérurier, 75019 Paris, France; Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France.
| | - Pierre Ellul
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, APHP, 48 boulevard Sérurier, 75019 Paris, France; INSERM Immunology-Immunopathology-Immunotherapy (i3), UMRS 959, Paris, France.
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17
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Miola A, Tondo L, Pinna M, Contu M, Baldessarini RJ. Comparison of bipolar disorder type II and major depressive disorder. J Affect Disord 2023; 323:204-212. [PMID: 36410453 DOI: 10.1016/j.jad.2022.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/03/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Compare patients diagnosed as DSM-5 type II bipolar disorder (BD2) vs. major depressive disorder (MDD). METHODS We compared characteristics of 3246 closely and repeatedly evaluated, consenting, adult patient-subjects (n = 706 BD2, 2540 MDD) at a specialty clinic using bivariate methods and multivariable modeling. RESULTS Factors more associated with BD2 than MDD included: [a] descriptors (more familial psychiatric, mood and bipolar disorders and suicide; younger at onset, diagnosis and first-treatment; more education; more unemployment; fewer marriages and children; higher cyclothymic, hyperthymic and irritable temperament ratings, lower anxious); [b] morbidity (more hypomanic, mixed or panic first episodes; more co-occurring general medical diagnoses, more Cluster B personality disorder diagnoses and ADHD; more alcohol and drug abuse and smoking; shorter depressive episodes and interepisode periods; lower intake ratings of depression and anxiety, higher for hypomania; far more mood-switching with antidepressants; lower %-time depressed; DMI > MDI course-pattern in BD2; more suicide attempts and violent suicidal behavior); [c] item-scores with intake HDRS21 higher for suicidality, paranoia, anhedonia, guilt, and circadian variation; lower somatic anxiety, depressed mood, insight, hypochondriasis, agitation, and insomnia; and [d] treatment (more lithium, mood-stabilizing anticonvulsants and antipsychotics, less antidepressants and benzodiazepines). CONCLUSIONS BD2 and MDD subjects differed greatly in many descriptive, psychopathological and treatment measures, notably including more familial risk, earlier onset, more frequent recurrences and greater suicidal risk with BD2. Such differences can contribute to improving differentiation of the disorders and planning for their treatment.
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Affiliation(s)
- Alessandro Miola
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, United States of America; Department of Neuroscience, Padova Neuroscience Center, University of Padova, Padua, Italy.
| | - Leonardo Tondo
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Lucio Bini Mood Disorder Center, Cagliari, Italy
| | - Marco Pinna
- Lucio Bini Mood Disorder Center, Cagliari, Italy; Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Italy
| | | | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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18
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Brancati GE, De Dominicis F, Petrucci A, Pallucchini A, Carli M, Medda P, Schiavi E, De Rossi P, Vicari S, Perugi G. Long-term treatment of adult ADHD in a naturalistic setting: clinical predictors of attrition, medication choice, improvement, and response. World J Biol Psychiatry 2023:1-16. [PMID: 36637001 DOI: 10.1080/15622975.2023.2168750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objectives: The aim of this study was to identify clinical predictors of treatment attrition, medication choice, improvement and response to pharmacotherapy in adult attention-deficit/hyperactivity disorder (ADHD). Methods: 150 ADHD patients were enrolled and naturalistically followed-up for at least 4 months. Conners' Adult ADHD Rating Scales-Observer: Screening Version (CAARS-O:SV) were used to measure ADHD severity. Results: 58 subjects (38.7%) were lost at follow-up, while 75 (50%) completed follow-up assessment, on average after 26.05 ± 11.99 weeks; 35 were treated with atomoxetine (ATX) and 40 with methylphenidate (MPH). Treatments were moderately effective (d = 0.72) and 37 patients (49.3%) were responders (≥30% CAARS-O:SV decrease). Patients lost at follow-up had lower inattentive symptoms, less generalized anxiety and family history of bipolar disorder, more amphetamine use disorder than follow-up completers. Compared to ATX-treated subjects, MPH-treated patients had greater severity of hyperactivity/impulsivity and were more frequently diagnosed with alcohol use disorder. While MPH and ATX showed similar efficacy, more pronounced improvements were observed in patients with combined ADHD, anxiety and substance use disorders. ADHD severity and comorbid substance use positively predicted response. Conclusions: Consensus-based hierarchical treatment of ADHD comorbidity is not consistently supported. Comorbid anxiety, mood and substance use disorders should not discourage the treatment of adult ADHD.
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Affiliation(s)
- Giulio Emilio Brancati
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | | | - Alessandra Petrucci
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | | | - Marco Carli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Pierpaolo Medda
- Psychiatry Unit 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Elisa Schiavi
- Psychiatry Unit 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Pietro De Rossi
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I.R.C.C.S. Bambino Gesù Children's Hospital, Rome (Italy)
| | - Stefano Vicari
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I.R.C.C.S. Bambino Gesù Children's Hospital, Rome (Italy)
| | - Giulio Perugi
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
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19
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Sesso G, Brancati GE, Masi G. Comorbidities in Youth with Bipolar Disorder: Clinical Features and Pharmacological Management. Curr Neuropharmacol 2023; 21:911-934. [PMID: 35794777 PMCID: PMC10227908 DOI: 10.2174/1570159x20666220706104117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/14/2022] [Accepted: 06/13/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Bipolar Disorder (BD) is a highly comorbid condition, and rates of cooccurring disorders are even higher in youth. Comorbid disorders strongly affect clinical presentation, natural course, prognosis, and treatment. METHODS This review focuses on the clinical and treatment implications of the comorbidity between BD and Attention-Deficit/Hyperactivity Disorder, disruptive behavior disorders (Oppositional Defiant Disorder and/or Conduct Disorder), alcohol and substance use disorders, Autism Spectrum Disorder, anxiety disorders, Obsessive-Compulsive Disorder, and eating disorders. RESULTS These associations define specific conditions which are not simply a sum of different clinical pictures, but occur as distinct and complex combinations with specific developmental pathways over time and selective therapeutic requirements. Pharmacological treatments can improve these clinical pictures by addressing the comorbid conditions, though the same treatments may also worsen BD by inducing manic or depressive switches. CONCLUSION The timely identification of BD comorbidities may have relevant clinical implications in terms of symptomatology, course, treatment and outcome. Specific studies addressing the pharmacological management of BD and comorbidities are still scarce, and information is particularly lacking in children and adolescents; for this reason, the present review also included studies conducted on adult samples. Developmentally-sensitive controlled clinical trials are thus warranted to improve the prognosis of these highly complex patients, requiring timely and finely personalized therapies.
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Affiliation(s)
- Gianluca Sesso
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiat., Calambrone (Pisa), Italy
| | | | - Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiat., Calambrone (Pisa), Italy
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20
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Bartoli F, Callovini T, Cavaleri D, Cioni RM, Bachi B, Calabrese A, Moretti F, Canestro A, Morreale M, Nasti C, Palpella D, Piacenti S, Nacinovich R, Riboldi I, Crocamo C, Carrà G. Clinical correlates of comorbid attention deficit hyperactivity disorder in adults suffering from bipolar disorder: A meta-analysis. Aust N Z J Psychiatry 2023; 57:34-48. [PMID: 35786010 DOI: 10.1177/00048674221106669] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Attention deficit hyperactivity disorder is a frequent comorbid condition in adults with bipolar disorder. We performed a meta-analysis aimed at assessing sociodemographic and clinical correlates of attention deficit hyperactivity disorder in bipolar disorder. METHOD We searched main electronic databases up to June 2021. Random-effects meta-analyses, with relevant meta-regression and quality-based sensitivity analyses, were carried out to estimate the association between attention deficit hyperactivity disorder and putative correlates, grading the quality of evidence. RESULTS We included 43 studies, based on 38 independent samples. Attention deficit hyperactivity disorder participants were more likely to be males (odds ratio = 1.46; p < 0.001) and unemployed (odds ratio = 1.45; p = 0.045), and less likely to be married (odds ratio = 0.62; p = 0.014). They had an earlier onset of bipolar disorder (standardized mean difference = -0.36; p < 0.001); more mood episodes (standardized mean difference = 0.35; p = 0.007), particularly depressive (standardized mean difference = 0.30; p = 0.011) and mixed (standardized mean difference = 0.30; p = 0.031) ones; higher odds of using antidepressants (odds ratio = 1.80; p = 0.024) and attempted suicides (odds ratio = 1.83; p < 0.001) and lower odds of psychotic features (odds ratio = 0.63; p = 0.010). Moreover, they were more likely to have generalized anxiety disorder (odds ratio = 1.50; p = 0.019), panic disorder (odds ratio = 1.89; p < 0.001), social phobia (odds ratio = 1.61; p = 0.017), eating disorders (odds ratio = 1.91; p = 0.007), antisocial personality disorder (odds ratio = 3.59; p = 0.004) and substance (odds ratio = 2.29; p < 0.001) or alcohol (odds ratio = 2.28; p < 0.001) use disorders. Quality of the evidence was generally low or very low for the majority of correlates, except for bipolar disorder onset and alcohol/substance use disorders (high), and suicide attempts (moderate). CONCLUSION Comorbid bipolar disorder/attention deficit hyperactivity disorder may have some distinctive clinical features including an earlier onset of bipolar disorder and higher comorbid alcohol/substance use disorder rates. Further research is needed to identify additional clinical characteristics of this comorbidity.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Daniele Cavaleri
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Bianca Bachi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Federico Moretti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Aurelia Canestro
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Morreale
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Christian Nasti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Dario Palpella
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Susanna Piacenti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Renata Nacinovich
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Division of Psychiatry, University College London, London, UK
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21
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Chen C, Tallman MJ, Cecil KM, Patino LR, Blom TJ, DelBello MP, McNamara RK. Symptom Profiles, But Not Prefrontal Neurochemistry, Differentiate ADHD Youth With and Without a Family History of Bipolar I Disorder. J Atten Disord 2022; 26:1762-1773. [PMID: 35658594 DOI: 10.1177/10870547221101645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To identify clinical and central features that differentiate ADHD youth with and without familial risk for bipolar I disorder (BD). Methods: Psychostimulant-free ADHD youth (10-18 years) with and without a first-degree relative with BD and healthy controls were enrolled. Bilateral ventrolateral prefrontal cortex (VLPFC) proton magnetic resonance spectroscopy (1H MRS) scans and a range of symptom ratings were performed. Results: A total of n = 145 youth were enrolled. ADHD youth with a family history of BD exhibited greater manic and depressive symptom severity, ADHD hyperactivity/impulsive symptom severity, and higher parent-reported ratings of dysregulation compared with ADHD youth without a BD family history. Although VLPFC metabolite levels did not differ across groups, choline levels in the left VLPFC correlated with different symptom ratings. Conclusion: Symptom profiles including more severe mood and externalizing symptoms, but not VLPFC neurochemistry, differentiate psychostimulant-free ADHD youth with and without a family history of BD.
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Affiliation(s)
| | | | - Kim M Cecil
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, OH, USA
| | | | - Thomas J Blom
- University of Cincinnati College of Medicine, OH, USA
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22
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Durdurak BB, Altaweel N, Upthegrove R, Marwaha S. Understanding the development of bipolar disorder and borderline personality disorder in young people: a meta-review of systematic reviews. Psychol Med 2022; 52:1-14. [PMID: 36177878 PMCID: PMC9816307 DOI: 10.1017/s0033291722003002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND There is ongoing debate on the nosological position of bipolar disorder (BD) and borderline personality disorder (BPD). Identifying the unique and shared risks, developmental pathways, and symptoms in emerging BD and BPD could help the field refine aetiological hypotheses and improve the prediction of the onset of these disorders. This study aimed to: (a) systematically synthesise the available evidence from systematic reviews (SRs) and meta-analyses (MAs) concerning environmental, psychosocial, biological, and clinical factors leading to the emergence of BD and BPD; (b) identify the main differences and common features between the two disorders to characterise their complex interplay and, (c) highlight remaining evidence gaps. METHODS Data sources were; PubMed, PsychINFO, Embase, Cochrane, CINAHL, Medline, ISI Web of Science. Overlap of included SRs/MAs was assessed using the corrected covered area process. The methodological quality of each included SR and MA was assessed using the AMSTAR. RESULTS 22 SRs and MAs involving 249 prospective studies met eligibility criteria. Results demonstrated that family history of psychopathology, affective instability, attention deficit hyperactivity disorder, anxiety disorders, depression, sleep disturbances, substance abuse, psychotic symptoms, suicidality, childhood adversity and temperament were common predisposing factors across both disorders. There are also distinct factors specific to emerging BD or BPD. CONCLUSIONS Prospective studies are required to increase our understanding of the development of BD and BPD onset and their complex interplay by concurrently examining multiple measures in BD and BPD at-risk populations.
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Affiliation(s)
- Buse Beril Durdurak
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Nada Altaweel
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Rachel Upthegrove
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- Specialist Mood Disorders Clinic, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
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23
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McNamara RK, Chen C, Tallman MJ, Schurdak JD, Patino LR, Blom TJ, DelBello MP. Familial risk for bipolar I disorder is associated with erythrocyte omega-3 polyunsaturated fatty acid deficits in youth with attention-deficit hyperactivity disorder. Psychiatry Res 2022; 313:114587. [PMID: 35550258 DOI: 10.1016/j.psychres.2022.114587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/06/2022] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
Abstract
Although attention-deficit/hyperactivity disorder (ADHD) and a family history of bipolar I disorder (BD) increase the risk for developing BD, associated pathoetiological mechanisms remain poorly understood. One candidate risk factor is a neurodevelopmental deficiency in omega-3 polyunsaturated fatty acids, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). This study investigated erythrocyte EPA+DHA biostatus in psychostimulant-free ADHD youth with ('high-risk', HR) and without ('low-risk', LR) a first-degree relative with BD, and healthy controls (HC). Erythrocyte EPA+DHA composition was determined by gas chromatography, and symptom ratings were performed. A total of n = 123 (HR, n = 41; LR, n = 42; HC, n = 40) youth (mean age: 14.4 ± 2.5 years) were included in the analysis. Compared with HC, erythrocyte EPA+DHA composition was significantly lower in HR (-13%) but not LR (-3%), and there was a trend for HR to be lower than LR (-11%). Both HR and LR differed significantly from HC on all symptom ratings. HR had greater ADHD hyperactivity/impulsive symptom severity, manic symptom severity, and higher parent-reported ratings of internalization, externalization, and dysregulation, compared with LR. ADHD youth with a BD family history exhibit erythrocyte EPA+DHA deficits and a more severe clinical profile, including greater manic and dysregulation symptoms, compared with ADHD youth without a BD family history.
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Affiliation(s)
- Robert K McNamara
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267 USA.
| | - Constance Chen
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267 USA
| | - Maxwell J Tallman
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267 USA
| | - Jennifer D Schurdak
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267 USA
| | - L Rodrigo Patino
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267 USA
| | - Thomas J Blom
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267 USA
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267 USA
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Comparelli A, Polidori L, Sarli G, Pistollato A, Pompili M. Differentiation and comorbidity of bipolar disorder and attention deficit and hyperactivity disorder in children, adolescents, and adults: A clinical and nosological perspective. Front Psychiatry 2022; 13:949375. [PMID: 36032257 PMCID: PMC9403243 DOI: 10.3389/fpsyt.2022.949375] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
Bipolar Disorder (BD) and Attention Deficit and Hyperactivity Disorder (ADHD) are mental disorders with high degree of lifetime comorbidity. Both BD and ADHD are disorders with onset in childhood and early adolescence. Both disorders are often undiagnosed, misdiagnosed, and sometimes overdiagnosed, leading to high rates of morbidity and disability. The psychiatric and behavioral symptoms associated with ADHD and BD have significant overlap. Albeit the existence of a large body of literature, it is far from being clear whether comorbidity can be explained by the confounding overlap of operationally defined criteria or whether it reflects a genuine comorbidity of two biologically distinct disorders. The aim of this paper is to recognize and/or differentiate the pattern of ADHD across the course of BD from a nosological point of view, focusing on specific clinical and neurobiological dimensions. We found that some critical issues may help to fulfill the purpose of our perspective. We suggest that the relationship between ADHD and BD, based on clinical, developmental, and epidemiological commonalities, can be better clarified using four different scenarios.
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Affiliation(s)
- Anna Comparelli
- Department of Psychiatry, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Lorenzo Polidori
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Sarli
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Andrea Pistollato
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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