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Volpe U. Need for further exploring at the intersection of ADHD medications and bipolar disorder. Bipolar Disord 2024. [PMID: 39043629 DOI: 10.1111/bdi.13467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Affiliation(s)
- U Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Università Politecnica delle Marche, Ancona, Italy
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2
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Osnaya-Brizuela N, Valenzuela-Peraza A, Santamaría-del Ángel D, García-Martínez Y, Pacheco-Rosado J, Pérez-Sánchez G, Sánchez-Huerta K. Is the acquired hypothyroidism a risk factor for developing psychiatric disorders? Front Psychiatry 2024; 15:1429255. [PMID: 39100850 PMCID: PMC11294236 DOI: 10.3389/fpsyt.2024.1429255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/20/2024] [Indexed: 08/06/2024] Open
Abstract
Hypothyroidism is a prevalent thyroid condition in which the thyroid gland fails to secrete an adequate amount of thyroid hormone into the bloodstream. This condition may develop due to genetic or acquired factors. The most frequent cause of acquired hypothyroidism is chronic autoimmune thyroiditis, also known as Hashimoto's disease. Acquired hypothyroidism is diagnosed when patients present with overt hypothyroidism (also known as clinical hypothyroidism), as they exhibit increased TSH and decreased T3 and T4 serum levels. This article examines the prevalence of psychiatric disorders among patients diagnosed with acquired hypothyroidism with or without Levothyroxine treatment. We discuss the available evidence indicating that acquired hypothyroidism may be a risk factor for psychiatric disorders, and the effectiveness of thyroid treatment in relieving psychiatric symptoms. Additionally, we provide critical details on thyroid hormone cutoff values reported in the literature, their potential clinical importance, and their correlation with psychiatric symptoms. Finally, we examined the various mechanisms by which acquired hypothyroidism can lead to depression. The high rate of comorbidity between hypothyroidism and psychiatric disorders deserves special attention, indicating the importance of consistent monitoring and timely identification of psychiatric symptoms to prevent disease exacerbation and facilitate therapeutic management. On the other hand, several mechanisms underlie the strong association between depression and acquired hypothyroidism. Deeper research into these mechanisms will allow knowledge of the pathophysiology of depression in patients with acquired hypothyroidism and will provide clues to design more precise therapeutic strategies for these patients.
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Affiliation(s)
- Norma Osnaya-Brizuela
- Laboratorio de Neurociencias, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Armando Valenzuela-Peraza
- Laboratorio de Neurociencias, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Daniel Santamaría-del Ángel
- Laboratorio de Neurociencias, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Yuliana García-Martínez
- Departamento de Fisiología “Mauricio Russek”, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Jorge Pacheco-Rosado
- Departamento de Fisiología “Mauricio Russek”, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Gilberto Pérez-Sánchez
- Laboratorio de Psicoinmunología, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Ciudad de México, Mexico
| | - Karla Sánchez-Huerta
- Laboratorio de Neurociencias, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Ciudad de México, Mexico
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Gaspar N, Kilarski LL, Rosen H, Huppertz M, Philipsen A, Rohner H. Attention Deficit Hyperactivity Disorder: A Risk Factor for Premature Discontinuation of Inpatient Opioid Withdrawal Treatment. J Clin Med 2024; 13:3301. [PMID: 38893012 PMCID: PMC11173055 DOI: 10.3390/jcm13113301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/11/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Substance use disorders present a tremendous challenge within contemporary healthcare systems. Specifically, in the domain of opioid use disorders (OUDs), several foundational elements are crucial for the efficacious management of afflicted individuals. Regrettably, the premature discontinuation of inpatient opioid withdrawal treatment is a prevalent phenomenon. This study aims to elucidate the prevalence of the premature termination of inpatient opioid withdrawal treatment among patients with comorbid ADHD. Methods: We conducted a comprehensive assessment of all participants currently undergoing inpatient opioid withdrawal treatment. Our assessment protocol included the administration of the ADHD Self-Report Scale (ADHD-SR) and the Wender Utah Rating Scale (WURS-k). Additionally, participants who met the thresholds on one or both questionnaires underwent further evaluation using the Diagnostic Interview for ADHD in Adults (DIVA-2.0). Results: The prevalence of individuals diagnosed with ADHD within the studied cohort was determined to be 29.3%. Among the subset of participants identified as ADHD-positive, a notable 54.5% prematurely ceased therapy. In contrast, among those identified as ADHD-negative, the premature discontinuation rate was substantially lower at 28.3%. Conclusions: In summary, the impact of ADHD as a comorbid condition on the efficacy of inpatient opioid withdrawal treatment has been underscored. By identifying comorbid ADHD early in the treatment process, tailored therapeutic approaches may help to maximize the effectiveness of interventions and may improve patient outcomes. This underscores the importance of proactive screening for ADHD as a psychiatric comorbidity in optimizing the management of individuals undergoing inpatient opioid withdrawal treatment.
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Affiliation(s)
- Nikolas Gaspar
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany
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Rodriguez VJ, Finley JCA, Liu Q, Alfonso D, Basurto KS, Oh A, Nili A, Paltell KC, Hoots JK, Ovsiew GP, Resch ZJ, Ulrich DM, Soble JR. Empirically derived symptom profiles in adults with attention-Deficit/hyperactivity disorder: An unsupervised machine learning approach. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-10. [PMID: 38657158 DOI: 10.1080/23279095.2024.2343022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is associated with various cognitive, behavioral, and mood symptoms that complicate diagnosis and treatment. The heterogeneity of these symptoms may also vary depending on certain sociodemographic factors. It is therefore important to establish more homogenous symptom profiles in patients with ADHD and determine their association with the patient's sociodemographic makeup. The current study used unsupervised machine learning to identify symptom profiles across various cognitive, behavioral, and mood symptoms in adults with ADHD. It was then examined whether symptom profiles differed based on relevant sociodemographic factors. METHODS Participants were 382 adult outpatients (62% female; 51% non-Hispanic White) referred for neuropsychological evaluation for ADHD. RESULTS Employing Gaussian Mixture Modeling, we identified two distinct symptom profiles in adults with ADHD: "ADHD-Plus Symptom Profile" and "ADHD-Predominate Symptom Profile." These profiles were primarily differentiated by internalizing psychopathology (Cohen's d = 1.94-2.05), rather than by subjective behavioral and cognitive symptoms of ADHD or neurocognitive test performance. In a subset of 126 adults without ADHD who were referred for the same evaluation, the unsupervised machine learning algorithm only identified one symptom profile. Group comparison analyses indicated that female patients were most likely to present with an ADHD-Plus Symptom Profile (χ2 = 5.43, p < .001). CONCLUSION The machine learning technique used in this study appears to be an effective way to elucidate symptom profiles emerging from comprehensive ADHD evaluations. These findings further underscore the importance of considering internalizing symptoms and patients' sex when contextualizing adult ADHD diagnosis and treatment.
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Affiliation(s)
- Violeta J Rodriguez
- Department of Psychology, University of Illinois at Urbana-Champaign, Illinois, USA
| | - John-Christopher A Finley
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Qimin Liu
- Department of Brain and Psychological Sciences, Boston, Massachusetts, USA
| | - Demy Alfonso
- Department of Psychiatry, University of Illinois at Chicago, Illinois, USA
| | - Karen S Basurto
- Department of Psychiatry, University of Illinois at Chicago, Illinois, USA
| | - Alison Oh
- Department of Psychiatry, University of Illinois at Chicago, Illinois, USA
| | - Amanda Nili
- Department of Psychiatry, University of Illinois at Chicago, Illinois, USA
| | | | - Jennifer K Hoots
- Department of Psychiatry, University of Illinois at Chicago, Illinois, USA
| | - Gabriel P Ovsiew
- Department of Psychiatry, University of Illinois at Chicago, Illinois, USA
| | - Zachary J Resch
- Department of Psychiatry, University of Illinois at Chicago, Illinois, USA
| | - Devin M Ulrich
- Department of Psychiatry, University of Illinois at Chicago, Illinois, USA
| | - Jason R Soble
- Department of Psychiatry, University of Illinois at Chicago, Illinois, USA
- Department of Neurology, University of Illinois at Chicago, Illinois, USA
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Wang C, Lv L, Xin B, Li N, Wang J, An C, Zhang K. Study on the Correlation between Hcy and Hs-CRP Levels and Cognitive Function in Patients with Bipolar Disorder and Borderline Personality Disorder. ACTAS ESPANOLAS DE PSIQUIATRIA 2024; 52:99-106. [PMID: 38622012 PMCID: PMC11015817 DOI: 10.62641/aep.v52i2.1548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVE This study aims to explore the correlation and clinical significance of homocysteine and high-sensitivity C-reactive protein levels with cognitive function in patients with bipolar disorder (BD) and borderline personality disorder (BPD). METHODS Patients with BD admitted to our hospital from January 2022 to December 2022 were chosen retrospectively. BPD patients were categorized into comorbidity groups, while those without BPD were assigned to non-comorbidity groups, each consisting of 60 cases. Enzyme-linked immunosorbent assay (ELISA) was utilized to assess serum levels of homocysteine (Hcy) and high-sensitivity C-reactive protein (hs-CRP) in both patient groups. Clinical symptoms were evaluated by the Hamilton Depression Rating Scale (HAMD) and the Young Mania Rating Scale (YMRS). Cognitive function was evaluated and compared using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Pearson correlation analysis was performed on the correlation between patients' serum Hcy and hs-CRP levels and HAMD, YMRS, and RBANS scores. RESULTS In the comorbidity group, patients exhibited significantly elevated serum Hcy and hs-CRP levels compared to the non-comorbidity group (p < 0.05). Patients in the comorbidity group displayed higher HAMD and YMRS scores than those in the non-comorbidity group (p < 0.05). Additionally, attention, speech, visual span, immediate memory, and delayed memory in the comorbidity group were notably lower than in the non-comorbidity group (p < 0.05). The speech, visual span, and immediate memory of RBANS in bipolar depressive patients with comorbid BPD were lower than those in bipolar depressive patients without comorbid BPD (p < 0.05), the speech of RBANS in bipolar manic patients with comorbid BPD was lower than those in bipolar manic patients without comorbid BPD (p < 0.05). Pearson correlation analysis showed that the expression of Hcy and hs-CRP in the comorbid group was positively correlated with HAMD and YMRS scores, and negatively correlated with attention, speech, visual span, immediate memory, and delayed memory, and these differences were statistically significant (p < 0.05). CONCLUSION High serum Hcy and hs-CRP expression levels may regulate inflammatory responses, aggravating cognitive impairment in patients with BD and BPD. Serum Hcy and hs-CRP expression levels are significantly related to cognitive dysfunction. They are expected to guide the prevention and treatment of BD comorbid BPD patients.
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Affiliation(s)
- Chaomin Wang
- Department of Psychiatry, The First Hospital of Hebei Medical University, 050031 Shijiazhuang, Hebei, China
| | - Lizhao Lv
- Department of Psychiatry, The First Hospital of Hebei Medical University, 050031 Shijiazhuang, Hebei, China
| | - Bo Xin
- Department of Psychiatry, The First Hospital of Hebei Medical University, 050031 Shijiazhuang, Hebei, China
| | - Na Li
- Department of Psychiatry, The First Hospital of Hebei Medical University, 050031 Shijiazhuang, Hebei, China
| | - Jincheng Wang
- Department of Psychiatry, The First Hospital of Hebei Medical University, 050031 Shijiazhuang, Hebei, China
| | - Cuixia An
- Department of Psychiatry, The First Hospital of Hebei Medical University, 050031 Shijiazhuang, Hebei, China
| | - Kun Zhang
- Department of Psychiatry, The First Hospital of Hebei Medical University, 050031 Shijiazhuang, Hebei, China
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Free M, Choi H, Baweja R. Compulsive Biting and Chewing with Mixed Amphetamine Salts: A Case Report. INNOVATIONS IN CLINICAL NEUROSCIENCE 2024; 21:11-13. [PMID: 38938532 PMCID: PMC11208004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Stimulants are the first-line pharmacological treatment for attention deficit hyperactivity disorder (ADHD). We present the unique case of a patient who developed a chewing compulsion when taking mixed amphetamine salts (MAS). A 32-year-old female patient with a past medical history of gastroesophageal reflux disease (GERD), gastroparesis, and migraines was seen for initial psychiatric assessment due to concerns for irritability. She was diagnosed with post-traumatic stress disorder (PTSD); generalized anxiety disorder; ADHD, inattentive type; and unspecified bipolar disorder. Lamotrigine was started and titrated to 25mg twice per day, with improved mood stability. MAS immediate-release (IR) was started at 2.5mg and titrated to 5mg daily for ADHD. She then experienced an uncontrollable urge to chew, finding relief when chewing on a child's teething necklace, which provided satisfaction and a reduction in anxiety. She denied jaw tightness or teeth grinding. The dose of MAS IR was reduced to 2.5mg daily with improvement in symptoms and later increased again to 5mg daily, which she was then able to tolerate. Stereotyped biting behaviors have been observed in rats with the use of amphetamines, and the onset of compulsive behavior has emerged in children with the use of dextroamphetamine. However, this is the first known case of compulsive chewing or biting movements reported in humans with MAS use. This case highlights the need to assess patients for adverse events, such as compulsive biting and chewing movements or other oral facial stereotypies, after commencement of stimulants, including MAS.
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Affiliation(s)
- Melissa Free
- Drs. Free and Baweja are with Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center in Hershey, Pennsylvania
| | - Hena Choi
- Ms. Choi is with Penn State College of Medicine in Hershey, Pennsylvania
| | - Ritika Baweja
- Drs. Free and Baweja are with Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center in Hershey, Pennsylvania
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Vallabh A. Pharmacologic treatment of bipolar disorder and comorbid adult attention-deficit/hyperactivity disorder. Ment Health Clin 2024; 14:82-84. [PMID: 38694888 PMCID: PMC11058322 DOI: 10.9740/mhc.2024.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 05/04/2024] Open
Affiliation(s)
- Anuja Vallabh
- Psychiatric Clinical Pharmacist Practitioner, VISN 12 Clinical Resource Hub, Jesse Brown VA Medical Center, Chicago, Illinois,
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Woods J, Kiai N, Padhy R, Bangasan R, Torrico T. Suspected geriatric onset of attention-deficit/hyperactivity disorder in a patient with comorbid bipolar disorder. BMC Geriatr 2024; 24:228. [PMID: 38443842 PMCID: PMC10916143 DOI: 10.1186/s12877-024-04852-2] [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: 03/31/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND An increasing number of adults over 60 years old are presenting with requests for treatment of attention-deficit/hyperactivity disorder (ADHD). However, the prevalence of ADHD in older adults in geriatrics is unknown. Further, comorbid bipolar disorder and adult ADHD are likely underrecognized with many patients only receiving treatment for one of these conditions. The occurrence of bipolar disorder with geriatric onset ADHD is unknown. CASE PRESENTATION A 64-year-old Hispanic woman with a psychiatric history of bipolar I disorder (diagnosed in early adulthood) was diagnosed with ADHD suspected of geriatric onset, and able to be successfully managed on concurrent mood stabilizers and psychostimulant medication. CONCLUSIONS The findings of this case report emphasize the importance of appropriately recognizing and treating comorbid ADHD and bipolar disorder in any age group, including the geriatric population for which this occurrence appears to be very rare. Additionally, this case report demonstrates the safe utilization of psychostimulant medications in a geriatric patient with bipolar disorder without inducing a manic episode or other significant adverse reactions.
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Affiliation(s)
- Joshua Woods
- Ross University School of Medicine, Miramar, Florida, USA
| | - Nakisa Kiai
- Kern Medical, Department of Psychiatry, Bakersfield, California, USA
| | - Ranjit Padhy
- Kern Medical, Department of Psychiatry, Bakersfield, California, USA
| | - Rossano Bangasan
- Kern Medical, Department of Psychiatry, Bakersfield, California, USA
| | - Tyler Torrico
- Kern Medical, Department of Psychiatry, Bakersfield, California, USA.
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Turiaco F, Cullotta C, Mannino F, Bruno A, Squadrito F, Pallio G, Irrera N. Attention Deficit Hyperactivity Disorder (ADHD) and Polyphenols: A Systematic Review. Int J Mol Sci 2024; 25:1536. [PMID: 38338814 PMCID: PMC10855440 DOI: 10.3390/ijms25031536] [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: 12/30/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Polyphenols are natural compounds also contained in daily consumed foods that show their efficacy in different clinical fields. Both pre-clinical and clinical studies demonstrated that polyphenols may manage neuroinflammation and oxidative stress processes tightly connected to neurodegenerative diseases and mental disorders. Thus, a neuroinflammatory state may influence the neurotransmitters pathways, such as the noradrenergic, glutamatergic, serotoninergic, and, in particular, dopaminergic ones, whose impairment is strongly associated with attention deficit hyperactivity disorder (ADHD). Therefore, the aim of the present systematic review is to provide an overview of the clinical outcomes' changes following ADHD treatment with polyphenols alone and in combination with the traditional drugs. This review was conducted according to PRISMA guidelines and recorded on PROSPERO with the number CRD42023438491; PubMed, Scopus, and Web of Science were used as search-engines to lead our research until June 2023. The inclusion criteria were articles written in English, including clinical, placebo-controlled, and case-control trials. We excluded reviews, metanalyses, background articles, and papers published in other languages. To avoid any bias, Rayyan software (COPYRIGHT © 2022 RAYYAN) was used to organize the work and manage the literature review. After screening, 10 studies were included, with a total of 556 patients that met the established inclusion criteria. The data obtained from these studies showed that polyphenols rebalanced oxidative stress pathways through different mechanisms, are effective for the treatment of ADHD both alone and in combination with traditional drugs, and are able to reduce symptoms as well as the side effects related to the use of conventional therapies. Finally, a positive effect of using polyphenols for ADHD prevention could be hypothesized.
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Affiliation(s)
- Fabrizio Turiaco
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (F.T.); (C.C.); (F.M.); (F.S.); (N.I.)
| | - Chiara Cullotta
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (F.T.); (C.C.); (F.M.); (F.S.); (N.I.)
| | - Federica Mannino
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (F.T.); (C.C.); (F.M.); (F.S.); (N.I.)
| | - Antonio Bruno
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98125 Messina, Italy;
| | - Francesco Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (F.T.); (C.C.); (F.M.); (F.S.); (N.I.)
| | - Giovanni Pallio
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98125 Messina, Italy;
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (F.T.); (C.C.); (F.M.); (F.S.); (N.I.)
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Lamas-Aguilar R, Diaz-Ruiz A, Navarro L, Miranda-Ojeda R, de Los Ángeles Martínez-Cárdenas M, Mata-Bermudez A, Rios C. Armodafinil as a Potential Pharmacological Treatment for Attention Deficit Hyperactivity Disorder in Adults: A Review. Curr Neuropharmacol 2024; 22:1899-1908. [PMID: 38486390 DOI: 10.2174/1570159x22666240131121642] [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: 08/30/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION Armodafinil is a psychostimulant that promotes alertness, and it has been shown to improve attention, memory, and fatigue in healthy adults and adults with neurodevelopmental conditions that share symptoms with Attention Deficit Hyperactivity Disorder (ADHD). It is generally well tolerated and safe, and most of the adverse events reported are considered not serious. However, the available evidence on the efficacy of armodafinil for the treatment of ADHD in adults is scarce. OBJECTIVE The present review aims to perform a systematized search of the available evidence on the possible therapeutic benefit of armodafinil treatment in adult patients with ADHD. METHODS A literature review using PubMed was conducted to compile and summarize the available clinical and scientific evidence on the possible use of armodafinil as a pharmacological treatment in adult patients with ADHD. RESULTS From the 86 articles reviewed, the available evidence showed that both acute and chronic treatment with armodafinil can improve wakefulness, memory, impulse control, and executive functions in adults with sleep disorders and other conditions. In addition, evidence of improvement in cognitive functions and mood alterations in other neuropsychiatric conditions was shown. CONCLUSION Armodafinil could be useful for the treatment of ADHD in adults, according to the review of the literature from both pre-clinical and clinical studies.
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Affiliation(s)
- Reyna Lamas-Aguilar
- Departamento de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - Araceli Diaz-Ruiz
- Departamento de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - Luz Navarro
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Raúl Miranda-Ojeda
- The Mind Project, Office for Equity, Diversity, Inclusion, and Belonging, Harvard University, Smith Campus Center, Cambridge, Massachusetts, USA
- Faculty of Medicine, Autonomous University of Mexico State, Toluca de Lerdo, Estado de Mexico, Mexico
| | | | - Alfonso Mata-Bermudez
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana Unidad Xochimilco, Ciudad de México, México
| | - Camilo Rios
- Dirección de Investigación, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra., Ciudad de México, México
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Kverno K, Ramos-Marcuse F. Reducing Risk in the Treatment of Attention-Deficit/Hyperactivity Disorder Among Adults With Comorbidities. J Psychosoc Nurs Ment Health Serv 2024; 62:8-11. [PMID: 38176004 DOI: 10.3928/02793695-20231212-01] [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: 01/06/2024]
Abstract
Recent widely publicized shortages in the U.S. supply of first-line medications for treatment of attention-deficit/hyperactivity disorder (ADHD) are thought to reflect increases in public awareness, help seeking, and treatment. ADHD is one of the most common neurodevelopmental disorders and is typically identified in childhood. In adulthood, ADHD symptoms are less likely to include hyperactivity, but inattention, impulsivity, and emotional dysregulation are common. Clinical evaluation of symptomatic adults who were not diagnosed as children requires corroboration of ADHD diagnostic symptoms in childhood and careful differentiation of ADHD from frequently co-occurring psychiatric and substance use disorders. Treatment of adult ADHD can result in improved functioning across multiple dimensions and comorbid disorders. Existing guidelines and consensus statements recommend an integrated approach to treating ADHD and all existing comorbid disorders, prioritizing the disorder that is creating the most difficulty for the individual. [Journal of Psychosocial Nursing and Mental Health Services, 62(1), 8-11.].
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Naik SS, Nidhi Y, Kumar K, Grover S. Diagnostic validity of premenstrual dysphoric disorder: revisited. Front Glob Womens Health 2023; 4:1181583. [PMID: 38090047 PMCID: PMC10711063 DOI: 10.3389/fgwh.2023.1181583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/04/2023] [Indexed: 06/30/2024] Open
Abstract
The World Health Organization (WHO) and American Psychiatric Association (APA) have recognised premenstrual dysphoric disorder (PMDD) as an independent diagnostic entity, legitimising the distress and socio-occupational impairment experienced by affected women. However, the biological validity of this diagnosis remains inexplicit. This illness has also been criticised for a feminist-led, sympathetic reaction to the modern cultural challenges of urban, literate, employed, high-functioning women. This article systematically reviews existing literature on PMDD using the criteria established by Robins and Guze for the validity of a psychiatric diagnosis (clinical description, laboratory study, exclusion of other disorders, follow-up study, and family study). Despite the early recognition of premenstrual syndrome (PMS) in the 1950s, the research has encountered challenges due to two groups of proponents viewing it with psychologising bias and medicalising bias. PMDD is currently understood as the most severe form of PMS, characterised by the presence of psychological features. Recent evidence suggests that PMDD perhaps has neurodevelopmental underpinnings (attention deficit hyperactive disorder, adverse childhood experiences) affecting the fronto-limbic circuit that regulates the emotions. In addition, the affected individuals exhibit an increased sensitivity to gonadal hormonal fluctuations as observed during premenstrual, pregnancy, and perimenopausal phases of life. The prevalence is comparable between high-income countries and low- and middle-income countries (LAMIC), refuting the notion that it mostly affects modern women. Instead, a greater prevalence is observed in LAMIC. Despite the fact that educated women possess knowledge regarding the importance of getting help, there is a prevalent issue of inadequate help-seeking behaviour. This can be attributed to the perception of seeking help as an isolating experience, which is influenced by profound internalised stigma and discrimination in the workplace. Future studies must aim to develop culturally validated assessment tools and more research to understand the life course of the illness, in addition to systematically examining for more biological validators (animal models, genetics, imaging, neurotransmitters).
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13
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MacDonald L, Sadek J. Management Strategies for Borderline Personality Disorder and Bipolar Disorder Comorbidities in Adults with ADHD: A Narrative Review. Brain Sci 2023; 13:1517. [PMID: 38002478 PMCID: PMC10669289 DOI: 10.3390/brainsci13111517] [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: 09/15/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
This narrative review examines two of the common comorbidities of attention-deficit/hyperactivity disorder, bipolar disorder (BD), and borderline personality disorder (BPD), which each share several common features with ADHD that can make assessment and diagnosis challenging. The review highlights some of the key symptomatic differences between adult ADHD and these disorders, allowing for more careful consideration before establishing a formal diagnosis. When the disorders are found to be comorbid, further complications may arise; thus, the review will also help to provide evidence-based treatment recommendations as well as suggestions on how to minimize adverse events. Incorporating evidence from systematic reviews, journal articles, randomized controlled trials, and case reports, this review highlights that the diagnosis of ADHD and some of its common comorbidities is challenging and requires full, in-depth assessment and management. The management strategies of these comorbidities will also be addressed, with emphasis on achieving mood stabilization for BD prior to initiating appropriate ADHD pharmacotherapy. Medications, specifically mood stabilizers, antipsychotics, and antidepressants, are fundamental in treating symptoms seen in BD and some cases of BPD, alongside psychotherapy and lifestyle modifications when appropriate. The review highlights the effectiveness of specific medications, including psychostimulants, atomoxetine, and bupropion, as add-on therapies to mood-stabilizing treatments for addressing ADHD symptoms in patients with these comorbidities. Despite limited research, the review will address various pharmacological and psychotherapeutic approaches for managing comorbid ADHD and BPD, emphasizing the need for further investigations to better understand the unique needs of this patient population.
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Affiliation(s)
- Luke MacDonald
- Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Joseph Sadek
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada
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Pouchon A, Nasserdine R, Dondé C, Bertrand A, Polosan M, Bioulac S. A systematic review of pharmacotherapy for attention-deficit/hyperactivity disorder in children and adolescents with bipolar disorders. Expert Opin Pharmacother 2023; 24:1497-1509. [PMID: 37300473 DOI: 10.1080/14656566.2023.2224920] [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: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The data suggests that in children and adolescents, bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD) may be strongly correlated. Even though drugs for ADHD and BD are largely accepted, there is relatively little research on the management of comorbidity in children and adolescents, particularly in terms of safety. We provide a synthesis of these findings because one hasn't been made yet. AREAS COVERED As a primary outcome, we wanted to determine whether stimulant or non-stimulant treatment of children and adolescents with ADHD and comorbid BD was effective. As a secondary outcome, we wanted to determine tolerability, especially the risk of mood switch. EXPERT OPINION The findings of this systematic review suggest that methylphenidate, when used with a mood stabilizer, may be safe and not significantly increase the risk of a manic switch or psychotic symptoms when used to treat ADHD that co-occurs with a BD. In situations where stimulants are ineffective or have low tolerance, atomoxetine also seems to be a good alternative, and also in cases of co-morbid anxiety, oppositional defiant disorder, conduct disorders, ICT disorders, and substance use disorders. Additional research with a higher level of evidence is necessary to corroborate these preliminary findings.
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Affiliation(s)
- Arnaud Pouchon
- Grenoble Institut Neurosciences, University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble, France
| | - Rayan Nasserdine
- Department of Psychiatry, University Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Clément Dondé
- Grenoble Institut Neurosciences, University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble, France
- Psychiatry Department, CH Alpes-Isère, Saint-Egrève, France
| | - Antoine Bertrand
- Grenoble Institut Neurosciences, University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble, France
| | - Mircea Polosan
- Grenoble Institut Neurosciences, University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble, France
| | - Stéphanie Bioulac
- Grenoble Institut Neurosciences, University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble, France
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Niu M, Guo H, Zhang Z, Fu Y. Abnormal temporal variability of rich-club organization in three major psychiatric conditions. Front Psychiatry 2023; 14:1226143. [PMID: 37720902 PMCID: PMC10500439 DOI: 10.3389/fpsyt.2023.1226143] [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: 05/20/2023] [Accepted: 08/07/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Convergent evidence has demonstrated a shared rich-club reorganization across multiple major psychiatric conditions. However, previous studies assessing altered functional couplings between rich-club regions have typically focused on the mean time series from entire functional magnetic resonance imaging (fMRI) scanning session, neglecting their time-varying properties. Methods In this study, we aim to explore the common and/or unique alterations in the temporal variability of rich-club organization among schizophrenia (SZ), bipolar disorder (BD), and attention deficit/hyperactivity disorder (ADHD). We employed a temporal rich-club (TRC) approach to quantitatively assess the propensity of well-connected nodes to form simultaneous and stable structures in a temporal network derived from resting-state fMRI data of 156 patients with major psychiatric disorders (SZ/BD/ADHD = 71/45/40) and 172 healthy controls. We executed the TRC workflow at both whole-brain and subnetwork scales across varying network sparsity, sliding window strategies, lengths and steps of sliding windows, and durations of TRC coefficients. Results The SZ and BD groups displayed significantly decreased TRC coefficients compared to corresponding HC groups at the whole-brain scale and in most subnetworks. In contrast, the ADHD group exhibited reduced TRC coefficients in longer durations, as opposed to shorter durations, which markedly differs from the SZ and BD groups. These findings reveal both transdiagnostic and illness-specific patterns in temporal variability of rich-club organization across SZ, BD, and ADHD. Discussion TRC may serve as an effective metric for detecting brain network disruptions in particular states, offering novel insights and potential biomarkers into the neurobiological basis underpinning the behavioral and cognitive deficits observed in these disorders.
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Affiliation(s)
- Meng Niu
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, China
- Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, China
| | - Hanning Guo
- Institute of Neuroscience and Medicine, Medical Imaging Physics (INM-4), Forschungszentrum Jülich, Jülich, Germany
| | - Zhe Zhang
- School of Physics, Hangzhou Normal University, Hangzhou, China
- Institute of Brain Science, Hangzhou Normal University, Hangzhou, China
| | - Yu Fu
- College of Information Science & Electronic Engineering, Zhejiang University, Hangzhou, China
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Weiss F, Tidona S, Carli M, Perugi G, Scarselli M. Triple Diagnosis of Attention-Deficit/Hyperactivity Disorder with Coexisting Bipolar and Alcohol Use Disorders: Clinical Aspects and Pharmacological Treatments. Curr Neuropharmacol 2023; 21:1467-1476. [PMID: 36306451 PMCID: PMC10472804 DOI: 10.2174/1570159x20666220830154002] [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: 05/13/2022] [Revised: 06/13/2022] [Accepted: 08/03/2022] [Indexed: 11/22/2022] Open
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD), Bipolar Disorder (BD) and Alcohol Use Disorder (AUD) are common medical conditions often coexisting and exerting mutual influence on disease course and pharmacological treatment response. Each disorder, when considered separately, relies on different therapeutic approaches, making it crucial to detect the plausible association between them. Treating solely the emerging condition (e.g., alcoholism) and disregarding the patient's whole psychopathological ground often leads to treatment failure and relapse. Clinical experience and scientific evidence rather show that tailoring treatments for these three conditions considering their co-occurrence as a sole complex disorder yields more fulfilling and durable clinical outcomes. In light of the above considerations, the purpose of the present review is to critically discuss the pharmacological strategies in the personalized treatment of complex conditions defined by ADHD-bipolarityalcoholism coexistence.
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Affiliation(s)
- Francesco Weiss
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Simone Tidona
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marco Carli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56126, Italy
| | - Giulio Perugi
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marco Scarselli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56126, Italy
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Sadeghian Nadooshan MR, Shahrivar Z, Mahmoudi Gharaie J, Salehi L. ADHD in adults with major depressive or bipolar disorder: does it affect clinical features, comorbidity, quality of life, and global functioning? BMC Psychiatry 2022; 22:707. [PMID: 36380307 PMCID: PMC9667673 DOI: 10.1186/s12888-022-04273-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study compared clinical characteristics, concurrent disorders, level of function, and quality of life in adults with bipolar (BD) or major depressive disorder (MDD) in those with/without adult attention defici1t hyperactivity disorder (AADHD). METHODS The participants were recruited among adult inpatients and outpatients with MDD or BD in their current partial remission in a psychiatric hospital. They were evaluated using the interview for adults with ADHD (DIVA-5), Conners' Adult ADHD Rating Scales-Self-Report-Screening Version (CAARS-SR-SV), Structured Clinical Interview for DSM-V (SCID-5), Beck Depression Inventory-II and Young Mania Rating Scale, Global Assessment of Functioning (GAF) and World Health Organization Quality of Life Scale-Brief (WHOQoL-BREF). RESULTS In those with MDD (n = 105) and BD (n = 103), AADHD was detected as 13.3% and 16.5%, respectively. The inattentive presentation was the most prevalent type among patients with AADHD. Compared to the patients without AADHD, the results regarding the prevalence of comorbidities, suicidal attempts, severity of affective episodes, the early emergence of the affective disorders, and level of quality of life and global functioning were poorer in the group with AADHD (p < 0.05). LIMITATIONS The participants were individuals with major depressive or bipolar type I disorder with a mostly manic episode, chosen among the referrals to a tertiary psychiatric hospital with high comorbidity and more severe psychopathology. This may limit the generalizability of the findings. CONCLUSION ADHD was common in adults with MDD and BD, along with high psychiatric comorbidity and negative consequences. Clinicians are suggested to screen adults with mood disorders for the symptoms of ADHD for a more precise and comprehensive diagnosis and to provide a more appropriate therapeutic intervention.
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Affiliation(s)
| | - Zahra Shahrivar
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Javad Mahmoudi Gharaie
- grid.411705.60000 0001 0166 0922Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leyla Salehi
- grid.411705.60000 0001 0166 0922Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Badrfam R, Zandifar A, Barkhori Mehni M, Farid M, Rahiminejad F. Comorbidity of adult ADHD and substance use disorder in a sample of inpatients bipolar disorder in Iran. BMC Psychiatry 2022; 22:480. [PMID: 35854247 PMCID: PMC9295524 DOI: 10.1186/s12888-022-04124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS The study of the relationship between adult Attention deficit hyperactivity disorder (ADHD) and bipolar disorder has received more attention in recent years and there is limited information in this area. On the other hand, there is a significant comorbidity between ADHD and bipolar disorder with substance use disorder. In this study, we investigated the prevalence of comorbidity of adult ADHD and substance use disorder among a group of bipolar patients admitted to a psychiatric hospital. METHODS One hundred fifty patients from a total of 200 consecutive patients who were referred to the emergency department of Roozbeh Psychiatric Hospital in Tehran, diagnosed with bipolar disorder based on the initial psychiatric interview and needed hospitalization, were evaluated again by an experienced faculty member psychiatrist by using a subsequent interview based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition(DSM-5). They were evaluated using the Structured Clinical Interview for DSM-5 (SCID-5) questionnaire to confirm the diagnosis of bipolar disorder and the comorbidity of adult ADHD and substance use disorder. RESULTS From 150 patients diagnosed with bipolar disorder, 106 patients (70.7%) had adult ADHD. 89 patients (59.3%) had substance use disorder and 58 patients (38.7%) had both of these comorbidities with bipolar disorder. Comorbidity of adult ADHD was associated with the earlier onset of the first mood episode in bipolar disorder (p value = 0.025). There was no statistically significant relationship between substance use disorder and age of onset of the first episode. (P value = 0.57). CONCLUSIONS Due to the limitations of studies on adult ADHD comorbidity with bipolar disorder, especially in hospital settings, as well as the increased risk of association with substance use disorder, further multicenter studies in this area with larger sample sizes can increase awareness in this regard.
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Affiliation(s)
- Rahim Badrfam
- grid.411705.60000 0001 0166 0922Department of Psychiatry, Faculty of Medicine, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Zandifar
- grid.411705.60000 0001 0166 0922Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran ,grid.411705.60000 0001 0166 0922Department of Psychiatry, Imam Hossein Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahdi Barkhori Mehni
- grid.411705.60000 0001 0166 0922Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Malihe Farid
- grid.411705.60000 0001 0166 0922Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran ,grid.411705.60000 0001 0166 0922Non Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Fatemeh Rahiminejad
- Department of Psychiatry, Faculty of Medicine, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Attention Deficit Hyperactivity Disorder and Bipolar Disorder: Diagnosis, Treatments, and Clinical Considerations: A Narrative Review. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint3010002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Attention-deficit Hyperactivity Disorder is one of the most common childhood mental health disorders, affecting about 5.6% of the population worldwide. Several studies have specifically shown a high prevalence of comorbid mood disorders, such as depression and bipolar disorder (BD), in those diagnosed with ADHD. Several common symptoms of ADHD are also found in BD, which are characterized by alternating periods of euthymia and mood disturbances. The inattention and impulsivity of ADHD can be seen in manic and hypomanic episodes of BD. Over the past decade, there has been an increased interest in research between the correlation of ADHD and pediatric bipolar disorder (PBD) in children. Some experts hypothesize that more children are comorbidly diagnosed with ADHD and PBD because of how many clinicians treat children with ADHD. Other factors, which may affect the dual diagnoses of ADHD and PBD, are overlapping diagnostic criteria for the two disorders, the inevitable biases seen when one disorder is diagnosed without the other, and related risk factors leading to prodromal relationships. By examining clinical trials, a better understanding of whether ADHD and PBD have a stepwise progression or if other factors influence these comorbidities, such as blurred lines of diagnostic criteria. Those with ADHD are also at an increased risk of impairment at work and in social settings. This manuscript explores both progression of this disease and its clinical connections to other disorders.
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