ADHD and Bipolar Disorder in Adulthood: Clinical and Treatment Implications.

Virginio Salvi,Umberto Volpe,Enrico Ribuoli,Michele Servasi,Laura Orsolini

doi:10.3390/medicina57050466

Abstract

Attention deficit hyperactivity disorder (ADHD) is a condition that usually has its onset in childhood. Although the disorder persists into adulthood in half of cases, adult ADHD is often not recognized due to different psychopathological characteristics, quite often overlapping with other diagnoses such as mood, anxiety and personality disorders. This is especially true for bipolar disorder (BD), which shares several symptoms with adult ADHD. Moreover, besides an overlapping clinical presentation, BD is often co-occurring in adults with ADHD, with comorbidity figures as high as 20%. This review will focus on the comorbidity between ADHD and BD by exploring the magnitude of the phenomenon and evaluating the clinical and functional characteristics associated with ADHD–BD comorbidity in adults. Finally, the review will address the implications of pharmacologically treating the ADHD–BD comorbidity, providing suggestions in how to treat these complex patients and addressing the issue of treatment-induced manic switch with the use of stimulants and other medications for ADHD.

Highlights

Attention deficit/hyperactivity disorder (ADHD) is a typical childhood-onset disorder characterized by a deficit of attention and motor hyperactivity leading to significant impairment in academic/occupational, familiar and social functioning [1]
Adult ADHD has a heterogeneous clinical presentation besides the hyperactivity and inattention described in the pediatric population, which includes a wider spectrum of emotional dysregulation and functional impairment [2]
Adult ADHD is often characterized by symptoms such as impulsivity, distractibility and restlessness, which clearly overlap with bipolar disorder (BD) symptomatology, making differential diagnosis between the two disorders a challenge

Summary

Introduction

Attention deficit/hyperactivity disorder (ADHD) is a typical childhood-onset disorder characterized by a deficit of attention and motor hyperactivity leading to significant impairment in academic/occupational, familiar and social functioning [1]. On the functional standpoint they may be unable to hold a job or maintain personal relationships Other complaints, such as feeling bored, being unable to make decisions, procrastinating and being disorganized and distracted are often an expression of inattention in adulthood [13]. This diversity in clinical presentation, along with the general dearth of general psychiatrists with ADHD expertise, possibly contributes to the diagnostic gap between children and adults. Another issue that further complicates the diagnostic process in ADHD adults is the high frequency of comorbid disorders, mood, anxiety, personality and substance use disorders. We discuss the implications and issues that arise when treating adults with co-occurring ADHD and BD

ADHD and Comorbid Psychiatric Disorders

ADHD and Bipolar Disorder

Treatment Implications of ADHD–BD Comorbidity

Findings

Conclusions