Abstract
BackgroundAttention Deficit Hyperactivity Disorder (ADHD) is a heterogeneous disorder. Therefore it is important to look for factors that can contribute to better diagnosis and classification of these patients. The aims of the study were to characterize adult psychiatric out-patients with a mixture of mood, anxiety and attentional problems using an objective neuropsychological test of attention combined with an assessment of mood instability.MethodNewly referred patients (n = 99; aged 18–65 years) requiring diagnostic evaluation of ADHD, mood or anxiety disorders were recruited, and were given a comprehensive diagnostic evaluation including the self-report form of the cyclothymic temperament scale and Conner’s Continuous Performance Test II (CPT-II). In addition to the traditional measures from this test we have extracted raw data and analysed time series using linear and non-linear mathematical methods.ResultsFifty patients fulfilled criteria for ADHD, while 49 did not, and were given other psychiatric diagnoses (clinical controls). When compared to the clinical controls the ADHD patients had more omission and commission errors, and higher reaction time variability. Analyses of response times showed higher values for skewness in the ADHD patients, and lower values for sample entropy and symbolic dynamics. Among the ADHD patients 59 % fulfilled criteria for a cyclothymic temperament, and this group had higher reaction time variability and lower scores on complexity than the group without this temperament.ConclusionThe CPT-II is a useful instrument in the assessment of ADHD in adult patients. Additional information from this test was obtained by analyzing response times using linear and non-linear methods, and this showed that ADHD patients with a cyclothymic temperament were different from those without this temperament.
Highlights
Attention Deficit Hyperactivity Disorder (ADHD) is a heterogeneous disorder
The Continuous Performance Test (CPT)-II is a useful instrument in the assessment of ADHD in adult patients
Additional information from this test was obtained by analyzing response times using linear and non-linear methods, and this showed that ADHD patients with a cyclothymic temperament were different from those without this temperament
Summary
Attention Deficit Hyperactivity Disorder (ADHD) is a heterogeneous disorder. it is important to look for factors that can contribute to better diagnosis and classification of these patients. Mood instability may be one such factor, and it is not one of the core criteria of ADHD it is an important clinical characteristic [4] of these patients This may represent a possible link to bipolar spectrum disorders [5], that include bipolar I, bipolar II, cyclothymia and cyclothymic temperament [6]. The cyclothymic temperament (CT) is characterized by mood instability, with intermittent cycles with rapid oscillations between elevated and depressed mood that characterize the habitual functioning of the individual, and is present since at least early adulthood [7] This temperament, defined according to the criteria of Akiskal et al [8, 9], is common in adult ADHD patients [6]. Positive scores on a self-evaluation form for this temperament separates a subgroup of ADHD patients with higher scores on ADHD symptom scales, a higher frequency of psychiatric symptoms, including drug and alcohol abuse, and more impairment, reflected in lower education and a reduced chance of being employed [6]
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