A systematic review of rates and diagnostic validity of comorbid adult attention-deficit/hyperactivity disorder and bipolar disorder.
A systematic review of rates and diagnostic validity of comorbid adult attention-deficit/hyperactivity disorder and bipolar disorder.
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DOI：
10.4088/jcp.v68n1118
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发表时间：
2007-11
期刊：
影响因子：
--
通讯作者：
A. Wingo;S. Ghaemi
中科院分区：
文献类型：
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作者：
A. Wingo;S. Ghaemi
目的成人注意力缺陷多动障碍（ADHD）越来越多地被认识到，并经常与双相情感障碍共存。成人ADHD和双相情感障碍的同时诊断仍然存在争议。在这项研究中，我们进行了一项系统的审查，以检查共病的成人ADHD和双相情感障碍的概念的比率和诊断的有效性。资料来源：检索MEDLINE、Embase、PsycInfo和科克伦数据库中2007年3月30日之前发表的文章，检索关键词躁狂、双相、注意力缺陷多动和成人。计算机检索还辅之以书目交叉参考。研究选择排除标准为仅儿科受试者、仅儿童ADHD而非成人ADHD、双相情感障碍或仅ADHD而非两者皆有的研究;综述文章、病例报告;致编辑的信件;书籍章节。在发现的262篇引文中，12篇研究符合我们的纳入标准。具体的诊断验证标准检查的现象学，病程，遗传，生物标志物和治疗反应。有6项关于共病率的研究，4项关于现象学的研究，3项关于病程的研究，2项关于遗传的研究，没有关于生物标志物的研究，1项关于治疗反应的研究。资料综合：共病综合征相当常见（成人ADHD患者中有47%，双相情感障碍患者中有21%），与双相情感障碍相比，其病程更严重，与其他精神疾病的共病率更高。它的治疗似乎需要最初的情绪稳定。结论：对成人ADHD和双相情感障碍共病的研究还不够充分，更多的是强调共病率，而关于病程、神经生物学、遗传和治疗的数据很少。成人ADHD/双相情感障碍作为一种真正的合并症的诊断有效性并没有在这些模棱两可和不充分的文献的基础上得到很好的确立。需要更多的研究来进一步阐明其诊断有效性和治疗方法。
OBJECTIVE Adult attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized and reported to frequently coexist with bipolar disorder. Concurrent diagnosis of adult ADHD and bipolar disorder remains controversial. In this study, we conducted a systematic review to examine the rates and diagnostic validity of the concept of comorbid adult ADHD and bipolar disorder. DATA SOURCES MEDLINE, Embase, PsycInfo, and Cochrane databases were searched for articles published before March 30, 2007, using the keywords manic, bipolar, attention deficit hyperactivity, and adult. The computer search was supplemented with bibliographic cross-referencing. STUDY SELECTION Exclusion criteria were studies with only pediatric subjects, childhood ADHD only but not adult ADHD, and either bipolar disorder or ADHD only, but not both; review articles, case reports; letters to the editor; and book chapters. Of the 262 citations found, 12 studies met our inclusion criteria. DATA EXTRACTION Specific diagnostic validating criteria examined were phenomenology, course of illness, heredity, biological markers, and treatment response. There were 6 studies on comorbid rates, 4 on phenomenology, 3 on course of illness, 2 on heredity, none on biological markers, and 1 on treatment response. DATA SYNTHESIS The proposed comorbid syndrome is fairly common (present in up to 47% of adult ADHD and 21% of bipolar disorder populations), with a more severe course of illness compared with that of bipolar disorder alone, and high rates of comorbidity with other psychiatric disorders. Its treatment appears to require initial mood stabilization. CONCLUSIONS Comorbid adult ADHD and bipolar disorder has been insufficiently studied, with more emphasis on comorbidity rates and few data on course, neurobiology, heredity, and treatment. The diagnostic validity of adult ADHD/ bipolar disorder as a true comorbidity is not well-established on the basis of this equivocal and insufficient literature. More studies are greatly needed to further clarify its diagnostic validity and treatment approach.