Attention Deficit/Hyperactivity Disorder symptoms in Italian bipolar adult patients: A preliminary report
Attention Deficit/Hyperactivity Disorder symptoms in Italian bipolar adult patients: A preliminary report
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DOI：
10.1016/j.jad.2012.12.010
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发表时间：
2013-07-01
影响因子：
6.6
通讯作者：
Dell'Osso, L.
中科院分区：
文献类型：
--
作者：
Perugi, G.;Ceraudo, G.;Dell'Osso, L.
背景：最近有研究表明，双相情感障碍(BD)合并ADHD代表了BD的一种独特的临床表型。为了评估ADHD症状的影响，我们调查了成人BD患者中ADHD的患病率、流行病学和临床特征。方法：共纳入96例门诊BD患者，年龄18-65岁。使用成人ADHD自我报告量表(ASRS)和诊断、临床和治疗检查表(DCTC)对所有患者进行筛查，诊断、临床和治疗检查表(DCTC)是一种半结构化访谈，旨在系统收集家庭、人口统计、记忆和临床信息，并探索DSM-IV-TR对情绪、焦虑、饮食、冲动控制以及酒精和药物使用障碍的诊断标准。DCTC还包括临床总体印象量表(CGI-BP)、全球功能评定量表(GAF)和Sheehan功能障碍量表(SDS)。结果：在我们的样本中，96例BD患者中有19例(19.8%)符合ASRS的当前和终生(7岁前起病)ADHD症状(ADHD+)标准。与无ADHD症状的BD先证者(ADHD-)相比，ADHD+患者当前混合性发作率较高，躁狂率较低。ADHD+患者在CGI-BP混合量表、抑郁量表和全球量表上的平均得分更高。在评估时，ADHD+患者中没有一人处于BD缓解期，而ADHD组中有24人(31.2%)。与ADHD+患者相比，ADHD+患者报告的终生共病与物质使用障碍(SUD)和酒精滥用的比率也更高。特别是，药物滥用的不同比率与可卡因和多种药物滥用有关。两组患者在功能和社会适应方面没有显著差异，但ADHD+患者的家庭适应能力比ADHD患者更差。限制：回顾设计和有限的样本量。结论：与非成人ADHD患者相比，ADHD+患者BD患者的混合状态发生率更高，精神病理更严重，家庭功能受损更多，并伴有药物、酒精和多种药物滥用的比例更高。我们的发现提示成人ADHD症状可能影响BD的临床表现、病程和预后。需要进一步的前瞻性研究来证实我们的发现，并探索对BD治疗的影响。(C)爱思唯尔出版的2012年。
Background: It has been recently suggested that bipolar disorder (BD) with comorbid ADHD represents a distinct clinical phenotype of BD. With the aim to assess the impact of ADHD symptoms, we investigated the prevalence, epidemiological and clinical features associated with such a comorbidity in a sample of adult BD patients.Methods: A total of 96 outpatients (aged 18-65 years) with BD were included. All patients were screened using the Adult ADHD Self-report Scale (ASRS) and the Diagnostic, Clinical and Therapeutic Checklist (DCTC), a semi-structured interview developed for systematic collection of familial, demographic, anamnestic and clinical informations and exploration of DSM-IV-TR diagnostic criteria for mood, anxiety, eating, impulse control and alcohol and substance use disorders. The DCTC also includes the Clinical Global Impression Bipolar scale (CGI-BP), the Global Assessment of Functioning scale (GAF) and the Sheehan Disability Scale (SDS).Results: In our sample, 19 (19.8%) out of 96 BD patients fulfilled ASRS criteria for current and lifetime (onset before 7 years of age) ADHD symptoms (ADHD+). Compared to BD probands without ADHD symptoms (ADHD-), ADHD+ patients showed higher rates of current mixed episode, and lower rates of mania. ADHD+ resulted in more severe mean scores on the CGI-BP mixed, depressive and global subscales. None of the ADHD+ patients were in remission of BD at the time of the evaluation, versus 24 (31.2%) of the ADHD- group. ADHD+ patients also reported higher rate of lifetime comorbidity with Substance Use Disorder (SUD) and Alcohol Abuse in comparison to ADHD- patients. In particular the different rate in substance abuse was related to cocaine and poly-drug abuse. The two groups did not report significant differences in functioning and social adjustment with the exception of familial adjustment that was more compromised in ADHD+ than in ADHD- patients.Limitations: Retrospective design and limited sample size.Conclusions: In ADHD+ patients, BD is associated with higher rate of mixed states, more severe psychopathology and more impaired familial functioning as well as higher rates of comorbid substance, alcohol and poly-drug abuse compared to BD patients without adult ADHD. Our findings suggest that ADHD symptoms in adults may influence clinical presentation, course and prognosis of BD. Further prospective research is needed to confirm our findings and to explore treatment implications for the management of BD. (C) 2012 Published by Elsevier B.V.