Childhood attention disorder influences course of bipolar disorder

MedWire News: People with bipolar disorder who have a childhood history of attention-deficit hyperactivity disorder tend to develop the mood disorder at a younger age and experience more frequent symptoms than those without such a history, research shows.

“Studies suggest that up to 85% of prepubertal children with bipolar disorder also meet the criteria for attention-deficit hyperactivity disorder, and conversely, that up to 22% of children with attention-deficit hyperactivity disorder also meet the criteria for bipolar disorder,” explain Mikael Landén (Karolinska Institute, Stockholm, Sweden) and team.

However, less is known about attention-deficit hyperactivity disorder in adults with bipolar disorder and whether such symptoms influence the course of the mood disorder.

To investigate, the researchers studied 60 men and 99 women with bipolar disorder who were aged an average of 39 years.

The participants underwent comprehensive evaluations to assess for mood disorder symptoms, such as mania, depression and “mixed” episodes, as well as childhood and current attention-deficit hyperactivity disorder.

Overall, 72% of the patients had “pure” bipolar disorder without childhood or adulthood attention-deficit hyperactivity disorder symptoms, 12% had a history of childhood attention-deficit hyperactivity disorder without symptoms in adulthood, and 16% met criteria for attention-deficit hyperactivity disorder in both childhood and adulthood.

Analysis revealed that the presence of either childhood only ADHD or childhood and current ADHD had a similar influence on the course of bipolar disorder.

Patients in the combined attention-deficit hyperactivity disorder groups had a significantly earlier average age at onset of their first psychotic symptoms, at 14.2 years, than those with pure bipolar disorder, at an average age of 21.9 years.

Furthermore, both attention-deficit hyperactivity disorder groups had a significantly earlier combined average age (16.7 years) at which they experienced their first mood disorder episode than those with pure bipolar disorder (22.7 years).

The researchers also found that patients in both attention-deficit hyperactivity disorder groups experienced significantly more mood episodes and more often had a history of interpersonal violence than those with pure bipolar disorder.

Dr Landén and team conclude: “The fact that bipolar patients with a history of childhood attention-deficit hyperactivity disorder have a different clinical outcome than the pure bipolar group, regardless of whether the attention-deficit hyperactivity disorder symptoms remained in adulthood or not, suggests that it represent a distinct early-onset [type] of bipolar disorder.”

The research is published in the in the journal Acta Psychiatrica Scandinavica.