ADHD symptoms in patients with Bipolar or Drug abuse disorder
Симптомы СДВГ у пациентов с биполярным расстройством или наркоманией
Background: Theattention deficitandhyperactivity disorder (ADHD) is defined asapersistent stateof inattentionand/or hyperactivity-impulsivity. Most adult patientswith ADHDsymptoms are diagnosed withothermental disorders in comorbidity. Substance Use Disorders(SUD) and Bipolar Disorder(BD) are the conditionsmost frequentlyassociated witha history ofADHD. Although the increasing number of studies on this topic, the relationshipbetweenSUD, BD andADHDremains unclear.
Aim: To evaluate the prevalence of ADHD spectrum symptoms in patients with SUD, BD or SUD+BD and the clinical features associated to these phenotypes.
Methods: 147 patients were consecutively recruited for a 12 month-period of at the outpatients’ service and Day Hospital of the Psychiatric Clinic of the University of Pisa, at the outpatients’ service and ward of the Department of Psychiatry, Versilia Hospital, at the outpatients’ clinic of the Service for Drug Addiction (Ser.T) of Viareggio. Outpatients attending the therapeutic community “Incontro” in Pistoia also entered in the study. Patients were investigated by means of the ASRS-v 1.1. (Adult ADHD Self-Report Scale) and the DCTC (Diagnostic, Clinical and Therapeutic Checklist). All patients satisfied DSM-IV-TR criteria as confirmed by the SCID-I administration.
Results: 50 patients were diagnosed with Bipolar I or II disorder (BD), 53 with Substance Use Disorder (SUD), and 44 with Dual Diagnosis (BD+SUD). 23 patients (15.6%) scored sufficiently high at the ASRS scale and showed a history of ADHD in childhood so that to satisfy the diagnosis of adult ADHD. Other 24 patients (16.3%) achieved high scores on ASRS scale but did not show a history of ADHD in childhood. BD+SUD patients were significantly more affected by comorbid ADHD compared to BD and SUD patients [13 (29.5%) vs. 6 (12%) and 4 (7.5%), respectively]. BD+SUD patients scored highest on all ASRS scale items even if significantly differences among groups resulted only in item 2, 14 and 17. These patients also referred a higher number of mixed episode in their lifetime and showed a worse global functioning.
Discussion and conclusions: Bipolar disorder comorbid with substance use disorder shows a more significant association with ADHD (in about a quarter of cases) compared with Bipolar or substance use disorder alone. The higher rate of ADHD and mixed symptoms in BD + SUD deserves clinical interest and careful attention to the treatment plan given the greater disease severity of this patient group. It is possible that the relationship between adult ADHD and SUD is mediated by the association with BD in both its full-blown and spectrum expressions.