The impact of psychiatric co-morbidity in the treatment of bipolar disorder: focus on co-occurring attention deficit hyperactivity disorder and eating disorders

2017 ◽  
Author(s):  
Anna I. Guerdjikova ◽  
Paul E. Keck ◽  
Susan L. McElroy
Keyword(s):  
Bipolar Disorder ◽  
Attention Deficit Hyperactivity Disorder ◽  
Eating Disorders ◽  
Attention Deficit ◽  
Case Reports ◽  
Open Label ◽  
Hyperactivity Disorder ◽  
Randomized Controlled ◽  
Co Morbidity ◽  
The Impact

Bipolar disorder (BD) commonly co-occurs with attention deficit hyperactivity disorder (ADHD) and eating disorders (EDs) in adolescents and in adults. The aim of this chapter is to summarize the available data regarding prevalence, clinical presentation, and psychological and pharmacological treatment of such complicated cases. Results of randomized controlled and open-label trials and case reports are reviewed. The main therapeutic goal when treating BD co-morbid with ADHD or ED is selecting a treatment strategy effective in the management of both syndromes, or at the minimum, selecting one that treats one syndrome without exacerbating the other. Controlled data are scarce. Various classes of medications, including stimulants, atomoxetine, bupropion, and wakefulness-provoking agents, might hold promise as adjunctive medication in improving ADHD symptoms in euthymic BD patients. The specificities of the ED, namely the predominance of undereating or overeating, need to be considered when selecting agents in the treatment of BD co-morbid with EDs.

scholarly journals Review of literature of attention-deficit/hyperactivity disorder with comorbid eating disorders

2008 ◽  
Vol 30 (4) ◽  
pp. 384-389 ◽  
Author(s):  
Bruno Palazzo Nazar ◽  
Camilla Moreira de Sousa Pinna ◽  
Gabriel Coutinho ◽  
Daniel Segenreich ◽  
Monica Duchesne ◽  
...  
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Eating Disorders ◽  
Bulimia Nervosa ◽  
Attention Deficit ◽  
Case Reports ◽  
Small Sample ◽  
Adult Women ◽  
Case Control Studies ◽  
Prevalence Studies ◽  
Hyperactivity Disorder

OBJECTIVE: According to studies of prevalence, up to 70% of adults with attention deficit/hyperactivity disorder have at least one psychiatric comorbidity, which leads to diagnostic and therapeutic difficulties as well as more severe functional impairment. There is a paucity of data on the comorbidity of attention deficit/hyperactivity disorder and eating disorders. The objective of this study was to review the literature regarding the attention deficit/hyperactivity disorder/eating disorders comorbidity, performing a critical analysis of relevant data. METHOD: Articles in Medline, Lilacs, SciELO, ISI and PsycINFO databases from 1980 up to 2008, were searched. The references from the articles were used as additional sources of data. RESULTS: Fourteen articles were found: five prevalence studies, four case reports, three case-control studies, one symptom-assessment study of attention deficit/hyperactivity disorder and eating disorders, and one article regarding possible causes of the association between attention deficit/hyperactivity disorder and eating disorders. These articles suggested that adult women with attention deficit/hyperactivity disorder are at higher risk of developing eating disorders, especially bulimia nervosa. Bulimia Nervosa rates found in attention deficit/hyperactivity disorder groups ranged from 1% to 12%, versus 0% to 2% in control groups. CONCLUSIONS: Although there seems to be a relationship between attention deficit/hyperactivity disorder and eating disorders, the reduced number of studies available, with various methodologies, and small sample sizes limit the generalization of the findings.

Bipolar disorder co-morbidity in children with attention deficit hyperactivity disorder

2011 ◽  
Vol 186 (2-3) ◽  
pp. 333-337 ◽  
Author(s):  
Renato Donfrancesco ◽  
Silvia Miano ◽  
Francesca Martines ◽  
Laura Ferrante ◽  
Maria Grazia Melegari ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Hyperactivity Disorder ◽  
Co Morbidity

scholarly journals Functional improvement and correlations with symptomatic improvement in adults with attention deficit hyperactivity disorder receiving long-acting methylphenidate

2011 ◽  
Vol 42 (1) ◽  
pp. 195-204 ◽  
Author(s):  
J. K. Buitelaar ◽  
M. Casas ◽  
A. Philipsen ◽  
J. J. S. Kooij ◽  
J. A. Ramos-Quiroga ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Daily Functioning ◽  
Open Label ◽  
Double Blind ◽  
Hyperactivity Disorder ◽  
Co Morbidity ◽  
Open Label Extension

BackgroundData on the relationship between core symptoms and daily functioning in adults with attention deficit hyperactivity disorder (ADHD) are limited. Daily functioning was assessed as part of an open-label extension, and associations with symptom scores were evaluated.MethodAfter a 5-week double-blind study with adults with ADHD receiving osmotic-controlled release oral delivery system (OROS) methylphenidate (MPH) 18, 36 or 72 mg/day, or placebo, participants were eligible for a 7-week open-label extension in which all patients received OROS MPH. Data for the Conners' Adult ADHD Rating Scale – Observer: Screening Version (CAARS-O:SV) (primary endpoint) have been presented previously. Secondary endpoints included the observer self-reported short version of the CAARS (CAARS-S:S) and the Clinical Global Impressions – Severity Scale (CGI-S). Daily functioning and quality of life were assessed using the Sheehan Disability Scale (SDS) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) respectively. In post-hoc analyses, changes in CAARS-O:SV were evaluated in subgroups. Relationships between symptom and functional outcomes were evaluated in a multivariate regression analysis.ResultsA total of 370 patients entered the open-label extension. Significant improvements from baseline in CAARS-O:SV were similar regardless of sex, ADHD subtype, prior treatment or psychiatric co-morbidity. Significant improvements from double-blind baseline were also seen for the CAARS-S:S, CGI-S, SDS and Q-LES-Q. Improvements in the CAARS-O:SV Hyperactivity/Impulsivity subscale were associated with improvements in SDS total and subscale scores, and in the Q-LES-Q score at open-label endpoint. Improvements in CAARS-O:SV Inattention subscale and CGI-S scores were not significantly associated with functional changes.ConclusionsImprovements in ADHD symptoms relating to hyperactivity and impulsivity in adults receiving OROS MPH are associated with improvements in daily functioning and quality of life.

scholarly journals Efficacy and safety of methylphenidate in 45 adults with attention-deficit/hyperactivity disorder. A randomized placebo-controlled double-blind cross-over trial

2004 ◽  
Vol 34 (6) ◽  
pp. 973-982 ◽  
Author(s):  
J. J. S. KOOIJ ◽  
H. BURGER ◽  
A. M. BOONSTRA ◽  
P. D. VAN DER LINDEN ◽  
L. E. KALMA ◽  
...  
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Response Rates ◽  
Dose Titration ◽  
Future Research ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Hyperactivity Disorder ◽  
Co Morbidity ◽  
The Impact

Background. Data on the efficacy and safety of methylphenidate in adults with attention deficit/hyperactivity disorder (ADHD) are lacking in Europe. This study was undertaken to report on the efficacy and safety of methylphenidate in an adult out-patient population with ADHD, and to compare results with US data.Method. A double-blind randomized cross-over trial comparing methylphenidate and placebo in 45 adults with ADHD with childhood onset was performed in a dose–titration design. Methylphenidate was titrated from 0·5 mg/kg per day in week 1 up to 1·0 mg/kg per day in week 3.Results. Response rates using methylphenidate varied between 38 and 51%, and using placebo between 7 and 18% (p<0·05), depending on outcome measure used. Although the overall percentage of subjects having any side effect on both methylphenidate and placebo was rather high, side effects on methylphenidate over and above those on placebo were few and mild.Conclusions. Methylphenidate proves to be an effective and well tolerated treatment for symptoms of ADHD in adults in the short term. Future research should study the long-term response and clarify the impact of gender, co-morbidity, socio-economic status and IQ on response rates in adults with ADHD.

scholarly journals Mixed Amphetamine Salts Without a Mood Stabilizer for Treating Comorbid Attention-Deficit Hyperactivity Disorder and Bipolar Disorder: Two Case Reports

2021 ◽  
Author(s):  
Cody Armstrong ◽  
Michelle R Kapolowicz
Keyword(s):  
Bipolar Disorder ◽  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Standard Treatment ◽  
Case Reports ◽  
Case Series ◽  
Mood Stabilizer ◽  
Comorbid Disorders ◽  
Hyperactivity Disorder

ABSTRACT Attention-deficit hyperactivity disorder (ADHD) and bipolar disorder (BD) are often comorbid in patients and can have significant overlap in symptoms. Because of this common comorbidity and often overlapping symptoms, accurate diagnoses can be difficult. The standard treatment for these comorbid disorders is a mood stabilizer with the possibility of adding a psychostimulant. However, research suggesting treatment for comorbid disorders with a psychostimulant without a mood stabilizer is lacking. Here, we present two cases where mixed amphetamine salts, which are traditionally avoided in those with BD, were effectively used without a mood stabilizer to treat comorbid BD and ADHD in both patients. The outcome of this case series serves to motivate future investigations which are needed to validate treatment with a psychostimulant without a mood stabilizer for the treatment of comorbid BD and ADHD.

scholarly journals The Safety and Efficacy of Methylphenidate and Dexmethylphenidate in Adults with Attention Deficit/Hyperactivity Disorder

2010 ◽  
Vol 2 ◽  
pp. JCNSD.S4178 ◽  
Author(s):  
Michael A. Sopko ◽  
Harjeet Caberwal ◽  
Benjamin Chavez
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Children And Adolescents ◽  
Attention Deficit ◽  
Case Reports ◽  
Data Extraction ◽  
Adult Population ◽  
Open Label ◽  
Safety And Efficacy ◽  
Hyperactivity Disorder ◽  
Double Blinded

Objective To review the literature on the safety and efficacy of methylphenidate, OROS-methylphenidate, methylphenidate ER, and dexmethylphenidate in adults with Attention-Deficit/Hyperactivity Disorder (ADHD). To analyze the effects of different doses of methylphenidate, it's various formulations, and methylphenidate on efficacy and safety in this population. Data Sources Literature retrieval was performed through Pubmed/MEDLINE (Up to May 2010) using the terms methylphenidate, dexmethylphenidate, and attention-deficit hyperactivity disorder. In addition, reference citations from publications identified were reviewed. Study Selection and Data Extraction Double-blinded, placebo-controlled clinical trials, as well as crossover and open-label trials found using the search criteria listed above were included for review. Case reports were not included in this review. Data Synthesis Attention-deficit/hyperactivity disorder (ADHD) is a psychiatric condition that is commonly seen in children and adolescents, that persists into adulthood for about 50% of patients. Methylphenidate and dexmethylphenidate are often prescribed to treat the symptoms associated with ADHD. The literature validating the safety and efficacy of methylphenidate and dexmethylphenidate in children and adolescents with ADHD is substantial. However, the literature specifically addressing the safety and efficacy of these medications in the adult population is less extensive and prescribing is often anecdotal based on child and adolescent data. Understanding the literature regarding methylphenidate and dexmethylphenidate and its effects in adults can enhance evidence-based medicine (EBM) and improve treatment outcomes Conclusion Methylphenidate and dexmethylphenidate are safe and effective medications to treat the symptoms of ADHD in adults. Based on the literature, increased doses are associated with better treatment response with moderate safety concerns. The different dosage forms available enable individualization of treatment.

Towards further understanding of the co-morbidity between attention deficit hyperactivity disorder and bipolar disorder: a MRI study of brain volumes

2007 ◽  
Vol 38 (7) ◽  
pp. 1045-1056 ◽  
Author(s):  
J. Biederman ◽  
N. Makris ◽  
E. M. Valera ◽  
M. C. Monuteaux ◽  
J. M. Goldstein ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Attention Deficit Hyperactivity Disorder ◽  
Prefrontal Cortex ◽  
Gray Matter ◽  
Attention Deficit ◽  
Anterior Cingulate ◽  
Mri Findings ◽  
Brain Volumes ◽  
Hyperactivity Disorder ◽  
Co Morbidity

BackgroundAlthough attention deficit hyperactivity disorder (ADHD) and bipolar disorder (BPD) co-occur frequently and represent a particularly morbid clinical form of both disorders, neuroimaging research addressing this co-morbidity is scarce. Our aim was to evaluate the morphometric magnetic resonance imaging (MRI) underpinnings of the co-morbidity of ADHD with BPD, testing the hypothesis that subjects with this co-morbidity would have neuroanatomical correlates of both disorders.MethodMorphometric MRI findings were compared between 31 adults with ADHD and BPD and with those of 18 with BPD, 26 with ADHD, and 23 healthy controls. The volumes (cm3) of our regions of interest (ROIs) were estimated as a function of ADHD status, BPD status, age, sex, and omnibus brain volume using linear regression models.ResultsWhen BPD was associated with a significantly smaller orbital prefrontal cortex and larger right thalamus, this pattern was found in co-morbid subjects with ADHD plus BPD. Likewise, when ADHD was associated with significantly less neocortical gray matter, less overall frontal lobe and superior prefrontal cortex volumes, a smaller right anterior cingulate cortex and less cerebellar gray matter, so did co-morbid ADHD plus BPD subjects.ConclusionsOur results support the hypothesis that ADHD and BPD independently contribute to volumetric alterations of selective and distinct brain structures. In the co-morbid state of ADHD plus BPD, the profile of brain volumetric abnormalities consists of structures that are altered in both disorders individually. Attention to co-morbidity is necessary to help clarify the heterogeneous neuroanatomy of both BPD and ADHD.

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