ADHD and Bipolar Disorder in Adulthood: Clinical and Treatment Implications.

Attention deficit hyperactivity disorder (ADHD) is a condition that usually has its onset in childhood. Although the disorder persists into adulthood in half of cases, adult ADHD is often not recognized due to different psychopathological characteristics, quite often overlapping with other diagnoses such as mood, anxiety and personality disorders. This is especially true for bipolar disorder (BD), which shares several symptoms with adult ADHD. Moreover, besides an overlapping clinical presentation, BD is often co-occurring in adults with ADHD, with comorbidity figures as high as 20%. This review will focus on the comorbidity between ADHD and BD by exploring the magnitude of the phenomenon and evaluating the clinical and functional characteristics associated with ADHD-BD comorbidity in adults. Finally, the review will address the implications of pharmacologically treating the ADHD-BD comorbidity, providing suggestions in how to treat these complex patients and addressing the issue of treatment-induced manic switch with the use of stimulants and other medications for ADHD.

Cyclothymic affective temperament and low positive attitude coping strategies as predictors of comorbid depressive symptomatology in adult ADHD patients.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) in adults could be frequently underdiagnosed due to concomitant psychiatric disorders, including depressive symptomatology, which could determine inappropriate treatments. Our study aims at clinically characterizing adult ADHD with or without depressive symptomatology in order to identify the relationship with specific affective temperamental profiles and coping strategies. METHODS: A total of 225 outpatients consecutively afferent to our outpatient adult ADHD service since September 2019 were retrospectively screened for eligibility and administered Beck Depression Inventory-II (BDI-II), Coping Orientation to Problems Experienced Inventory (COPE-NV) and Temperament Evaluation of the Memphis, Pisa, Paris and San Diego (TEMPS-M). RESULTS: 64.7 % of patients displayed a significant comorbid depressive symptomatology. According to the multivariate linear regression model, depressive levels were positively predicted by TEMPS-M cyclothymic subscale (B = 0.567, p = 0.004) and negatively predicted by COPE-NVI "positive attitude" subscale (B = -0.438, p = 0.024) (R = 0.496, R2 = 0.246, F(2,66) = 10.747, p < 0.001). LIMITATION: While considering the results, it should be taken in consideration that: the assessment was carried out only at baseline, our sample is constituted only by adult ADHD patients and mostly without a previous ADHD diagnosis, the presence of a discrepancy between the rates of ADHD subtypes, the absence of a healthy control group and emotional dysregulation was not directly assessed. CONCLUSION: Affective temperamental profiles and coping strategies could help in clinically characterizing and personalizing treatment in adult comorbid ADHD-depressive symptomatology patients. Further research is warranted to explore the efficacy of targeted psychotherapeutic and pharmacological interventions within this ADHD sub-sample.