Bipolar Disorder and ADHD Co-Occurrence Rates Indicate Need For Screenings
(Part 2 of 2)
The high co-occurrence rates of bipolar disorder (BD) and attention/deficit-hyperactivity disorder (ADHD) indicate clinicians need to routinely carry out screenings for adults with either condition, according to a meta-analysis published online in Neuroscience & Biobehavioral Reviews. If clinicians overlook these diagnoses, patients may not receive adequate treatment, researchers wrote.
In part 2 of this Q&A series, lead author Carmen Schiweck, PhD, Goethe University Frankfurt, Germany, discusses the surprising outcomes, practical applications for clinicians, and further research. See Part 1 to learn about the motivation for the study, the methods, and critical findings.
Q: Were any outcomes different than you expected?
A: We were somewhat surprised that age did not have a significant effect: we would expect higher rates of comorbidity in older samples. That being said, a meta-analysis doesn’t allow one to investigate the effect of covariates as would be the case for regular case-control study. Rather than investigating the effect of age as a continuous variable, we investigated the effect of the sample’s mean age on the outcome, which is important to keep in mind.
Q: Are there any practical applications of your findings for clinicians treating patients with ADHD and adult bipolar disorder?
A: I certainly believe there is: in an ideal world, clinicians should routinely carry out screenings for ADHD in adult patients with BD and vice versa, clinicians treating children and adolescents with ADHD should be aware that their patients are at risk to develop BD, perhaps even at a younger age than they would normally expect. Screening for ADHD in BD patients is particularly important, as it might likely be overlooked (in contrast it is rather unlikely that BD is overlooked in ADHD) and, consequently, undertreated. Because the treatments for ADHD and BD are different, failure to identify comorbid disorders would mean that some patients do not receive the treatment needed for the comorbid disorder.
Q: Are you conducting any more research in this area, and are there any other studies you feel are needed?
A: In our studies we attempt to assess comorbidities as thoroughly as possible. We have several ongoing studies in patients with adult ADHD in scope of a dietary intervention and are keen to look at first results, including how comorbidities influence response rates. I do feel that there is a real need for studies which include a detailed psychological profile. It would be interesting to assess if treatment responses and responses to behavioral tests differ between patients with and without comorbidities—this could be an easily applicable target for precision medicine approaches. What should come next is to address neurobiological and genetic studies to explain the overlapping mechanisms, for which, we are already well underway.
Q: Any final thoughts pertaining to this research?
A: I do hope that having an estimate of how frequent ADHD and BD occur together, will help clinicians to screen for comorbidity and make informed choices when treating their patients.
Reference
Dr. Carmen Schiweck has studied psychology and neurosciences in Paris, France, Maastricht, and the Netherlands. She holds a PhD in Biomedical Sciences from KU Leuven University, Belgium, and has a research interest in neurobiological processes in affective and psychotic disorders. Dr. Schiweck is currently working at Goethe University in Frankfurt, Germany, where she works in the lab of Professor Andreas Reif.
