Bipolar Disorder Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
ADHD Program, Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Catalonia, Spain.
J Affect Disord. 2018 Feb;227:117-125. doi: 10.1016/j.jad.2017.09.037. Epub 2017 Sep 25.
It is well established that patients with either bipolar disorder (BD) or attention-deficit/hyperactivity disorder (ADHD) present functional impairment even when in remission. Nevertheless, research on functional impairment with adult patients with bipolar disorder comorbid to ADHD (BD+ADHD) is very scarce. The main objective of the current report was to evaluate the overall and specific domains of functioning, in patients with BD+ADHD compared to patients with pure bipolar disorder (pBD) and healthy controls (HCs).
162 subjects from 3 groups were compared: 63 pBD, 23 BD+ADHD and 76 HCs. All the patients with BD had been euthymic for at least 6 months and they were recruited at the Hospital Clinic of Barcelona. All the participants were assessed with the 17-item Hamilton Depression Rating Scale (HAM-D), the Young Mania Rating Scale (YMRS) and the Functioning Assessment Short Test (FAST). Clinical, and sociodemographic data were also recorded.
Clinical groups, pBD and BD+ADHD, showed lower overall functioning (p < 0.001) in each domain of the FAST scale compared to the HCs. Moreover, the Tukey post hoc test revealed that the BD+ADHD group showed a worse score than pBD in the cognitive domain of the FAST. However, after controlling for potential confounding variables, only the HDRS scores (p < 0.026) remained significant for the cognitive domain of the FAST.
The small sample size of the comorbid BD+ADHD group.
Adult patients with BD+ADHD showed the worst scores in functioning compared with the HCs, but did not show more severe functional impairment than the pBD group except for the cognitive domain. Therefore our findings suggest that depressive symptoms in adults with BD+ADHD may negatively influence cognitive functioning. Further studies are needed to confirm our findings for the management of BD+ADHD.
众所周知，即使在缓解期，双相障碍（BD）或注意力缺陷/多动障碍（ADHD）患者也存在功能障碍。然而，针对伴有 ADHD 的成年双相障碍患者（BD+ADHD）的功能障碍研究却非常有限。本研究的主要目的是评估与单纯双相障碍患者（pBD）和健康对照组（HC）相比，BD+ADHD 患者的整体和特定领域的功能。
将 3 组共 162 名患者进行比较：63 名 pBD，23 名 BD+ADHD 和 76 名 HCs。所有 BD 患者均已缓解至少 6 个月，在巴塞罗那 Clinic 医院招募。所有患者均采用汉密尔顿抑郁量表（HAM-D）、Young 躁狂评定量表（YMRS）和功能评估简表（FAST）进行评估。还记录了临床和社会人口统计学数据。
临床组（pBD 和 BD+ADHD）在 FAST 量表的每个领域的整体功能评分均低于 HC（p<0.001）。此外，Tukey 事后检验显示，BD+ADHD 组在 FAST 的认知领域的得分比 pBD 组差。然而，在控制潜在的混杂变量后，只有 HAM-D 评分（p<0.026）对 FAST 的认知领域仍具有显著意义。
BD+ADHD 共病组的样本量较小。
与 HC 相比，BD+ADHD 成年患者的功能障碍评分最差，但除认知领域外，BD+ADHD 患者的功能障碍并未比 pBD 组更严重。因此，我们的研究结果表明，BD+ADHD 成人患者的抑郁症状可能会对认知功能产生负面影响。需要进一步的研究来证实我们的研究结果，以管理 BD+ADHD。
