Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Fondazione BRF, Istituto per la Ricerca Scientifica in Psichiatria e Neuroscienze, Lucca, Italy.
Curr Med Chem. 2019;26(38):6942-6969. doi: 10.2174/0929867326666190805153610.
Attention deficit hyperactivity (ADHD) disorder is a neurodevelopmental disorder characterized by inattention, hyperactivity, disruptive behaviour, and impulsivity. Despite considered typical of children for a long time, the persistence of ADHD symptoms in adulthood gained increasing interest during the last decades. Indeed, its diagnosis, albeit controversial, is rarely carried out even because ADHD is often comorbid with several other psychiatric diosrders, in particular with bipolar disorders (BDs), a condition that complicates the clinical picture, assessment and treatment.
The aim of this paper was to systematically review the scientific literature on the neurobiological, clinical features and current pharmacological management of ADHD comorbid with BDs across the entire lifespan, with a major focus on the adulthood.
The pharmacology of ADHD-BD in adults is still empirical and influenced by the individual experience of the clinicians. Stimulants are endowed of a prompt efficacy and safety, whilst non-stimulants are useful when a substance abuse history is detected, although they require some weeks in order to be fully effective. In any case, an in-depth diagnostic and clinical evaluation of the single individual is mandatory.
The comorbidity of ADHD with BD is still a controversial matter, as it is the notion of adult ADHD as a distinct nosological category. Indeed, some findings highlighted the presence of common neurobiological mechanisms and overlapping clinical features, although disagreement does exist. In any case, while expecting to disentangle this crucial question, a correct management of this comorbidity is essential, which requires the co-administration of mood stabilizers. Further controlled clinical studies in large samples of adult ADHD-BD patients appear extremely urgent in order to better define possible therapeutic guidelines, as well as alternative approaches for this potentially invalidating condition.
注意力缺陷多动障碍（ADHD）是一种神经发育障碍，其特征是注意力不集中、多动、行为障碍和冲动。尽管 ADHD 的症状长期以来一直被认为是儿童的典型表现，但近年来，ADHD 症状在成年期的持续性引起了越来越多的关注。事实上，尽管 ADHD 的诊断存在争议，但即使是因为 ADHD 经常与其他几种精神疾病共病，特别是与双相情感障碍（BD）共病，这种情况也会使临床症状、评估和治疗变得复杂，其诊断也很少进行。
本文旨在系统综述关于 ADHD 与 BD 共病的神经生物学、临床特征和当前药物治疗的科学文献，重点关注成年期。
ADHD-BD 成人患者的药理学仍然是经验性的，受到临床医生个人经验的影响。兴奋剂具有迅速的疗效和安全性，而非兴奋剂在发现药物滥用史时有用，尽管它们需要几周时间才能完全有效。在任何情况下，对个体进行深入的诊断和临床评估都是强制性的。
ADHD 与 BD 的共病仍然是一个有争议的问题，因为 ADHD 作为一个独立的疾病分类在成人中仍然存在争议。事实上，一些研究结果强调了共同的神经生物学机制和重叠的临床特征的存在，尽管存在分歧。在任何情况下，虽然期待解决这个关键问题，但正确管理这种共病是至关重要的，这需要联合使用情绪稳定剂。在大量 ADHD-BD 成年患者中进行进一步的对照临床研究显得极其紧迫，以便更好地定义可能的治疗指南，以及为这种潜在致残的情况提供替代方法。
