Bartoli Francesco, Callovini Tommaso, Cavaleri Daniele, Cioni Riccardo Matteo, Bachi Bianca, Calabrese Angela, Moretti Federico, Canestro Aurelia, Morreale Marco, Nasti Christian, Palpella Dario, Piacenti Susanna, Nacinovich Renata, Riboldi Ilaria, Crocamo Cristina, Carrà Giuseppe
Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Division of Psychiatry, University College London, London, UK.
Aust N Z J Psychiatry. 2023 Jan;57(1):34-48. doi: 10.1177/00048674221106669. Epub 2022 Jul 2.
Attention deficit hyperactivity disorder is a frequent comorbid condition in adults with bipolar disorder. We performed a meta-analysis aimed at assessing sociodemographic and clinical correlates of attention deficit hyperactivity disorder in bipolar disorder.
We searched main electronic databases up to June 2021. Random-effects meta-analyses, with relevant meta-regression and quality-based sensitivity analyses, were carried out to estimate the association between attention deficit hyperactivity disorder and putative correlates, grading the quality of evidence.
We included 43 studies, based on 38 independent samples. Attention deficit hyperactivity disorder participants were more likely to be males (odds ratio = 1.46; < 0.001) and unemployed (odds ratio = 1.45; = 0.045), and less likely to be married (odds ratio = 0.62; = 0.014). They had an earlier onset of bipolar disorder (standardized mean difference = -0.36; < 0.001); more mood episodes (standardized mean difference = 0.35; = 0.007), particularly depressive (standardized mean difference = 0.30; = 0.011) and mixed (standardized mean difference = 0.30; = 0.031) ones; higher odds of using antidepressants (odds ratio = 1.80; = 0.024) and attempted suicides (odds ratio = 1.83; < 0.001) and lower odds of psychotic features (odds ratio = 0.63; = 0.010). Moreover, they were more likely to have generalized anxiety disorder (odds ratio = 1.50; = 0.019), panic disorder (odds ratio = 1.89; < 0.001), social phobia (odds ratio = 1.61; = 0.017), eating disorders (odds ratio = 1.91; = 0.007), antisocial personality disorder (odds ratio = 3.59; = 0.004) and substance (odds ratio = 2.29; < 0.001) or alcohol (odds ratio = 2.28; < 0.001) use disorders. Quality of the evidence was generally low or very low for the majority of correlates, except for bipolar disorder onset and alcohol/substance use disorders (high), and suicide attempts (moderate).
Comorbid bipolar disorder/attention deficit hyperactivity disorder may have some distinctive clinical features including an earlier onset of bipolar disorder and higher comorbid alcohol/substance use disorder rates. Further research is needed to identify additional clinical characteristics of this comorbidity.
注意缺陷多动障碍是双相情感障碍成人患者中常见的共病情况。我们进行了一项荟萃分析，旨在评估双相情感障碍中注意缺陷多动障碍的社会人口统计学和临床相关因素。
我们检索了截至2021年6月的主要电子数据库。进行随机效应荟萃分析，并进行相关的荟萃回归和基于质量的敏感性分析，以估计注意缺陷多动障碍与假定相关因素之间的关联，并对证据质量进行分级。
我们纳入了43项研究，基于38个独立样本。注意缺陷多动障碍参与者更可能为男性（优势比=1.46；<0.001）且失业（优势比=1.45；=0.045），结婚的可能性较小（优势比=0.62；=0.014）。他们双相情感障碍的起病更早（标准化均值差=-0.36；<0.001）；有更多的情绪发作（标准化均值差=0.35；=0.007），尤其是抑郁发作（标准化均值差=0.30；=0.011）和混合发作（标准化均值差=0.30；=0.031）；使用抗抑郁药的几率更高（优势比=1.80；=0.024）以及有自杀未遂的几率更高（优势比=1.83；<0.001），而有精神病性特征的几率更低（优势比=0.63；=0.010）。此外，他们更可能患有广泛性焦虑障碍（优势比=1.50；=0.019）、惊恐障碍（优势比=1.89；<0.001）、社交恐惧症（优势比=1.61；=0.017）、饮食失调（优势比=1.91；=0.007）、反社会人格障碍（优势比=3.59；=0.004）以及物质（优势比=2.29；<0.001）或酒精（优势比=2.28；<0.001）使用障碍。除了双相情感障碍起病以及酒精/物质使用障碍（高质量）和自杀未遂（中等质量）外，大多数相关因素的证据质量普遍较低或非常低。
双相情感障碍/注意缺陷多动障碍共病可能具有一些独特的临床特征，包括双相情感障碍起病更早以及更高的共病酒精/物质使用障碍发生率。需要进一步研究以确定这种共病的其他临床特征。
