van Hal Rianne, Geurts Dirk, van Eijndhoven Philip, Kist Joosje, Collard Rose M, Tendolkar Indira, Vrijsen Janna N
Radboud University Medical Center, Department of Psychiatry, Nijmegen, the Netherlands.
Radboud University Medical Center, Department of Psychiatry, Nijmegen, the Netherlands; Donders Institute, Radboud University Medical Center, Nijmegen, the Netherlands.
J Psychiatr Res. 2023 Sep;165:315-324. doi: 10.1016/j.jpsychires.2023.07.028. Epub 2023 Jul 29.
Major Depressive disorder (MDD) and Attention Deficit Hyperactivity Disorder (ADHD) are prevalent mental disorders that often co-occur. There is overlap in symptomatology between MDD and ADHD that complicates diagnostics and treatment selection. Hence, to aid diagnostics of single and comorbid disorders, we aimed to examine the discriminative power of common symptom measures and cognitive dysfunction to differentiate between participants diagnosed with MDD, ADHD, ADHD and comorbid MDD and without a mental disorder.
Four diagnosed groups were compared: MDD (n = 103), ADHD (n = 78), comorbid MDD + ADHD (n = 29), healthy controls (HC; n = 123). We examined between-group differences and discriminative functions of clinically validated self-report symptom questionnaires, as well as task-based and self-report measures of cognitive dysfunction.
Based on the between group comparisons, all patient groups were characterized by clinically relevant levels of ADHD-symptomatology, executive dysfunction, and diminished cognitive performances in the domain of attention; even the MDD-only group. In addition, based on self-reported symptoms of MDD, ADHD, and executive dysfunction, discriminant function analysis classified all HC correctly (100%) and patients diagnosed with ADHD or MDD relatively well (resp. 85% and 82%). Comorbid MDD + ADHD was poorly differentiated from single MDD or ADHD by the commonly used self-report symptom questionnaires for MDD and ADHD (0% correct predictions), which substantially improved by incorporating the questionnaire on executive functioning (42% correct predictions).
In both MDD and ADHD, clinical levels of attentional and executive dysfunction were found, while these clinical groups differed in cognitive flexibility, initiating, inhibition and meta-cognition. Comorbid MDD + ADHD was poorly distinguishable from non-comorbid MDD and ADHD based on self-reported symptoms of depression and ADHD. Addition of subjective executive function in the discrimination models resulted in increased discriminative power. Our findings indicate that executive functioning measure can improve the diagnostic process of ADHD and MDD.
重度抑郁症（MDD）和注意力缺陷多动障碍（ADHD）是常见的精神障碍，且常同时出现。MDD和ADHD在症状学上存在重叠，这使得诊断和治疗选择变得复杂。因此，为了辅助单一和共病障碍的诊断，我们旨在研究常见症状测量和认知功能障碍在区分被诊断为MDD、ADHD、ADHD合并MDD以及无精神障碍的参与者方面的鉴别能力。
比较了四个诊断组：MDD（n = 103）、ADHD（n = 78）、MDD + ADHD共病组（n = 29）、健康对照组（HC；n = 123）。我们研究了经过临床验证的自我报告症状问卷的组间差异和鉴别功能，以及基于任务和自我报告的认知功能障碍测量。
基于组间比较，所有患者组的特征均为具有临床相关水平的ADHD症状、执行功能障碍以及注意力领域的认知表现下降；即使是仅患有MDD的组。此外，基于自我报告的MDD、ADHD和执行功能障碍症状，判别函数分析正确分类了所有HC（100%），并且对被诊断为ADHD或MDD的患者分类相对较好（分别为85%和82%）。常用的MDD和ADHD自我报告症状问卷很难区分MDD + ADHD共病组与单一的MDD或ADHD组（正确预测率为0%），但通过纳入执行功能问卷，这一情况有了显著改善（正确预测率为42%）。
在MDD和ADHD中均发现了注意力和执行功能障碍的临床水平，而这些临床组在认知灵活性、启动、抑制和元认知方面存在差异。基于自我报告的抑郁和ADHD症状，MDD + ADHD共病组很难与非共病的MDD和ADHD区分开来。在判别模型中加入主观执行功能可提高鉴别能力。我们的研究结果表明，执行功能测量可以改善ADHD和MDD的诊断过程。
