A Systematic Review of Rates and Diagnostic Validity of Comorbid Adult Attention-Deficit/Hyperactivity Disorder and Bipolar Disorder
Abstract
OBJECTIVE: Adult attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized and reported to frequently coexist with bipolar disorder. Concurrent diagnosis of adult ADHD and bipolar disorder remains controversial. In this study, we conducted a systematic review to examine the rates and diagnostic validity of the concept of comorbid adult ADHD and bipolar disorder. DATA SOURCES: MEDLINE, Embase, PsycInfo, and Cochrane databases were searched for articles published before March 30, 2007, using the keywords manic, bipolar, attention deficit hyperactivity, and adult. The computer search was supplemented with bibliographic cross-referencing. STUDY SELECTION: Exclusion criteria were studies with only pediatric subjects, childhood ADHD only but not adult ADHD, and either bipolar disorder or ADHD only, but not both; review articles, case reports; letters to the editor; and book chapters. Of the 262 citations found, 12 studies met our inclusion criteria. DATA EXTRACTION: Specific diagnostic validating criteria examined were phenomenology, course of illness, heredity, biological markers, and treatment response. There were 6 studies on comorbid rates, 4 on phenomenology, 3 on course of illness, 2 on heredity, none on biological markers, and 1 on treatment response. DATA SYNTHESIS: The proposed comorbid syndrome is fairly common (present in up to 47% of adult ADHD and 21% of bipolar disorder populations), with a more severe course of illness compared with that of bipolar disorder alone, and high rates of comorbidity with other psychiatric disorders. Its treatment appears to require initial mood stabilization. CONCLUSIONS: Comorbid adult ADHD and bipolar disorder has been insufficiently studied, with more emphasis on comorbidity rates and few data on course, neurobiology, heredity, and treatment. The diagnostic validity of adult ADHD/ bipolar disorder as a true comorbidity is not well-established on the basis of this equivocal and insufficient literature. More studies are greatly needed to further clarify its diagnostic validity and treatment approach.
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In bipolar disorder, mood stabilization is a prerequisite for effective ADHD treatment.
“In bipolar disorder, mood stabilization is a prerequisite for effective ADHD treatment [76].”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [76]
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BackgroundDIRAS2 is Associated with Adult ADHD, Related Traits, and Co-Morbid Disorders
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“They often co-occur [30, 31], particularly in the combined presentation of ADHD [32].”
BackgroundPersonalized and precision medicine as informants for treatment management of bipolar disorder
Perugi, G., Rossi, P. D., Fagiolini, A. M., Girardi, P., Maina, G., Sani, G., & Serretti, A. (2019) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000260 · Cited by 25 · see citing works
“…disorder and ADHD have a tangled relationship; high rates of comorbidity between the two disorders have been shown both in children and adult clinical populations (Wingo and Ghaemi, 2007; Nierenberg et al., 2005; Rydén et al., 2009; Bond et al., 2012; Skirrow et al., 2012; Tamam et al., 2008).”
BackgroundMartz, É., Bertschy, G., Kraemer, C., Weibel, S., & Weiner, L. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113988 · Cited by 21 · see citing works
Hypomania spectrum disorder in adolescence: a 15-year follow-up of non-mood morbidity in adulthood
Päären, A., Bohman, H., von Knorring, A., von Knorring, L., Olsson, G., & Jonsson, U. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-9 · Cited by 20 · see citing works
Zamani, L., Shahrivar, Z., Alaghband‐Rad, J., Sharifi, V., Davoodi, E., Ansari, S., Emari, F., Wynchank, D., Kooij, J. J. S., & Asherson, P. J. (2020) · Journal of Attention Disorders · doi:10.1177/1087054720930816 · Cited by 23 · see citing works
“Bipolar disorder was significantly higher in the AADHD group, which is consistent with several studies reporting high prevalence of bipolar disorders in the AADHD population (Marangoni et al., 2015; Wingo & Ghaemi, 2007).”
ResultMucci, F., Avella, M. T., & Marazziti, D. (2019) · Current Medicinal Chemistry · doi:10.2174/0929867326666190805153610 · Cited by 20 · see citing works
Lee, M., Anumagalla, P., Talluri, P., & Pavuluri, M. N. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.05.011 · Cited by 18 · see citing works
Torres, I., Solé, B., Corrales, M., Jiménez, E., Rotger, S., Serra-Pla, J., Forcada, I., Richarte, V., Mora, E., Jacas, C., et al. (2017) · Bipolar Disorders · doi:10.1111/bdi.12540 · Cited by 18 · see citing works
Wernicke, J., Li, M., Sha, P., Zhou, M., Sindermann, C., Becker, B., Kendrick, K. M., & Montag, C. (2018) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-018-0266-9 · Cited by 21 · see citing works
Functional impairment in adult bipolar disorder with ADHD
Torres, I., Garriga, M., Solé, B., Bonnín, C. D. M., Montse Corrales, F., Jiménez, E., Solé, E., Ramos‐Quiroga, J. A., Vieta, E., Goikolea, J. M., et al. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.09.037 · Cited by 15 · see citing works
Bipolar disorder risk alleles in children with ADHD
SCHIMMELMANN, B. G., Hinney, A., Scherag, A., Pütter, C., Pechlivanis, S., Cichon, S., Jöckel, K., Schreiber, S., Wichmann, H. ‐., Albayrak, Ö., et al. (2013) · Journal of Neural Transmission · doi:10.1007/s00702-013-1035-8 · Cited by 18 · see citing works
“…(Birmaher et al. 2010), partly overlapped in phenotype, i.e., impaired impulse control, dysregulation of energy/activity level as well as mood instability (Skirrow et al. 2009), and frequently co-occurred in adults (Wingo and Ghaerni 2007), and thus likely to share some common genetic risk factors.”
BackgroundThe Characteristics of Mood Polarity, Temperament, and Suicide Risk in Adult ADHD
Giupponi, G., Innamorati, M., Rogante, E., Sarubbi, S., Erbuto, D., Maniscalco, I., Sanna, L., Conca, A., Lester, D., & Pompili, M. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17082871 · Cited by 18 · see citing works
“1%, with a higher prevalence of Bipolar I disorder than Bipolar II [19].”
BackgroundSalarvan, S., Sparding, T., Clements, C., Rydén, E., & Landén, M. (2019) · International Journal of Bipolar Disorders · doi:10.1186/s40345-019-0149-9 · Cited by 16 · see citing works
Delineating ADHD and bipolar disorder: A comparison of clinical profiles in adult women
Kitsune, G. L., Kuntsi, J., Costello, H., Frangou, S., Hosang, G. M., McLoughlin, G., & Asherson, P. J. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.12.024 · Cited by 16 · see citing works
“Meta-analysis examining comorbidity of ADHD and BD in adults identi fi ed rates ranging from 5% to 47% (Wingo and Ghaemi, 2007), and studies of familial co-variation indicate that the disorders co-occur at a higher rate than in the general population, suggesting a potential familial relationship…”
BackgroundDISC1 in adult ADHD patients: An association study in two European samples
Jacobsen, K. K., Halmøy, A., Sánchez‐Mora, C., Ramos‐Quiroga, J. A., Cormand, B., Haavik, J., & Johansson, S. (2013) · American Journal of Medical Genetics Part B Neuropsychiatric Genetics · doi:10.1002/ajmg.b.32136 · Cited by 16 · see citing works
MacDonald, L., & Sadek, J. R. (2023) · Brain Sciences · doi:10.3390/brainsci13111517 · Cited by 18 · see citing works
“Both bipolar I disorder and bipolar II disorder are found at higher rates among adult patients with ADHD [8].”
BackgroundAedo, A., Murru, A., Sanchez, R., Grande, I., Vieta, E., & Undurraga, J. P. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.07.051 · Cited by 17 · see citing works
Torrente, F. M., López, P. L., Lischinsky, A. G., Cetkovich, M., & Manes, F. F. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.06.040 · Cited by 18 · see citing works
Türkyılmaz, E., Yavuz, B. G., Karamustafalıoğlu, O., Özer, Ö. A., & Bakım, B. (2012) · International Journal of Psychiatry in Clinical Practice · doi:10.3109/13651501.2012.674532 · Cited by 14 · see citing works
Kavakçı, Ö., Kuğu, N., Semiz, M., Meydan, F., Karsikaya, S., & Doğan, O. (2012) · The European Journal of Psychiatry · doi:10.4321/s0213-61632012000200004 · Cited by 15 · see citing works
Uchida, M., Bukhari, Q., DiSalvo, M., Green, A., Serra, G., Vater, C. H., Ghosh, S., Faraone, S. V., Gabrieli, J. D. E., & Biederman, J. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.09.051 · Cited by 16 · see citing works
Amen, D., Henderson, T. A., & Newberg, A. B. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.725788 · Cited by 20 · see citing works
“An estimated 20–47% of adults with ADHD are comorbid for bipolar disorder (87, 88).”
BackgroundPPP2R2C as a candidate gene of a temperament and character trait-based endophenotype of ADHD
Jacob, C., Nguyen, T., Weissflog, L., Herrmann, M., Liedel, S., Zamzow, K., Jans, T., Renner, T., Reichert, S., Gross-Lesch, S., et al. (2012) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-012-0080-8 · Cited by 13
Bartoli, F., Callovini, T., Calabrese, A., Cioni, R., Riboldi, I., Crocamo, C., & Carrà, G. (2021) · Brain Science · doi:10.3390/brainsci12010038 · Cited by 12 · see citing works
“Moreover, since the validity of comorbid ADHD diagnosis in BD is not well-established [54,55], its assessment would require careful attention to phenomenology, childhood history, and lifetime course of symptoms [56].”
BackgroundLifetime evolution of ADHD treatment
Mucci, F., Carpita, B., Pagni, G., Vecchia, A. D., Bjedov, S., Pozza, A., & Marazziti, D. (2021) · Journal of Neural Transmission · doi:10.1007/s00702-021-02336-w · Cited by 14 · see citing works
Wang, H., Jung, Y.-E., Chung, S.-K., Hong, J., Kang, N., Kim, M.-D., & Bahk, W. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.09.040 · Cited by 10 · see citing works
Adult ADHD in the Arab World: A review
Hayek, G. Y. E., Saab, D., Farhat, C., Krayem, Z., & Karam, E. (2019) · Archives of Psychology · doi:10.31296/aop.v3i7.115 · Cited by 9 · see citing works
“Meta-analysis examining comorbidity of ADHD and BD in adults identified rates ranging from 5% to 47%, regardless of whether comorbidity is assessed in ADHD or BD populations (Wingo & Ghaemi, 2007).”
MethodRisk Stratification for Bipolar Disorder Using Polygenic Risk Scores Among Young High-Risk Adults
Biere, S., Kranz, T. M., Matura, S., Petrova, K., Streit, F., Chiocchetti, A. G., Grimm, O., Brum, M., Brunkhorst-Kanaan, N., Oertel, V., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.552532 · Cited by 7 · see citing works
Öhlund, L., Ott, M., Lundqvist, R., Sandlund, M., Renberg, E. S., & Werneke, U. (2020) · Therapeutic Advances in Psychopharmacology · doi:10.1177/2045125320947502 · Cited by 10 · see citing works
Jhanda, S., Malhotra, S., & Grover, S. (2018) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2018.05.015 · Cited by 8 · see citing works
Treatment of Comorbid Psychiatric Disorders with Bipolar Disorder
Altınbaş, K. (2021) · Nöropsikiyatri arşivi · doi:10.29399/npa.27615 · Cited by 7 · see citing works
“In studies evaluating the comorbidity of ADHD and BD in adulthood, the prevalence of ADHD comorbidity in BD was found to be 20%, and these rates are much higher in adolescence (45-48).”
BackgroundMori, D., Inami, C., Ikeda, R., Sawahata, M., Urata, S., Yamaguchi, S. T., Kobayashi, Y., Fujita, K., Arioka, Y., Okumura, H., et al. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-02952-6 · Cited by 6 · see citing works
- Authors
- Wingo, A. P., & Ghaemi, S. N.
- Affiliations
- Emory University (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2007-11-15
- Volume
- 68
- Issue
- 11
- Pages
- 1776-1784
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2024945874
- Cited by
- 160
- References
- 0
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 4 · 2023: 9 · 2022: 6 · 2021: 10 · 2020: 11 · 2019: 12 · 2018: 8 · 2017: 11 · 2016: 8 · 2015: 10 · 2014: 16 · 2013: 6 · 2012: 14
- FWCI
- 4.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH-64189, K23MH064189)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- adult ADHD, bipolar disorder, comorbidities, diagnostic validity, clinical course, heredity (biology), biomarkers, treatment response, mood stabilization, psychiatric comorbidity
- MeSH terms
- Attention Deficit Disorder with Hyperactivity, Bipolar Disorder, Child, Diagnosis, Differential, Humans, Comorbidity
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