ADHD dell’adulto

tra bipolarità e ossessività

Giuseppe Maina

S.C.D.U Psichiatria - A.O.U. San Luigi Gonzaga Università degli Studi di Torino

Adult ADHD and Bipolar Disorder

Adult ADHD and Bipolar Disorder

1. DIAGNOSTIC OVERLAP

Adult ADHD and Bipolar Disorder

1. DIAGNOSTIC OVERLAP

2. COMORBIDITIES

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1. DIAGNOSTIC OVERLAP

Babcock and Ornstein. Postgraduate Medicine, 2009

European Network Adult ADHD Conference, 2011

ImpatienceImpatience

Mood instabilityMood instability

ForgetfulnessForgetfulness

DistractibilityDistractibility

Initial insomniaInitial insomnia

Inner restlessnessInner restlessness

Low self-esteemLow self-esteem

Over-activityOver-activity

Emotionally unstableEmotionally unstable

InattentionInattention

ImpulsivenessImpulsiveness

Ipo/maniaDepression

Kooij et al, J Att Dis 2012

Mood and anxiety symptoms and ADHD

Neurobiological overlap between ADHD and BD

Rommel et al, Brain Topogr 2016

Reimherr et al, Journal of Clinical Psychiatry 2007

Emotional dysregulation co-varies with ADHD symptoms during treatment response

0

10

20

30

40

50

60

70

80

90

100 p <.001 p <.001p<.001

p=.002

Ch

oe

n's

d

Outcomes for adhd clinical scale as a function of treatment (methylphenidate or placebo)

ADHD and Bipolar Disorder:main differences

Clinical course:

stable Vs recurrent

Onset:

early Vs variable

Adult ADHD and Bipolar Disorder

2. COMORBIDITIES

Kooij et al, J Att Dis 2012

Comorbid disorders : 50% to 75%

ADHD

Patients with Bipolar Disorder

Comorbidity of ADHD with other DSM-IV disorders

Kessler et al, Am J Psychiatry 2006

ADHD comorbidity in Bipolar adults

Nieremberg et al, Biol Psychiatry 2005

ADHD DISTURBO BIPOLARE

ADHD

DISTURBO BIPOLARE

OPPURE

ADHD comorbidity in Bipolar adults

Nieremberg et al, Biol Psychiatry 2005

0,00%

10,00%

20,00%

30,00%

40,00%

50,00%

60,00%

70,00%

80,00%

90,00%

Bipolar I Bipolar II

Bipolar I vs. Bipolar II

ADHD no ADHD

p= .04

p= .013

N = 1000

Patients with ADHD

X

BIPOLAR

DISORDER

Patients with ADHD

X

X

X X

Hesson and Fowler, Journal of Attention Disorder 2015

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Abuso disostanze

Depressionemaggiore

SpettroBipolare

Disturbi diPersonalità

DOC Disturbi diansia

ADHD senzacomorbidità

ADHD dell’adulto (n= 128): comorbidità

Oliva et al, data on file

0%

10%

20%

30%

40%

50%

60%

70%

80%

ANTIDEPRESSIVI BDZ AC VALPROICO SALI DI LITIO ALTRI STAB

ADHD dell’adulto (n= 128): trattamenti in corso

(prima valutazione)

Oliva et al, data on file

Wang et al, Journal of Psychiatric Research 2016

n= 144920

Wang et al, Journal of Psychiatric Research, 2016

La terapia con metilfenidatolong-term (>365 gg)

protegge dallo sviluppo di DB

Etain et al, Australian & New Zealand Journal of Psychiatry, 2016n= 276

ABUSO DI SOSTANZE

Etain et al, Australian & New Zealand Journal of Psychiatry, 2016

NUMERO DI TAC

n= 276

n= 413

Yen et al, Acta Psychiatrica Scandinavica, 2016

Wen-Hsuan Lan et al Journal of Attention Disorders, 2015

ADHD was an independent risk factor for suicide

attempts in BD

n= 500 pts (15 to 24 years old)

Psychosomatics 2013; 54: 437-442

5,20%

5,40%

5,60%

5,80%

6,00%

6,20%

6,40%

6,60%

6,80%

7,00%

current lifetime

ADHD comorbidity in bipolar disorders (n=309)

6.8%

5.8%

Psychosomatics 2013; 54: 437-442

0%

5%

10%

15%

20%

25%

with ADHD without ADHD

At least one suicide attempt

Suicide attempts in bipolar patients with and without ADHD (n=309)

20.6%

14.2%

Psychosomatics 2013; 54: 437-442

Suicide attempts in bipolar patients with and without ADHD (n=309)

0

0,5

1

1,5

2

2,5

with ADHD without ADHD

Number of suicide attempts

Response to mood stabilizer in bipolar adolescents with ADHD

State et al, J Clinical Psychiatry, 2004

lithium vs.

divalproex=

no differences

Viktorin et al, The American Journal of Psychiatry, 2016

n= 2037

Adult ADHD and OCD

Kooij et al, J Att Dis, 2012

Comorbid disorders : 50% to 75%

ADHD comorbidity (definite or probable) in a large sampleof patients with Obsessive-Compulsive Disorder (n=405)

Maina et al, data on file

8

n

1.97Total OCD patients (n=405)

%Lifetime ADHD comorbidity

Çelebi et al, Journal of Attention Disorders, 2016

The Features of comorbidity of childhoodADHD in patients with

Obsessive Compulsive Disorder

Çelebi et al, Journal of Attention Disorders, 2016

The Features of comorbidity of childhoodADHD in patients with

Obsessive Compulsive Disorder

ADHD comorbidity (definite or probable) in a large sampleof pazients with Obsessive-Compulsive Disorder (n=405)

Maina et al, data on file

3

8

n

16.6OCD with tics (n=18)

1.97Total OCD patients (n=405)

%Lifetime ADHD comorbidity

Sheppard et al, Depression and anxiety, 2010

0,00%

5,00%

10,00%

15,00%

20,00%

25,00%

30,00%

35,00%

40,00%

45,00%

Probable or definite hoarding Definite Hoarding

ADHD vs. no ADHD in OCD patients

ADHD no ADHD

p= .01

p= .09

Sheppard et al, Depression and anxiety, 2010

ADHD comorbidity (definite or probable) in a large sampleof pazients with Obsessive-Compulsive Disorder (n=405)

Maina et al, data on file

7

3

8

n

14.6OCD with prominent hoarding (n=48)

16.6OCD with tics (n=18)

1.97Total OCD patients (n=405)

%Lifetime ADHD comorbidity

ADHD nell’adulto e disturbo bipolare

CONCLUSIONI:

1. Ampia sovrapposizione diagnostica

2. Frequente comorbidità lifetime ADHD espone al rischio di disturbo bipolare

3. Significativa influenza sulla storia clinica del

disturbo bipolare

decorso sfavorevole

risposta ai trattamenti

ADHD nell’adulto e DOC

CONCLUSIONI:

1. Associazione significativa con

Disturbo da accumulo

Disturbo da tic

1. Non dati su trattamenti specifici

AMBULATORIO ADHD DELL’ADULTO

SCDU PSICHIATRIA AOU SAN LUIGI GONZAGA

DIRETTORE: PROF. GIUSEPPE MAINA

RESPONSABILE: DOTT. FRANCESCO OLIVA

COLLABORATORI:DOTT. STEFANO BRAMANTEDOTT. CLAUDIO CAREZANA

DOTT. GABRIELE NIBBIODOTT. ALBERTO PORTIGLIATTI POMERI