Advertisement

Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD)

  • Esther Sobanski
  • Daniel Brüggemann
  • Barbara Alm
  • Sebastian Kern
  • Monika Deschner
  • Thomas Schubert
  • Alexandra Philipsen
  • Marcella Rietschel
ORIGINAL PAPER

Abstract

Objective

This exploratory study aims to compare lifetime psychiatric axis-I-comorbidity and psychosocial functioning in a clinically referred sample of adult patients with attention-deficit/hyperactivity disorder (ADHD) with a population-based healthy control group and to examine whether patients with ADHD and lifetime comorbid diagnoses differ from patients with pure ADHD in their functional impairment.

Method

Seventy adult patients with ADHD according to DSM-IV criteria and a gender- as well as age-matched population based control group underwent diagnostic evaluations with clinical interviews for ADHD, DSM-IV disorders and demographic information.

Results

The prevalence of psychiatric lifetime comorbidity was 77.1% in patients with ADHD and thus exceeded the rate in the control group, which was 45.7%. Significantly more patients suffered from depressive episodes, substance related disorders and eating disorders. Compared to the control group adults with ADHD were significantly impaired in a variety of psychosocial functions (education, occupational training). Patients with ADHD and lifetime diagnosis of comorbid psychiatric disorders differed from patients with pure ADHD in their psychosocial functioning only in the percentage of unemployed individuals, which was higher in patients with psychiatric comorbidity.

Conclusion

Adults with ADHD suffer significantly more often from other psychiatric disorders than individuals of the population-based control group and are impaired in several areas of psychosocial functioning. Poor psychosocial outcome is primarily related to ADHD and not to additional psychiatric disorders. Due to the limited number of assessed patients these results need to be confirmed by studies with larger sample size.

Keywords

adult attention-deficit/hyperactivity disorder ADHD psychiatric comorbidity psychosocial functioning 

Notes

Acknowledgements

We would like to thank Uwe Ruhl, Georg-August-Universität, Göttingen, for making us the use of the German version of the Brown attention deficit disorders scales available.

References

  1. 1.
    Akiskal HS, Burgeois ML, Angst J, Post R, Möller H, Hirschfeld R (2000) Re-evaluating the prevalence of and diagnostic composition within the broad sprectrum of bipolar disorders. J Affect Disorders 59:S5–S30CrossRefPubMedGoogle Scholar
  2. 2.
    American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Press, Washington, DCGoogle Scholar
  3. 3.
    Barkley RA (2002) Major life activity and health outcomes associated with attention-deficit/hyperactivity disorder. J Clin Psychiatry 63(12):10–15PubMedGoogle Scholar
  4. 4.
    Berger M (1999) Affective disorders. In: Berger M (ed) Psychiatry and psychotherapy. Urban & Schwarzenberg, München, Wien, BaltimoreGoogle Scholar
  5. 5.
    Biederman J, Faraone SV, Spencer T, Wilens T, Norman D, Lapey KA, et al. (1993) Patterns of comorbidity, cognition and psychosocial functioning in adults with attention-deficit hyperactivity disorder. Am J Psychiatry 150(12):1792–1797PubMedGoogle Scholar
  6. 6.
    Biederman J, Wilens T, Mick E, et al. (1995) Psychoactive substance use disorders in adults with attention deficit hyperactivity disorder (ADHD): effects of ADHD and psychiatric comorbidity. Am J Psychiatry 152:1652–1658PubMedGoogle Scholar
  7. 7.
    Brown TE (1996) Brown attention-deficit disorder scales manual. The Psychological Corporation, San AntoniaGoogle Scholar
  8. 8.
    Curran S, Newman S, Taylor E, Asherson P (2000) Hypescheme: an operational criteria checklist for molecular genetic studies of attention deficit and hyperactivity disorders. Am J Med Genet 96(3):244–250CrossRefPubMedGoogle Scholar
  9. 9.
    Dukarm CP (2005) Bulimia nervosa and ADHD: a possible role for stimulant medication. J Womens Health Gend Based Med 14(4):345–50Google Scholar
  10. 10.
    Dwivedi KN, Banhatti RG (2005) Attention deficit/hyperactivity disorder and ethnicity. Arch Dis Child 90(1):10–12CrossRefGoogle Scholar
  11. 11.
    Fangerau H, Ohlraun S, Granath RO, Nöthen MM, Rietschel M, Schulze TG (2004) Computer-assisted phenotype characterization for genetic research in psychiatry. Hum Hered 58:122–130CrossRefPubMedGoogle Scholar
  12. 12.
    Faraone SV, Biederman J (1998) Neurobiology of attention-deficit hyperactivity disorder. Biol Psychiatry 44:951–958CrossRefPubMedGoogle Scholar
  13. 13.
    First M, Spitzer R, Gibbon M, Williams J (1997) Structured clinical interview for DSM-IV axis-I disorders (SCID-I). American Psychiatric Press, Washington, DCGoogle Scholar
  14. 14.
    Geller B, Zimmerman B, Williams M, Bolhoffer K, Craney JL, et al. (2000) Diagnostic characteristics of 93 cases of a prepubertal and early adolescent bipolar disorder phenotype by gender, puberty and comorbid attention deficit hyperactivity disorder. J Child Adolesc Psychopharmacol 10:157–164CrossRefPubMedGoogle Scholar
  15. 15.
    Gillberg C, Gillberg IC, Rasmussen P, Kadesjö B, Söderstöm H, Rastam M (2004) Co-existing disorders in ADHD—implications for diagnosis and intervention. Eur Child Adolesc Psychiatry 13(Suppl. 1):80–92Google Scholar
  16. 16.
    Horn W (1962) Leistungsprüfsystem. Verlag für Psychologie, GöttingenGoogle Scholar
  17. 17.
    Hornig M (1998) Adressing comorbidity in adults with attention-deficit/hyperactivity disorder. J Clin Psychiatry 59(7):69–75PubMedGoogle Scholar
  18. 18.
    Kent L, Craddocok N (2003) Is there a relationship between attention deficit hyperactivity disorder and bipolar disorder? J Affect Dis 73:211–221CrossRefPubMedGoogle Scholar
  19. 19.
    Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. (2006) The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication (NCS-R). Am J Psychiatry 163(4):716–723CrossRefPubMedGoogle Scholar
  20. 20.
    Kessler RC, Berglund P, Demler O, Jin R, Walters E (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:593–602CrossRefPubMedGoogle Scholar
  21. 21.
    Kooij JJS, Burger H, Boonstra AM, Van der Linden PD, Kalma LE, Buitelaar JK (2004) Efficacy and safety of methylphenidate in 45 adults with attention-deficit/hyperactivity disorder. A randomized placebo-controlled trial. Psychol Med 34:973–982CrossRefPubMedGoogle Scholar
  22. 22.
    Manuzza S, Klein RG, Bessler A, et al. (1993) Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric status. Arch Gen Psychiatry 50(7):565–567Google Scholar
  23. 23.
    McGough JJ, Smalley SL, McCracken JT, Yang M, Del’Homme M, et al. (2005) Psychiatric comorbidity in adult attention deficit hyperactivity disorder: findings from multiplex families. Am J Psychiatry 162(9):1621–1627CrossRefPubMedGoogle Scholar
  24. 24.
    Murphy KR, Barkley RA, Bush T (2002) Young adults with attention deficit hyperactivity disorder: subtype differences in comorbidity, educational and clinical history. J Nerv Ment Dis 190(3):147–157CrossRefPubMedGoogle Scholar
  25. 25.
    Nierenberg AA, Miyahara S, Spencer T, Wisniewski SR, Otto MW, et al. (2005) Clinical and diagnostic implications of lifetime comorbidity of attention-deficit/hyperactivity disorder in adults with bipolar disorder. Data from the first 1000 STEP-BD participants. Biol Psychiatry 57(11):1467–1473CrossRefPubMedGoogle Scholar
  26. 26.
    Perkonigg A, Wittchen HU (1995) Epidemiology of anxiety disorders. In: Kasper S, Möller HJ (eds) Anxiety and panic disorders Fischer, Jena, Stuttgart, pp 137–156Google Scholar
  27. 27.
    Rasmussen P, Gillberg C (2000) Natural outcome of ADHD with developmental coordination disorder at age 22 years: a controlled, longitudinal, community-based study. J Am Acad Child Adolesc Psychiatry 39(11):1424–1431CrossRefPubMedGoogle Scholar
  28. 28.
    Retz-Junginger P., Retz W, Blocher D, Stieglitz R-D, Georg T, Supprian T, Wender PH, Rösler M (2003) Validity and reliability of the German short version of the Wender–Utah rating scale for the retrospective assessment of attention-deficit/hyperactivity disorder. Nervenarzt 74:987–993CrossRefPubMedGoogle Scholar
  29. 29.
    Rösler M, Retz W, Retz-Junginger P, Hengesch G, Schneider M, Supprian T, et al. (2004) Prevalence of attention-deficit-/hyperactivity disorder (ADHD) and comorbid disorders in young male prison inmates. Europ Arch Psychiatry Clin Neurosci 254:365–371CrossRefGoogle Scholar
  30. 30.
    Satterfield JH, Schell A (1997) A prospective study of hyperactive boys with conduct problems and normal boys: adolescent and adult criminality. J Am Acad Child Adolesc Psychiatry 36(12):1726–1735CrossRefPubMedGoogle Scholar
  31. 31.
    Schweickert LA, Strober M, Moslowitz A (1997) Efficacy of methylphenidate in bulimia nervosa with comorbid attention-deficit/hyperactivity disorder. Int J Eat Dis 21:299–301CrossRefGoogle Scholar
  32. 32.
    Secnik K, Sneusen A, Lage MJ (2005) Comorbidities and costs of adult patients diagnosed with attention–deficit hyperactivity disorder. Pharmacoeconomics 23(1):93–102CrossRefPubMedGoogle Scholar
  33. 33.
    Shekim W, Asarnow RF, Hess E, et al. (1990) A clinical and demographic profile of a sample of adults with attention deficit hyperactivity disorder, residual state. Compr Psychiatry 31:416–425CrossRefPubMedGoogle Scholar
  34. 34.
    Spencer T, Biederman J, Wilens T, Doyle R, Surman C, Prince J, et al. (2005) A large double-blind, randomized trial of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder. Biol Psychiatry 57:456–463CrossRefPubMedGoogle Scholar
  35. 35.
    Sullivan MA Rudnik-Levin F (2000) Attention-deficit/hyperactivity disorder and substance abuse: diagnostic and therapeutic considerations. Ann N Y Acad Sci:251–270Google Scholar
  36. 36.
    Ward KF, Wender PH, Reimherr FW (1993) The Wender Utah rating scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry 150:885–890PubMedGoogle Scholar
  37. 37.
    Weiss G, Hechtman L, Milroy T, et al. (1985) Psychiatric status of hyperactives as adults: a controlled prospective 15-year follow-up of 63 hyperactive children. J Am Acad Child Adolesc Psychiatry 24:211–223CrossRefGoogle Scholar
  38. 38.
    West S, McElroy, Strakowski S, Keck P, McConville B (1995) Attention-deficit hyperactivity disorder in adolesecent mania. J Affect Disord 51:145–151Google Scholar

Copyright information

© Springer 2007

Authors and Affiliations

  • Esther Sobanski
    • 1
  • Daniel Brüggemann
    • 1
  • Barbara Alm
    • 1
  • Sebastian Kern
    • 1
  • Monika Deschner
    • 2
  • Thomas Schubert
    • 3
  • Alexandra Philipsen
    • 4
  • Marcella Rietschel
    • 2
  1. 1.Department of Psychiatry and PsychotherapyCentral Institute of Mental Health, J 5MannheimGermany
  2. 2.Division of Genetic Epidemiology in PsychiatryCentral Institute of Mental Health, J 5MannheimGermany
  3. 3.Psychiatrisches Zentrum Stadtmitte, E 2-15MannheimGermany
  4. 4.Department of Psychiatry and PsychotherapyUniversity of FreiburgFreiburgGermany

Personalised recommendations