Adult attention-deficit/hyperactivity disorder in major depressed and bipolar subjects: role of personality traits and clinical implications

  • Marco Di Nicola
  • Loretta Sala
  • Lucia Romo
  • Valeria Catalano
  • Christian Even
  • Caroline Dubertret
  • Giovanni Martinotti
  • Giovanni Camardese
  • Marianna Mazza
  • Daniela Tedeschi
  • Antonino Callea
  • Luisa De Risio
  • Julien Daniel Guelfi
  • Fréderic Rouillon
  • Luigi Janiri
  • Philip Gorwood
Original Paper

Abstract

A significant comorbidity between attention-deficit/hyperactivity disorder (ADHD) and affective disorders has been consistently reported in adults. Less data regarding the role of personality traits and the influence of ADHD co-occurrence on clinical characteristics and outcome of mood disorders are currently available. One hundred and six remitted major depressed, 102 euthymic bipolar subjects, and 120 healthy controls, homogeneous with respect to demographic characteristics, were included in the study. ADHD diagnosis was based on DSM-IV-TR criteria. Childhood and adult ADHD features were measured with the Wender Utah Rating Scale, the Adult ADHD Self-rating Scale, and the Brown Attention-Deficit Disorder Scale. The Revised NEO Personality Inventory was also administered to the clinical groups, in order to investigate personality dimensions. The occurrence of adult ADHD in subjects with bipolar disorders (BD) or major depressive disorder (MDD) was 15.7 and 7.5 %, respectively, compared to 3.3 % in healthy controls (HC). Significant associations (p < .001) between personality traits (neuroticism, conscientiousness, and extraversion) and ADHD features were observed. Logistic regression analysis of all clinical subjects (n = 208) showed that those with lower levels of neuroticism (OR = 1.031; p = .025) had a lower frequency of ADHD comorbidity. The present study emphasizes the close relationship between affective disorders, especially BD, and ADHD in adults. Our findings support the need to assess subjects with mood disorders in the clinical setting for possible coexisting ADHD and to further investigate personality traits to better understand the etiology of affective disorders and ADHD co-occurrence.

Keywords

Attention-deficit/hyperactivity disorder Bipolar disorder Major depressive disorder Comorbidity Personality Neuroticism 

References

  1. 1.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn., text revision. American Psychiatric Association, Washington, DCGoogle Scholar
  2. 2.
    Biederman J, Faraone SV (2005) Attention-deficit hyperactivity disorders. Lancet 366(9481):237–248PubMedCrossRefGoogle Scholar
  3. 3.
    Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K, Spencer T, Ustun TB, Walters EE, Zaslavsky AM (2006) The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 163(4):716–723PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, Demyttenaere K, De Girolamo G, Haro JM, Karam EG, Lara C, Lépine JP, Ormel J, Posada-Villa J, Zaslavsky AM, Jin R (2007) Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry 190(5):402–409PubMedCrossRefGoogle Scholar
  5. 5.
    Barkley RA, Fischer M, Smallish L, Fletcher K (2002) The persistence of attention deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. J Abnorm Psychol 111:279–289PubMedCrossRefGoogle Scholar
  6. 6.
    Kessler RC, Adler LA, Barkley R, Biederman J, Conners CK, Faraone SV, Greenhill LL, Jaeger S, Secnik K, Spencer T, Ustün TB, Zaslavsky AM (2005) Patterns and predictors of attention deficit/hyperactivity persistence in adulthood: results from the National Comorbidity Survey Replication. Biol Psychiatry 57:1442–1451PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Karam RG, Bau CH, Salgado CA, Kalil KL, Victor MM, Sousa NO, Vitola ES, Picon FA, Zeni GD, Rohde LA, Belmonte-de-Abreu P, Grevet EH (2009) Late-onset ADHD in adults: milder, but still dysfunctional. J Psychiatr Res 43(7):697–701PubMedCrossRefGoogle Scholar
  8. 8.
    Cumyn L, Kolar D, Keller A, Hetchman L (2007) Current issues and trends in the diagnosis and treatment of adults with ADHD. Expert Rev Neurother 7:1375–1390PubMedCrossRefGoogle Scholar
  9. 9.
    McIntyre RS, Kennedy SH, Soczynska JK et al (2010) Attention-deficit/hyperactivity disorder in adults with bipolar disorder or major depressive disorder: results from the International Mood Disorders Collaborative Project. Prim Care Companion J Clin Psychiatry 12:e1–e7Google Scholar
  10. 10.
    Bond DJ, Hadjipavlou G, Lam RW, McIntyre RS, Beaulieu S, Schaffer A, Weiss M (2012) The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid attention-deficit/hyperactivity disorder. Ann Clin Psychiatry 24(1):23–37PubMedGoogle Scholar
  11. 11.
    Sobanski E, Brüggemann D, Alm B, Kern S, Deschner M, Schubert T, Philipsen A, Rietschel M (2007) Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci 257:371–377PubMedCrossRefGoogle Scholar
  12. 12.
    Biederman J, Ball SW, Monuteaux MC, Mick E, Spencer TJ, McCreary M (2008) New insights into the comorbidity between ADHD and major depression in adolescent and young adult females. J Am Acad Child Adolesc Psychiatry 47:426–434PubMedCrossRefGoogle Scholar
  13. 13.
    Nierenberg AA, Miyahara S, Spencer T, Wisniewski SR, Otto MW, Simon N, Pollack MH, Ostacher MJ, Yan L, Siegel R, Sachs GS (1000) STEP-BD Investigators. Clinical and diagnostic implications of lifetime attention-deficit/hyperactivity disorder comorbidity in adults with bipolar disorder: data from the first 1000 STEP-BD participants. Biol Psychiatry 57(11):1467–1473CrossRefGoogle Scholar
  14. 14.
    Miller TW, Nigg JT, Miller RL (2009) Attention deficit hyperactivity disorder in African American children: what can be concluded from the past ten years? Clin Psychol Rev 29(1):77–86PubMedCrossRefGoogle Scholar
  15. 15.
    Klassen LJ, Katzman MA, Chokka MP (2010) Adult ADHD and its comorbidities, with a focus on bipolar disorder. J Affect Disord 124(1–2):1–8PubMedCrossRefGoogle Scholar
  16. 16.
    Sachs GS, Baldassano CF, Truman CJ, Guille C (2000) Comorbidity of attention deficit hyperactivity disorder with early- and late-onset bipolar disorder. Am J Psychiatry 157(3):466–468PubMedCrossRefGoogle Scholar
  17. 17.
    Rothbart M, Bates J (2006) Temperament. In: Damon W, Lerner R (eds) Handbook of child. Psychology. Wiley, New York, pp 99–166Google Scholar
  18. 18.
    Martel MM, Nigg JT, Von EA (2009) How do trait dimensions map onto ADHD symptom domains? J Abnorm Child Psychol 37(3):337–348PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Martel MM, Pierce L, Nigg JT, Jester JM, Adams K, Puttler LI, Buu A, Fitzgerald H, Zucker RA (2009) Temperament pathways to childhood disruptive behavior and adolescent substance abuse: testing a cascade model. J Abnorm Child Psychol 37(3):363–373PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Bernardi S, Cortese M, Solanto M, Hollander E, Pallanti S (2010) Bipolar disorder and comorbid attention deficit hyperactivity disorder. A distinct clinical phenotype? Clinical characteristics and personality traits. World J Biol Psychiatry 11(4):656–666PubMedCrossRefGoogle Scholar
  21. 21.
    Valero S, Ramos-Quiroga A, Gomà-I-Freixanet M, Bosch R, Gómez-Barros N, Nogueira M, Palomar G, Corrales M, Casas M (2012) Personality profile of adult ADHD: the alternative five factor model. Psychiatry Res 198(1):130–134PubMedCrossRefGoogle Scholar
  22. 22.
    Guy W (1976) ECDEU Assessment Manual for Psychopharmacology. Revised, 1976. DHEW Publication No. (ADM), pp 76–338Google Scholar
  23. 23.
    Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Young R, Biggs J, Ziegler V, Meyer D (1978) A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 133:429–435PubMedCrossRefGoogle Scholar
  25. 25.
    First MB, Spitzer RL, Gibbon M, Williams JB (1995) Structured Clinical Interview for DSM-IV Axis I Disorders—Patient Edition (SCID-I/P, Version 2.0). Biometrics Research, New York State Psychiatric Institute, New YorkGoogle Scholar
  26. 26.
    Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59 Suppl. 20:22–33, quiz 34–57Google Scholar
  27. 27.
    First MB, Spitzer RL, Gibbon M, Williams BW, Benjamin L (1990) Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Biometrics Research, New York State Psychiatric Institute, New YorkGoogle Scholar
  28. 28.
    Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, Howes MJ, Jin R, Secnik K, Spencer T, Ustun TB, Walters EE (2005) The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med 35(2):245–256PubMedCrossRefGoogle Scholar
  29. 29.
    Rucklidge JJ, Tannock R (2002) Validity of the Brown ADD scales: an investigation in a predominantly inattentive ADHD adolescent sample with and without reading disabilities. J Atten Disord 5(3):155–164PubMedCrossRefGoogle Scholar
  30. 30.
    Romo L, Legauffre C, Mille S, Chèze N, Fougères AL, Marquez S, Excoffier A, Dubertret C, Adès J (2010) Psychometric properties of the French version of the Wender Utah Rating Scale and Brown’s Attention Deficit Disorders Scale for adults. Encephale 36(5):380–389PubMedCrossRefGoogle Scholar
  31. 31.
    Fossati A, Di Ceglie A, Acquarini E, Donati D, Donini D, Novella L, Maffei C (2001) The retrospective assessment of childhood attention deficit hyperactivity disorder in adults: reliability and validity of the Italian version of the Wender Utah Rating Scale. Compr Psychiatry 42:326–336PubMedCrossRefGoogle Scholar
  32. 32.
    Costa PT Jr, McCrae RR (2000) Overview: innovations in assessment using the revised NEO personality inventory. Assessment 7(4):325–327PubMedCrossRefGoogle Scholar
  33. 33.
    McIntosh D, Kutcher S, Binder C, Levitt A, Fallu A, Rosenbluth M (2009) Adult ADHD and comorbid depression: a consensus-derived diagnostic algorithm for ADHD. Neuropsychiatr Dis Treat 5:137–150PubMedCentralPubMedGoogle Scholar
  34. 34.
    Tamam L, Karakus G, Ozpoyraz N (2008) Comorbidity of adult attention-deficit hyperactivity disorder and bipolar disorder: prevalence and clinical correlates. Eur Arch Psychiatry Clin Neurosci 258:385–393PubMedCrossRefGoogle Scholar
  35. 35.
    Joo EJ, Lee KY, Choi K, Kim SH, Song JY, Bang YW, Ahn YM, Kim YS (2012) Childhood attention deficit hyperactivity disorder features in adult mood disorders. Compr Psychiatry 53:217–223PubMedCrossRefGoogle Scholar
  36. 36.
    Barnett JH, Smoller JW (2009) The genetics of bipolar disorder. Neuroscience 164(1):331–343PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Franke B, Neale BM, Faraone SV (2009) Genome-wide association studies in ADHD. Hum Genet 126(1):13–50PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Hegerl U, Himmerich H, Engmann B, Hensch T (2010) Mania and attention-deficit/hyperactivity disorder: common symptomatology, common pathophysiology and common treatment? Curr Opin Psychiatry 23(1):1–7PubMedCrossRefGoogle Scholar
  39. 39.
    Skirrow C, Hosang GM, Farmer AE, Asherson P (2012) An update on the debated association between ADHD and bipolar disorder across the lifespan. J Affect Disord 141(2–3):143–159PubMedCrossRefGoogle Scholar
  40. 40.
    Brown A, Biederman J, Valera E, Lomedico A, Aleardi M, Makris N, Seidman LJ (2012) Working memory network alterations and associated symptoms in adults with ADHD and Bipolar Disorder. J Psychiatr Res 46(4):476–483PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Townsend JD, Sugar CA, Walshaw PD, Vasquez RE, Foland-Ross LC, Moody TD, Bookheimer SY, McGough JJ, Altshuler LL (2013) Frontostriatal neuroimaging findings differ in patients with bipolar disorder who have or do not have ADHD comorbidity. J Affect Disord 147(1–3):389–396. doi:10.1016/j.jad.2012.08.019 PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Makris N, Seidman LJ, Brown A, Valera EM, Kaiser JR, Petty CR, Liang L, Aleardi M, Boriel D, Henderson CS, Giddens M, Faraone SV, Spencer TJ, Biederman J (2012) Further understanding of the comorbidity between Attention-Deficit/Hyperactivity Disorder and bipolar disorder in adults: an MRI study of cortical thickness. Psychiatry Res 202(1):1–11PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Hegarty CE, Foland-Ross LC, Narr KL, Sugar CA, McGough JJ, Thompson PM, Altshuler LL (2012) ADHD comorbidity can matter when assessing cortical thickness abnormalities in patients with bipolar disorder. Bipolar Disord 14:843–855PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Catalano V, Harnic D, Di Nicola M, Mazza M, Martinotti G, Bruschi A, Di Felice C, Carnevale E, Marano G, Pozzi G, Bria P, Janiri L (2011) Diagnosis of attention deficit/hyperactivity disorder (ADHD) in patients with bipolar or unipolar depression: an experimental study. Clin Ter 162(2):107–111PubMedGoogle Scholar
  45. 45.
    Landaas ET, Halmøy A, Oedegaard KJ, Fasmer OB, Haavik J (2012) The impact of cyclothymic temperament in adult ADHD. J Affect Disorder 142(1–3):241–247. doi:10.1016/j.jad.2012.04.034 CrossRefGoogle Scholar
  46. 46.
    Eisenberg N, Fabes RA, Karbon M, Murphy BC, Wosinski M, Polazzi L, Carlo G, Juhnke C (1996) The relations of children’s dispositional prosocial behavior to emotionality, regulation, and social functioning. Child Dev 67(3):974–992PubMedCrossRefGoogle Scholar
  47. 47.
    Eisenberg N, Fabes RA, Guthrie IK, Reiser M (2000) Dispositional emotionality and regulation: their role in predicting quality of social functioning. J Pers Soc Psychol 78(1):136–157PubMedCrossRefGoogle Scholar
  48. 48.
    McKinney AA, Canu WH, Schneider HG (2013) Distinct ADHD symptom clusters differentially associated with personality traits. J Atten Disord 17(4):358–366PubMedCrossRefGoogle Scholar
  49. 49.
    Wu PJ, Chang SM, Lu MK, Chen WJ, Yang YK, Yeh TL, Liao SC, Lu RB, Kuo PH (2012) The profile and familiarity of personality traits in mood disorder families. J Affect Disord 138(3):367–374PubMedCrossRefGoogle Scholar
  50. 50.
    Rösler M, Retz W, Thome J, Schneider M, Stieglitz RD, Falkai P (2006) Psychopathological rating scales for diagnostic use in adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci 256 Suppl 1:i3–11. ReviewGoogle Scholar
  51. 51.
    Eich D, Angst J, Frei A, Ajdacic-Gross V, Rössler W, Gamma A (2012) A new rating scale for adult ADHD based on the Symptom Checklist 90 (SCL-90-R). Eur Arch Psychiatry Clin Neurosci 262(6):519–528PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Marco Di Nicola
    • 1
    • 7
  • Loretta Sala
    • 2
  • Lucia Romo
    • 2
    • 5
  • Valeria Catalano
    • 1
  • Christian Even
    • 2
  • Caroline Dubertret
    • 3
  • Giovanni Martinotti
    • 8
  • Giovanni Camardese
    • 1
  • Marianna Mazza
    • 1
  • Daniela Tedeschi
    • 1
  • Antonino Callea
    • 6
  • Luisa De Risio
    • 1
  • Julien Daniel Guelfi
    • 2
  • Fréderic Rouillon
    • 2
    • 4
  • Luigi Janiri
    • 1
    • 7
  • Philip Gorwood
    • 2
    • 4
  1. 1.Institute of Psychiatry and PsychologyCatholic University of Sacred Heart RomeItaly
  2. 2.CMME, Sainte-Anne HospitalParis Descartes UniversityParisFrance
  3. 3.Louis Mourier University HospitalColombesFrance
  4. 4.Centre of Psychiatry and NeurosciencesINSERM U894ParisFrance
  5. 5.Laboratoire EvaclipsyUniversity Paris Ouest Nanterre La DéfenseParisFrance
  6. 6.Science of EducationLUMSA UniversityRomeItaly
  7. 7.University Consortium HumanitasRomeItaly
  8. 8.Department of Neuroscience and ImagingUniversity “G. d’Annunzio”ChietiItaly

Personalised recommendations