Childhood attention deficit hyperactivity disorder (ADHD) symptoms in adult bipolar patients and their outcomes – A hospital based cross-sectional study

Abstract

Background: Adult ADHD appeared to be a common comorbidity in adults with BPAD. It is more prevalent in Bipolar disorder than MDD (Major Depressive Disorder). It has been suggested by a few studies that the course of mood disorder is severe when presented with co morbid ADHD. Objectives: The objectives were to study the relationship between clinical characteristics of bipolar affective disorder with childhood externalizing factors; to study the correlation between bipolar affective disorders severity and ADHD symptoms; and to assess their quality of life. Methods: This was a case control study conducted in the Institute of Mental health, Madras Medical College, Chennai, Tamil Nadu, India for a duration of four months between March 2017 and August 2017. The study included subjects with Bipolar affective disorder (BPAD) who were in remission. The healthy controls and their parents as attenders/care givers were selected from the community. Results: Nearly 50% of cases have a positive family history for psychiatric illness whereas among controls it was 6.7% – a statistically significant difference. It was found that 32.5% had anxiety symptoms, 25.8% had hyperactivity symptoms, 21.7% had inattention symptoms, 12.5% had ODD features, and 10.0% had conduct features. The number of episodes and the number of manic episodes were higher among those with ADHD. The duration of an episode was also high among ADHD group. Inattention component was significantly associated with suicidal attempt by preventing it. Aggression was significantly associated with those who had hyperactivity, ODD features, and conduct features. Psychotic features were increased in all the subscales. The results of quality-of-life scores in WHO QOL BREF scale showed that the mean (SD) physical, psychological, social and environmental health was 56.83 (9.58), 53.53 (9.41), 37.47 (14.33) and 47.98 (9.26) respectively. Conclusion: Childhood ADHD does not lead only to mood disorder in adulthood. It may also lead to anxiety disorder, substance abuse and psychosis hence studying the entire psychological sequelae will benefit more.