Bipolar Symptoms in Adult Attention-Deficit/Hyperactivity Disorder: A Cross-Sectional Study of 510 Clinically Diagnosed Patients and 417 Population-Based Controls

Objective: Bipolar spectrum disorders (BSD) have several symptoms and features in common with attention-deficit/hyperactivity disorder (ADHD). Here we explored the prevalence of BSD and the relationship between symptoms of BSD and ADHD in adult ADHD patients.

Method: Norwegian adults diagnosed with DSM-IV ADHD during 1997 through 2007 (n‘ ‰=‘ ‰510) and a random sample of 417 controls from the general population (aged 18-40 years) were recruited and responded to 85 questions rating symptoms of ADHD, lifetime symptoms of mood disorders, other comorbid conditions, and sociodemographic data.

Results: According to the Mood Disorder Questionnaire (MDQ), 50.6% of the ADHD patients screened positive for BSD, compared to 8.3% of the controls. In comparison, the prevalence of BSD according to DSM-IV in a subsample of interviewed patients (n‘ ‰=‘ ‰50) was 32%. In the whole study sample (N‘ ‰=‘ ‰927), an ADHD diagnosis was the strongest predictor for screening positive on the MDQ (OR‘ ‰=‘ ‰5.0, P‘ ‰<‘ ‰.001), but the correlation between dimensional symptom levels of ADHD and of BSD was strongest in the control group (Pearson correlation r‘ ‰=‘ ‰0.7, P‘ ‰<‘ ‰.001 vs r‘ ‰=‘ ‰0.3, P‘ ‰<‘ ‰.001). Patients screening positive on the MDQ had significantly more drug problems, higher ADHD symptom scores, and lower educational and occupational levels.

Conclusions: Our findings illustrate the close relationship between some symptoms of BSD and ADHD in adults. In clinical and research settings, patients screening positive for BSD should be assessed for a possible underlying or coexisting ADHD condition and vice versa.

Submitted: September 17, 2008; accepted January 30, 2009

Corresponding author: Anne Halmøy, MD, Department of Biomedicine, University of Bergen, Jonas Lies vei 91, N-5009 Bergen, Norway (anne.halmoy@biomed.uib.no).