Functional impairment in adult bipolar disorder with ADHD

Background: It is well established that patients with either bipolar disorder (BD) or attention-deficit/hyperactivity disorder (ADHD) present functional impairment even when in remission. Nevertheless, research on functional impairment with adult patients with bipolar disorder comorbid to ADHD (BD + ADHD) is very scarce. The main objective of the current report was to evaluate the overall and specific domains of functioning, in patients with BD + ADHD compared to patients with pure bipolar disorder (pBD) and healthy controls (HCs). Method: 162 subjects from 3 groups were compared: 63 pBD, 23 BD + ADHD and 76 HCs. All the patients with BD had been euthymic for at least 6 months and they were recruited at the Hospital Clinic of Barcelona. All the participants were assessed with the 17-item Hamilton Depression Rating Scale (HAM-D), the Young Mania Rating Scale (YMRS) and the Functioning Assessment Short Test (FAST). Clinical, and sociodemographic data were also recorded. Results: Clinical groups, pBD and BD+ ADHD, showed lower overall functioning (p < 0.001) in each domain of the FAST scale compared to the HCs. Moreover, the Tukey post hoc test revealed that the BD+ ADHD group showed a worse score than pBD in the cognitive domain of the FAST. However, after controlling for potential confounding variables, only the HDRS scores (p < 0.026) remained significant for the cognitive domain of the FAST. Limitations: The small sample size of the comorbid BD+ ADHD group. Conclusions: Adult patients with BD+ ADHD showed the worst scores in functioning compared with the HCs, but did not show more severe functional impairment than the pBD group except for the cognitive domain. Therefore our findings suggest that depressive symptoms in adults with BD+ ADHD may negatively influence cognitive functioning. Further studies are needed to confirm our findings for the management of BD+ ADHD.