title: Attention-deficit hyperactivity disorder -- bipolar comorbidity in children and adolescents.
abstract: OBJECTIVE
  A substantial portion of juvenile bipolar disorder (BD) has a comorbid attention-deficit hyperactivity disorder (ADHD). The aim of our study was to analyze the cross-sectional and longitudinal implications of such comorbidity in children and adolescents with BD.
  
  
  METHODS
  Ninety-eight refereed patients (mean age 13.7 +/- 3.0 years) with a diagnosis of BD by the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime version (K-SADS-PL) were followed for 6 months.
  
  
  RESULTS
  Thirty-seven BD patients (37.8%) presented a lifetime diagnosis of comorbid ADHD. The mean age of onset of ADHD was 3.7 +/- 1.1 years, and the mean age of onset of BD was 10.0 +/- 3.2 years. Bipolar subjects with comorbid ADHD were predominantly male, younger, and had an earlier onset of BD (8.1 +/- 2.8 versus 11.1 +/- 2.9 years). Bipolar-ADHD patients presented more frequently a chronic rather than an episodic course of BD, with an irritable rather than an elated mood. They showed higher rates of oppositional defiant disorder/conduct disorder, lower rates of panic disorder, and less frequently received antidepressant medications. Finally, ADHD comorbidity was associated with a greater psychosocial impairment.
  
  
  CONCLUSIONS
  ADHD comorbidity is frequent in juvenile BD and can influence age of onset, phenomenology, comorbidity, and course of BD. A timely diagnosis should improve our efforts regarding the outcome of these subjects.
authors.affiliation: IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy. gabriele.masi@inpe.unipi.it
authors.forename: Gabriele
authors.initials: G
authors.lastname: Masi
authors.forename: Giulio
authors.initials: G
authors.lastname: Perugi
authors.forename: Cristina
authors.initials: C
authors.lastname: Toni
authors.forename: Stefania
authors.initials: S
authors.lastname: Millepiedi
authors.forename: Maria
authors.initials: M
authors.lastname: Mucci
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Bertini
authors.forename: Chiara
authors.initials: C
authors.lastname: Pfanner
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000453:epidemiology*; D001714:Bipolar Disorder / Q000188:drug therapy / Q000453:epidemiology*; D016009:Chi-Square Distribution; D002648:Child; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008137:Longitudinal Studies; D008297:Male; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data
chemical_list: D014150:Antipsychotic Agents