title: ADHD comorbidity can matter when assessing cortical thickness abnormalities in patients with bipolar disorder.
abstract: OBJECTIVE
  Attention-deficit hyperactivity disorder (ADHD) is prevalent in patients with bipolar disorder (BP), but very few studies consider this when interpreting magnetic resonance imaging findings. No studies, to our knowledge, have screened for or controlled for the presence of ADHD when examining cortical thickness in patients with BP. We used a 2 × 2 design to evaluate the joint effects of BP and ADHD on cortical thickness and uncover the importance of ADHD comorbidity in BP subjects.
  
  
  METHODS
  The study included 85 subjects: 31 healthy controls, 17 BP-only, 19 ADHD-only, and 18 BP/ADHD. All patients with BP were subtype I, euthymic, and not taking lithium. Groups did not differ significantly in age or gender distribution. We used cortical thickness measuring tools combined with cortical pattern matching methods to align sulcal/gyral anatomy across participants. Significance maps were used to check for both main effects of BP and ADHD and their interaction. Post-hoc comparisons assessed how the effects of BP on cortical thickness varied as a function of the presence or absence of ADHD.
  
  
  RESULTS
  Interactions of BP and ADHD diagnoses were found in the left subgenual cingulate and right orbitofrontal cortex, demonstrating that the effect of BP on cortical thickness depends on ADHD status.
  
  
  CONCLUSIONS
  Some brain abnormalities attributed to BP may result from the presence of ADHD. Diagnostic interactions were found in regions previously implicated in the pathophysiology of BP, making it vital to control for an ADHD comorbid diagnosis when attempting to isolate neural or genetic abnormalities specific to BP.
authors.affiliation: Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California at Los Angeles (UCLA), Los Angeles, CA 90095, USA.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Hegarty
authors.forename: Lara C
authors.initials: LC
authors.lastname: Foland-Ross
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Narr
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Sugar
authors.forename: James J
authors.initials: JJ
authors.lastname: McGough
authors.forename: Paul M
authors.initials: PM
authors.lastname: Thompson
authors.forename: Lori L
authors.initials: LL
authors.lastname: Altshuler
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000473:pathology*; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000473:pathology*; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000473:pathology*; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055815:Young Adult