title: Association between childhood dimensions of attention deficit hyperactivity disorder and adulthood clinical severity of bipolar disorders.
abstract: BACKGROUND
  Clinical features of attention deficit hyperactivity disorder can be frequently observed in cases with bipolar disorders and associated with greater severity of bipolar disorders. Although designed as a screening tool for attention deficit hyperactivity disorder, the Wender Utah Rating Scale could, given its factorial structure, be useful in investigating the early history of impulsive, inattentive or mood-related symptoms among patients with bipolar disorders.
  
  
  METHODS
  We rated the Wender Utah Rating Scale in 276 adult bipolar disorder cases and 228 healthy controls and tested its factorial structure and any associations with bipolar disorder phenomenology.
  
  
  RESULTS
  We confirmed a three-factor structure for the Wender Utah Rating Scale (' impulsivity/temper', ' inattentiveness' and ' mood/self-esteem'). Cases and controls differed significantly on Wender Utah Rating Scale total score and sub-scale scores ( p-values < 10-5). About 23% of bipolar disorder cases versus 5% of controls were classified as ' WURS positive' (odds ratio = 5.21 [2.73-9.95]). In bipolar disorders, higher Wender Utah Rating Scale score was associated with earlier age at onset, severity of suicidal behaviors and polysubstance misuse; multivariate analyses, controlling for age and gender, confirmed the associations with age at onset ( p = 0.001) and alcohol and substance misuse ( p = 0.001).
  
  
  CONCLUSIONS
  Adults with bipolar disorders who reported higher levels of childhood symptoms on the Wender Utah Rating Scale presented a more severe expression of bipolar disorders in terms of age at onset and comorbidity. The Wender Utah Rating Scale could be employed to screen for attention deficit hyperactivity disorder but also for ' at-risk behaviors' in adult bipolar disorder cases and possibly for prodromal signs of early onset in high-risk subjects.
authors.affiliation: 1 Faculté de Médecine, Université Paris-Est Créteil, Créteil, France.|2 Inserm U955, Equipe Psychiatrie Translationnelle, Créteil, France.|3 AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France.|4 Fondation Fondamental, Créteil, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Etain
authors.affiliation: 1 Faculté de Médecine, Université Paris-Est Créteil, Créteil, France.
authors.forename: M
authors.initials: M
authors.lastname: Lajnef
authors.affiliation: 4 Fondation Fondamental, Créteil, France.|5 Centre Expert Trouble Bipolaire, Hospital Princesse Grace, Monaco.
authors.forename: J
authors.initials: J
authors.lastname: Loftus
authors.affiliation: 1 Faculté de Médecine, Université Paris-Est Créteil, Créteil, France.|2 Inserm U955, Equipe Psychiatrie Translationnelle, Créteil, France.|3 AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France.|4 Fondation Fondamental, Créteil, France.
authors.forename: C
authors.initials: C
authors.lastname: Henry
authors.affiliation: 3 AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France.
authors.forename: A
authors.initials: A
authors.lastname: Raust
authors.affiliation: 4 Fondation Fondamental, Créteil, France.|6 Service de Psychiatrie Adulte, Hôpital Charles Perrens Bordeaux, Bordeaux, France.
authors.forename: S
authors.initials: S
authors.lastname: Gard
authors.affiliation: 4 Fondation Fondamental, Créteil, France.|7 CHU de Nancy-Hôpitaux de Brabois, Service de Psychiatrie et Psychologie Clinique, Vandoeuvre Les Nancy, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Kahn
authors.affiliation: 1 Faculté de Médecine, Université Paris-Est Créteil, Créteil, France.|2 Inserm U955, Equipe Psychiatrie Translationnelle, Créteil, France.|3 AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France.|4 Fondation Fondamental, Créteil, France.
authors.forename: M
authors.initials: M
authors.lastname: Leboyer
authors.affiliation: 8 Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: J
authors.initials: J
authors.lastname: Scott
authors.affiliation: 4 Fondation Fondamental, Créteil, France.|9 AP-HP, GH Saint-Louis-Lariboisière-Fernand-Widal, Pôle Neurosciences, Paris, France.|10 Université Paris Diderot, UMR-S 1144, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Bellivier
mesh_terms: D000328:Adult; D017668:Age of Onset; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000523:psychology*; D001714:Bipolar Disorder / Q000150:complications / Q000175:diagnosis*; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D005602:France; D006801:Humans; D007175:Impulsive Behavior; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011569:Psychiatric Status Rating Scales; D012649:Self Concept; D012720:Severity of Illness Index; D013405:Suicide
keywords: Bipolar disorder; attention deficit; hyperactivity; impulsivity; misuse; onset; suicide