The aim of this study was to determine the frequency of adult attention deficit hyperactivity disorder (ADHD) comorbidity with lifetime bipolar disorder, and the influence of this comorbidity on various demographic and clinical variables in patients. Patients (n=159) with a previous diagnosis of bipolar disorder (79 female, 80 male) were included in this study. All patients were interviewed for the presence of current adult and childhood ADHD diagnosis and other axis I psychiatric disorder comorbidities using the structured clinical interview for DSM-IV (SCID) and the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL). The subjects also completed a Wender Utah rating scale (WURS-25) and a Current Symptoms Scale for ADHD symptoms. In particular, patients' clinical characteristics, the age of onset of bipolar disorder, and the number of episodes were noted. Twenty-six of the 159 bipolar patients (16.3%) were diagnosed with adult ADHD, while another subgroup of patients (n=17, 10.7%) received a diagnosis of childhood ADHD but did not fulfill criteria for adult ADHD. Both of these two subgroups (patients with adult ADHD, and patients with only childhood ADHD) had an earlier age of onset of the disease and a higher number of previous total affective or depressive episodes than those without any lifetime ADHD comorbidity. However only bipolar patients with adult ADHD comorbidity had higher lifetime comorbidity rates for axis I psychiatric disorders, such as panic disorder and alcohol abuse/dependence, compared to patients without lifetime ADHD. Bipolar patients with comorbid adult ADHD did not differ from bipolar patients with comorbid childhood ADHD in terms of any demographic or clinical variables except for adult ADHD scale scores. In conclusion, ADHD is a common comorbidity in bipolar patients, and it adversely affects the course of the disease and disrupts the social adjustment of the patients. Regular monitoring of ADHD will help to prevent problems and complications that could arise in the course of the disease, particularly in patients with early onset bipolar disorder.

The aim of this study was to assess the comorbidity of lifetime and current prevalences of anxiety disorders among 70 patients with bipolar I disorder in remission using structured diagnostic interviews and to examine the association between comorbidity and several demographic and clinical variables. Forty-three (61.4%) bipolar I patients also met DSM-IV criteria for at least one lifetime comorbid anxiety disorder. Obsessive-compulsive disorder (39%) was the most common comorbid lifetime anxiety disorder, followed by simple phobia (26%) and social phobia (20%). First episode and male sex were found to have lower rates of comorbid current anxiety disorders. The presence of anxiety disorders was related to significantly higher scores on both anxiety and general psychopathology scales. The results of the present study support previous findings of a high comorbidity rate of anxiety disorders in bipolar I disorder cases and indicate that the presence of an anxiety disorder leads to more severe psychopathology levels in bipolar I patients.

Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed in the treatment of depression and anxiety, as well as obsessive-compulsive, eating, and impulse-control disorders. Paralleling their widespread use has been an increase in adverse-effect reports not noted during short-term efficacy studies. Significant among these adverse effects is SSRI discontinuation syndrome, which follows the interruption of extended treatment or a reduction in drug dosage and entails somatic and psychological symptoms. These self-limiting symptoms resolve on reintroduction of the drug and cannot be explained as a remanifestation of the original disorder. To facilitate proper diagnosis and avoid unnecessary therapeutic or diagnostic interventions, all physicians who prescribe SSRIs should become familiar with these symptoms. The most appropriate approach to therapy for discontinuation syndrome involves educating patients and reassuring them that this is a reversible condition, reinstating the original SSRI, and further slowing the rate of tapering.

The purposes of this study were to evaluate possible effects of lithium on thyroid function, determine the relationship among thyroid function, antibody levels, and demographic/clinical variables, and establish the prevalence of lithium-related goiter, clinical hypothyroidism, and thyroid antibodies. Forty-nine patients who had taken lithium for a minimum of 6 months were enrolled, as were 46 age- and sex-matched controls naïve to lithium use. Blood was drawn to measure levels of total and free T3, T4, thyroid-stimulating hormone (TSH), and antimicrosomal and antithyroglobulin antibodies. Thyroid volume was quantified on ultrasonography. Twenty-nine patients in the study group (59%) and 7 in the control group (15%) had goiter. Free T4 levels were significantly lower in the study group, and TSH levels were higher. Among lithium-treated patients, 12% had clinical hypothyroidism and 2% had subclinical hypothyroidism. Thyroid antibodies were present in 23% of the lithium group and 15% of the control group. No significant relationship was apparent among thyroid antibodies, thyroid volume, and clinical hypothyroidism. Our findings suggested that along with its goitrogenic effects, lithium inhibited thyroid function and led to clinical hypothyroidism. Older age, family history of thyroid disorders, and the presence of thyroid antibodies significantly influenced thyroid function in the present study.

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