Developmental Pathways for Different Subtypes of Early-Onset Bipolarity in Youths

Abstract

The presence of comorbid ADHD versus anxiety disorders is indicative of fundamental differences in the phenomenology of bipolar disorder in youth. While ADHD prior to bipolar disorder is associated with a specific bipolar phenotype, bipolar patients with multiple anxiety disorders are similar to "typical" bipolar patients.

Bipolar Disorder and ADHD: Comorbidity and Diagnostic Distinctions

“…Mood symptoms are prominent in BD, but mood fluctuations and dysregulation are common in children and adolescents with ADHD, both with and without a co-occurring mood disorder [50]. A long history of severe irritability, dysphoria, crying spells, temper tantrums, and mood lability have been described as precursors of BD, especially in early onset BD [37,45,47].…”

Staging Models and Functional Outcomes in Bipolar Disorder: Clinical Implications

“…Cannabis and alcohol use disorders were also associated with higher symptomatology and lower functioning in a longitudinal study in patients with BD [38]. Comorbidity with attention deficit hyperactivity disorder (ADHD) has been associated with suicide attempts, earlier onset of BD, functional impairment, and treatment resistance [37,39]. It seems that co-occurring PTSD has been associated with worse social functioning [40], inter-episode depression, and quality of life [41].…”

Staging Models in Bipolar Disorder

“…Specifically, cannabis and alcohol use disorders were associated with higher symptomatology and lower functioning in a longitudinal study of 137 BD patients (26). Moreover, BD patients with attention deficit hyperactivity disorder (ADHD) presented an earlier onset and had a chronic course, irritable mood, and greater clinical and functional impairment, and treatment resistance (27). In a meta-regression analysis, comorbid ADHD was significantly associated with suicide attempts (23).…”