Adult attention-deficit/hyperactivity disorder in major depressed and bipolar subjects: role of personality traits and clinical implications

Abstract

A significant comorbidity between attention-deficit/hyperactivity disorder (ADHD) and affective disorders has been consistently reported in adults. Less data regarding the role of personality traits and the influence of ADHD co-occurrence on clinical characteristics and outcome of mood disorders are currently available. One hundred and six remitted major depressed, 102 euthymic bipolar subjects, and 120 healthy controls, homogeneous with respect to demographic characteristics, were included in the study. ADHD diagnosis was based on DSM-IV-TR criteria. Childhood and adult ADHD features were measured with the Wender Utah Rating Scale, the Adult ADHD Self-rating Scale, and the Brown Attention-Deficit Disorder Scale. The Revised NEO Personality Inventory was also administered to the clinical groups, in order to investigate personality dimensions. The occurrence of adult ADHD in subjects with bipolar disorders (BD) or major depressive disorder (MDD) was 15.7 and 7.5 %, respectively, compared to 3.3 % in healthy controls (HC). Significant associations (p < .001) between personality traits (neuroticism, conscientiousness, and extraversion) and ADHD features were observed. Logistic regression analysis of all clinical subjects (n = 208) showed that those with lower levels of neuroticism (OR = 1.031; p = .025) had a lower frequency of ADHD comorbidity. The present study emphasizes the close relationship between affective disorders, especially BD, and ADHD in adults. Our findings support the need to assess subjects with mood disorders in the clinical setting for possible coexisting ADHD and to further investigate personality traits to better understand the etiology of affective disorders and ADHD co-occurrence.

Adult ADHD: Associations with Personality and Other Psychopathology

“…Similar to the meta-analytic findings presented by Gomez and Corr (2014), Di Nicola et al (2014) found that combined ADHD symptoms correlated moderately and positively with neuroticism, moderately and negatively with conscientiousness, weakly and negatively with extraversion, and were unrelated to openness and agreeableness. Furthermore, they found positive associations between combined ADHD symptoms and both depression and bipolar disorder, with ADHD overlapping especially strongly with the latter.…”

“…Most research in this area has focused solely on examining the relations between ADHD diagnoses, personality, and other psychopathology; however, recent work indicates that incremental information is gained when explicating ADHD relations at the symptom (rather than diagnostic) level (De Alwis et al 2014;Di Nicola et al 2014;Gudjonsson et al 2013;McKinney et al 2013;Roberts et al 2014). In a related vein, Markon et al (2011) analyses of data from 58 studies involving 59,575 participants indicate that continuous psychopathology measures are both more reliable and valid than discrete measures.…”

“…Openness relates weakly to both dimensions, and the evidence for extraversion is mixed (see Nigg et al 2004). Regarding the latter trait, some studies have found positive relations with ADHD (Braaten and Rosén 1997;Martel et al 2010), but others have reported very weak or negative associations (Di Nicola et al 2014;Miller et al 2008).…”

“…Two recent studies (Di Nicola et al 2014;McKinney et al 2013) not included in Gomez and Corr's (2014) meta-analysis adopted an approach similar to our own, presenting data regarding how continuous symptom-based measures of ADHD are associated with personality domains and other psychopathology. Similar to the meta-analytic findings presented by Gomez and Corr (2014), Di Nicola et al (2014) found that combined ADHD symptoms correlated moderately and positively with neuroticism, moderately and negatively with conscientiousness, weakly and negatively with extraversion, and were unrelated to openness and agreeableness.…”

Historical aspects of Mozart’s mental health and diagnostic insights of ADHD and personality disorders

“…Since the finding of CH probands consuming more cigarettes each day in adulthood dissolved after removing the only available adolescent study, it needs further studies with adolescents under 20 to investigate a possible association between CH and smoking behavior. Based on consistently reported significant comorbidity between attention-deficit/hyperactivity disorder (ADHD) and affective disorders, Di Nicola et al [3] hypothesized co-occurrence of ADHD in patients with bipolar (BD) or major depressive disorder (MDD) to be associated with more maladaptive personality traits (neuroticism, conscientiousness, and extraversion) plus worse clinical characteristics, outcome, and level of functioning. Comparing remitted MDD, euthymic BD patients, and healthy controls confirmed not only the close relationship between affective disorders, particularly BD, and ADHD, but also revealed a significant association between personality traits and ADHD features, for which reason possible coexisting ADHD should regularly be assessed in patients with affective disorders.…”