The same concept can be transferred to adult patients with ADHD and/or BD to examine whether treatment-emergent bipolarity (mania in particular) in ADHD patients may also produce higher diagnostic rates of BD. A comparison of such longitudinal results on adults with data obtained from children and adolescents could also help to determine whether a specific group of children and adolescents with PBD and ADHD
symptoms may be at a specific risk of developing bipolar symptoms in adolescence Inhibitors,research,lifescience,medical and later adulthood, and whether this risk could be related to early exposure to stimulants and/or antidepressants. Such research could contribute to developing concepts on how to identify those children and juveniles at risk, and to develop strategies for prevention and treatment. Clinical aspects In considering potential explanations for the co-occurrence Inhibitors,research,lifescience,medical of PBD with ADHD, it was proposed that the presence of PBD symptoms could lead to an artificial increase in diagnostic rates for PBD in
ADHD samples, and that ADHD could be an early and prodromal manifestation of PBD. This proposition was then linked with the findings on treatment-emergent mania – mania triggered by pharmacological treatment Inhibitors,research,lifescience,medical with stimulants and/or antidepressants.16 Following this, it was proposed that ADHD and its associated factors, such as treatment with stimulants, may induce PBD symptoms, and that PBD and ADHD could have
an underlying Akt activity common etiology Inhibitors,research,lifescience,medical as regards genetic and neurobiological risk factors.15 In a recent review analysis, Singh et al have provided evidence that individuals at risk of developing ADHD symptoms may represent early prodromal states of PBD, and that PBD with comorbid ADHD may constitute a particular phenotype of early-onset disturbed mood and impaired affective regulation referred to as early PBD.16 However, these findings are Inhibitors,research,lifescience,medical far from definite, and the extent of comorbidity and the severity of symptom overlap between ADHD and PBD is not yet clear. Moreover, there out are also nonoverlapping symptoms, as depicted in (Figure 3). Figure 3. DSM-IV symptoms of attention deficit-hyperactivity disorder and bipolar mania not showing an overlap. Adapted from ref 23: Wingo AP, Ghaemi SN. A systematic review of rates in diagnostic validity of comorbid adult attention-deficit/hyperactivity disorder … Clarification on these issues is handicapped by the lack of longitudinal data on developmental processes in juvenile PB D, which can in part be put down to problems of feasibility in investigations, one of which constitutes patient recruitment for follow-up measures. In research, the Child Behavior Checklist (CBCL) has frequently been implemented as a tool for the diagnosis of PBD.