Impact of psychiatric comorbidities on adults with ADHD

by Prof. Dr. Iuliana Dobrescu

Espen Anker, Bothild Bendiksen, Trond Heir (2018).

Comorbid psychiatric disorders in a clinical sample of adults with ADHD, and associations with education, work and social characteristics: a crosssectional  study. BMJ Open. doi: 10.1136/bmjopen-2017-019700.

Objectives. Adults with attention-deficit hyperactive disorder (ADHD) report high rates of comorbid disorders, educational and occupational failure, and family instability. The aim of this study was to examine the prevalence of comorbid psychiatric disorders in a clinical population of adults with ADHD and to examine associations between educational level, work participation, social characteristics and the rates of psychiatric comorbidity.

Methods. Out of 796 patients diagnosed with ADHD in a specialised outpatient clinic in Oslo, Norway, 548 (68%) agreed to participate in this cross-sectional study: 277 women and 271 men. ADHD was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Comorbid disorders were diagnosed using the Mini-International Neuropsychiatric Interview.

Results. In this clinical sample, 53.5% had at least one current comorbid psychiatric disorder. The most prevalent disorders were major depression, substance use disorders and social phobia. Women had more eating disorders than men, whereas men had more alcohol and substance use disorders. Education above high school level (>12 years) and work participation were associated with lower rates of comorbid disorders (adjusted ORs 0.52 and0.63, respectively). Gender, age, marital status, living with children or living in a city were not associated with comorbidity.

Conclusions. Adult ADHD is associated with high rates of comorbid psychiatric disorders, irrespective of gender and age. It appears that higher education and work participation are related to lower probability of comorbidity.

Short comment
ADHD is accompanied by one or more psychiatric disorders in three quarters of cases. The average number of comorbid disorders in ADHD adult patients is three (Kooij, 2010). This means that ADHD is not an insignificant condition, but often an undiscovered disorder in patients who have already sought help for complex problems, probably resistant to therapy. Thus, it can be issued the conclusion that ADHD whose symptomatology does not remit or was not treated in time, leads to co-morbid chronic disorders. This hypothesis applies in affective disorders, generalized anxiety disorder or conduct disorders secondary to chronic use of psychoactive substances.

Those co-existent psychiatric conditions are investigated also in the selected article, the results indicating that more than half of the subjects had at least one current comorbid psychiatric disorder. In the selected group, the most prevalent comorbid disorders were major depression, substance abuse or dependence and social phobia. Substance dependence was the most prevalent comorbid disorder in men, whereas major depression was the most prevalent one in women.

The pattern of drug addiction problems in adults with ADHD still requires thorough research because addiction adversely affects clinical evolution of ADHD as the patient gets older, through complications such as cognitive impairment and memory problems. Apart from the somatic and mental problems, the existence of comorbidities, especially of the chronic abuse of psychoactive substances, also implies affecting the quality of life. According to the study, higher education and work participation were associated with lower probability of comorbidity.

Early diagnosis of ADHD and comorbidities could better guide therapeutic and preventive intervention for these patients in order to improve the quality of life and the prospect of their cognitive and personality development. The originality of the paper lies primarily in the chosen topic, because the diagnosis of ADHD in adults is a new concept. The conclusions of the study bring new, innovative details about the way that co-existent disorders can affect certain areas of patients’ life, in order to raise awareness of the use of ADHD diagnosis in adult psychiatry services. This aspect also implies the chance that these patients benefit from better specialized intervention (both pharmacological and psychotherapeutic) in order to improve the quality of life.