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Published Online: 1 December 2012

Examining the Comorbidity Between Attention Deficit Hyperactivity Disorder and Bipolar I Disorder: A Meta-Analysis of Family Genetic Studies

Abstract

Objective

The existence of comorbidity between attention deficit hyperactivity disorder (ADHD) and bipolar I disorder has been documented in clinical and epidemiological studies, in studies of children and adults, and in diagnosed ADHD and bipolar I patient samples. Yet questions remain about the validity of diagnosing bipolar I disorder in ADHD youth. The authors aim to clarify these issues by reviewing family genetic studies of ADHD and bipolar I disorder.

Method

The authors applied random-effects meta-analysis to family genetic studies of ADHD and bipolar I disorder. Twenty bipolar proband studies provided 37 estimates of the prevalence of ADHD in 4,301 relatives of bipolar probands and 1,937 relatives of comparison probands. Seven ADHD proband studies provided 12 estimates of the prevalence of bipolar I disorder in 1,877 relatives of ADHD probands and 1,601 relatives of comparison probands.

Results

These studies found a significantly higher prevalence of ADHD among relatives of bipolar probands and a significantly higher prevalence of bipolar I disorder among relatives of ADHD probands. These results could not be accounted for by publication biases, unusual results from any one observation, sample characteristics, or study design features. The authors found no evidence of heterogeneity in the ADHD or bipolar family studies.

Conclusions

The results suggest that ADHD plus bipolar comorbidity cannot be accounted for by misdiagnoses, but additional research is needed to rule out artifactual sources of comorbidity. More research is also needed to determine whether comorbidity of ADHD and bipolar I disorder constitutes a familial subtype distinct from its constituent disorders, which if confirmed would have implications for diagnostic nosology and genetic studies.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 1256 - 1266
PubMed: 23212057

History

Received: 18 January 2012
Revision received: 19 April 2012
Accepted: 11 June 2012
Published online: 1 December 2012
Published in print: December 2012

Authors

Details

Stephen V. Faraone, Ph.D.
From the Departments of Psychiatry and Neuroscience and Physiology, SUNY Upstate Medical University; the Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston; and the Department of Psychiatry, Harvard Medical School, Boston.
Joseph Biederman, M.D.
From the Departments of Psychiatry and Neuroscience and Physiology, SUNY Upstate Medical University; the Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston; and the Department of Psychiatry, Harvard Medical School, Boston.
Janet Wozniak, M.D.
From the Departments of Psychiatry and Neuroscience and Physiology, SUNY Upstate Medical University; the Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston; and the Department of Psychiatry, Harvard Medical School, Boston.

Notes

Address correspondence to Dr. Faraone ([email protected]).

Funding Information

Dr. Faraone has received consulting fees and support from Alcobra and Shire and support from NIH; has received consulting or advisory board fees or participated in continuing medical education programs sponsored by Eli Lilly, Janssen, McNeil, Novartis, Pfizer, and Shire; and has received royalties from Guilford Press and Oxford University Press. Dr. Biederman has received support from Elminda, Janssen, McNeil, and Shire; has received speakers fees from Fundacion Areces, Medice Pharmaceuticals, and the Spanish Child Psychiatry Association; has received research support, consultation fees, or speakers fees from Abbott, Alza, AstraZeneca, Bristol-Myers Squibb, Celltech, Cephalon, Eli Lilly, Esai, Forest, GlaxoSmithKline, Gliatech, Janssen, McNeil, Merck, NARSAD, National Institute on Drug Abuse, New River, National Institute of Child Health and Human Development, NIMH, Novartis, Noven, Neurosearch, Organon, Otsuka, Pfizer, Pharmacia, the Prechter Foundation, Shire, the Stanley Foundation, UCB Pharma, and Wyeth. Dr. Wozniak has received speaking fees from McNeil, Primedia/Massachusetts General Hospital Psychiatry Academy; has served on advisory boards for Pfizer and Shire; and has received research support from Eli Lilly, McNeil, NIMH, and Shire. Dr. Wozniak’s spouse has served on speakers bureaus for Boehringer-Ingelheim, Cephalon, GlaxoSmithKline, King, Sanofi-Aventis, Sepracor, Takeda; has served on advisory boards for Axon Labs, Boehringer-Ingelheim, GlaxoSmithKline, Jazz Pharmaceuticals, Neurogen, Novartis, Novadel Pharma, Pfizer, Sepracor, Takeda, and UCB (Schwarz) Pharma; and has received research support from Boehringer-Ingelheim, GlaxoSmithKline, Sepracor, and UCB (Schwarz) Pharma.

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