"Adults With ADHD Have Many Comorbidities," The New England Journal Of Medicine

Superb Summary Of ADHD In Adults

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Adults with ADHD Have Many Comorbidities
http://response.jwatch.org/t?ctl=42F5E:B79A8C01EB71785AF38328DB5584AEFBD2B71D9A95FA21D3&?query=topic_diabetes&jwd=000003014730&jspc=GP

Joel Yager, MD reviewing Chen Q et al. PLoS One 2018 Sep 26

Adults with attention-deficit/hyperactivity disorder had roughly nine times higher rates for various psychiatric disorders and twice the rates for metabolic disorders as the general population.

Attention-deficit/hyperactivity disorder (ADHD) has long been associated with vulnerabilities to psychiatric and substance use disorders. To learn more, researchers examined data on four psychiatric disorders and two metabolic disorders in 5.6 million adults (age range, 18–64) from Swedish national registries; 1.1% were diagnosed with ADHD in adulthood according to International Classification of Diseases criteria.

Analyses adjusted for sex and age. Prevalence ratios (PRs) of comorbid anxiety, depression, and substance use disorder (SUD) were approximately nine times higher in individuals with ADHD than in the general population, PR of bipolar disorder was 20 times higher, and PRs of type 2 diabetes and hypertension were doubled. Among people with ADHD, rates for comorbid mood and anxiety disorders were higher in women than men, whereas men had higher rates of SUD, diabetes, and hypertension. In a subanalysis of 1.7 million older adults (age range, 50–64), ADHD prevalence was 0.29%, and associations with comorbidities remained significant.

Comment

This is the first study to evaluate associations of metabolic disorders with ADHD. We don't know how many study participants receiving ADHD diagnoses in adulthood also had ADHD in childhood or whether comorbidities preceded or followed onset of ADHD; attentional difficulties following other psychiatric disorders could be sufficient to merit independent ADHD diagnosis. ADHD associations with diabetes and hypertension might reflect common underlying genetic vulnerabilities, lifestyle factors, or, occasionally, effects of psychiatric medications.

Clinicians seeing adults with ADHD can expect comorbidities. Determining suitable treatment requires clarifying the age of ADHD onset and the temporal sequencing of attentional symptoms and comorbid states. Treating comorbid conditions first might improve ADHD symptoms.

Editor Disclosures at Time of Publication

Disclosures for Joel Yager, MD at time of publication

Editorial Boards Bulletin of the Menninger Clinic; Eating Disorders Review; International Journal of Eating Disorders; UpToDate; FOCUS: The Journal of Lifelong Learning in Psychiatry

Citation(s):
   
Chen Q et al. Common psychiatric and metabolic comorbidity of adult attention-deficit/hyperactivity disorder: A population-based cross-sectional study. PLoS One 2018 Sep 26; 13:e0204516. < http://response.jwatch.org/t?ctl=42F62:B79A8C01EB71785AF38328DB5584AEFBD2B71D9A95FA21D3& >