| 1. |
- Rydén, E., et al.
(författare)
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A history of childhood attention-deficit hyperactivity disorder (ADHD) impacts clinical outcome in adult bipolar patients regardless of current ADHD
- 2009
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Ingår i: Acta Psychiatrica Scandinavica. - Malden, USA : Wiley-Blackwell. - 0001-690X .- 1600-0447. ; 120:3, s. 239-246
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The occurrence of comorbid attention-deficit hyperactivity disorder (ADHD) might have an impact of the course of the bipolar disorder.Method: Patients with bipolar disorder (n = 159) underwent a comprehensive evaluation with respect to affective symptoms. Independent psychiatrists assessed childhood and current ADHD, and an interview with a parent was undertaken.Results: The prevalence of adult ADHD was 16%. An additional 12% met the criteria for childhood ADHD without meeting criteria for adult ADHD. Both these groups had significantly earlier onset of their first affective episode, more frequent affective episodes (except manic episodes), and more interpersonal violence than the bipolar patients without a history of ADHD.Conclusion: The fact that bipolar patients with a history of childhood ADHD have a different clinical outcome than the pure bipolar group, regardless of whether the ADHD symptoms remained in adulthood or not, suggests that it represent a distinct early-onset phenotype of bipolar disorder.
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| 2. |
- Viktorin, Alexander, et al.
(författare)
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The Risk of Treatment-Emergent Mania With Methylphenidate in Bipolar Disorder
- 2017
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Ingår i: American Journal of Psychiatry. - Arlington, USA : American Psychiatric Association Publishing. - 0002-953X .- 1535-7228. ; 174:4, s. 341-348
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The authors sought to determine the risk of treatment-emergent mania associated with methylphenidate, used in monotherapy or with a concomitant mood-stabilizing medication, in patients with bipolar disorder.Method: Using linked Swedish national registries, the authors identified 2,307 adults with bipolar disorder who initiated therapy with methylphenidate between 2006 and 2014. The cohort was divided into two groups: those with and those without concomitant mood-stabilizing treatment. To adjust for individual-specific confounders, including disorder severity, genetic makeup, and early environmental factors, Cox regression analyses were used, conditioning on individual to compare the rate of mania (defined as hospitalization for mania or a new dispensation of stabilizing medication) 0-3 months and 3-6 months after medication start following nontreated periods.Results: Patients on methylphenidate monotherapy displayed an increased rate of manic episodes within 3 months of medication initiation (hazard ratio=6.7, 95% CI=2.0-22.4), with similar results for the subsequent 3 months. By contrast, for patients taking mood stabilizers, the risk of mania was lower after starting methylphenidate (hazard ratio=0.6, 95% CI=0.4-0.9). Comparable results were observed when only hospitalizations for mania were counted.Conclusions: No evidence was found for a positive association between methylphenidate and treatment-emergent mania among patients with bipolar disorder who were concomitantly receiving a mood-stabilizing medication. This is clinically important given that up to 20% of people with bipolar disorder suffer from comorbid ADHD. Given the markedly increased hazard ratio of mania following methylphenidate initiation in bipolar patients not taking mood stabilizers, careful assessment to rule out bipolar disorder is indicated before initiating monotherapy with psychostimulants.
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| 3. |
- Rydén, E., et al.
(författare)
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Autism spectrum disorder in an adult psychiatric population : A naturalistic cross sectional controlled study
- 2008
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Ingår i: Clinical Neuropsychiatry. - 1724-4935. ; 5:1, s. 13-21
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Tidskriftsartikel (refereegranskat)abstract
- Object: Autism spectrum disorders (ASD) e.g. autism, Asperger syndrome, and Pervasive developmental disorder not otherwise specified, have yet to become a focus of attention in clinical adult psychiatry. The aims of the present study were firstly to characterize psychiatric patients with ASD in regard to demographical factors, psychiatric comorbidity and personality traits and compare the ASD group with a psychiatric control group in these respects. Secondly. we wanted to compare differences of personalily traits between females and males in the ASD group.Method: Adult psychiatric patients where ASD or attention deficit hyperactivily disorder (ADHD) was suspected were referred to a tertiary unit in Stockholm 2001-2006. All patients diagnosed at the unit with ASD (n=84; 39 females and 45 males) were consecutively included and compared to all 46 identically interviewed and assessed patients who did not receive an ASD or ADHD diagnosis. Among scales used were the Global Assessment of Functioning (GAF), SCID II Screen, and Swedish universities Scales of Personality (SSP).Results: ASD patients had an equal educational level but a lower social and occupational functioniug. Their GAF scores were significantly lower compared to the control group. Prior to referral, major depressive disorder and obsessive-compulsive disorders were the most common psychiatric diagnoses. In the assessment approximately 1/3 fulfilled diagnostic criteria for comorbid ADHD. The patients with ASD also had significantly more schizotypal and avoidant personality traits according to SCID II screen. In SSP, patients with ASD rated themselves significantly higher on Stress-susceptibility, Embitterment, Detachment, Trait irritability and Lack of assertiveness than controls. Females with ASD scored significantly higher than males on borderline and passive-aggressive traits according to the SCID II Screen and on Embitterment and Trait irritability m the SSP.Conclusions: We could show that psychiatric patients with ASD have a low level of functioning and a personality profile which is gender specific. This may contribute to the identification and understanding of patients with ASD in adult psychiatry.
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