ADHD comorbidity can matter when assessing cortical thickness abnormalities in patients with bipolar disorder

Authors

  • Catherine E Hegarty,

    1. Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California at Los Angeles (UCLA), Los Angeles
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  • Lara C Foland-Ross,

    1. Mood and Anxiety Disorders Laboratory, Department of Psychology, Stanford University, Stanford
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  • Katherine L Narr,

    1. Laboratory of Neuro Imaging, Department of Neurology, David Geffen School of Medicine, UCLA
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  • Catherine A Sugar,

    1. Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California at Los Angeles (UCLA), Los Angeles
    2. Department of Biostatistics, School of Public Health, UCLA
    3. Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center
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  • James J McGough,

    1. Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California at Los Angeles (UCLA), Los Angeles
    2. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, USA
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  • Paul M Thompson,

    1. Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California at Los Angeles (UCLA), Los Angeles
    2. Laboratory of Neuro Imaging, Department of Neurology, David Geffen School of Medicine, UCLA
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  • Lori L Altshuler

    1. Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California at Los Angeles (UCLA), Los Angeles
    2. Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center
    3. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, USA
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Corresponding author:
Lori L. Altshuler, M.D.
UCLA Mood Disorders Research Program
300 UCLA Medical Plaza
Suite 1544, Box 956968
Los Angeles, CA 90095-7057
USA
Fax: 310-794-9915
E-mail: laltshuler@mednet.ucla.edu

Abstract

Hegarty CE, Foland-Ross LC, Narr KL, Sugar CA, McGough JJ, Thompson PM, Altshuler LL. ADHD comorbidity can matter when assessing cortical thickness abnormalities in patients with bipolar disorder.
Bipolar Disord 2012: 14: 843–855. © 2012 John Wiley & Sons A/S.Published by Blackwell Publishing Ltd.

Objectives: Attention-deficit hyperactivity disorder (ADHD) is prevalent in patients with bipolar disorder (BP), but very few studies consider this when interpreting magnetic resonance imaging findings. No studies, to our knowledge, have screened for or controlled for the presence of ADHD when examining cortical thickness in patients with BP. We used a 2 × 2 design to evaluate the joint effects of BP and ADHD on cortical thickness and uncover the importance of ADHD comorbidity in BP subjects.

Methods: The study included 85 subjects: 31 healthy controls, 17 BP-only, 19 ADHD-only, and 18 BP/ADHD. All patients with BP were subtype I, euthymic, and not taking lithium. Groups did not differ significantly in age or gender distribution. We used cortical thickness measuring tools combined with cortical pattern matching methods to align sulcal/gyral anatomy across participants. Significance maps were used to check for both main effects of BP and ADHD and their interaction. Post-hoc comparisons assessed how the effects of BP on cortical thickness varied as a function of the presence or absence of ADHD.

Results: Interactions of BP and ADHD diagnoses were found in the left subgenual cingulate and right orbitofrontal cortex, demonstrating that the effect of BP on cortical thickness depends on ADHD status.

Conclusions: Some brain abnormalities attributed to BP may result from the presence of ADHD. Diagnostic interactions were found in regions previously implicated in the pathophysiology of BP, making it vital to control for an ADHD comorbid diagnosis when attempting to isolate neural or genetic abnormalities specific to BP.

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