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Could comorbid bipolar disorder account for a significant share of executive function deficits in adults with attention-deficit hyperactivity disorder?

Authors

  • Katiane L Silva,

    1. ADHD Outpatient Program–Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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  • Diego L Rovaris,

    1. ADHD Outpatient Program–Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
    2. Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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  • Paula O Guimarães-da-Silva,

    1. ADHD Outpatient Program–Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
    2. Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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  • Marcelo M Victor,

    1. ADHD Outpatient Program–Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
    2. Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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  • Carlos AI Salgado,

    1. ADHD Outpatient Program–Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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  • Eduardo S Vitola,

    1. ADHD Outpatient Program–Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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  • Verônica Contini,

    1. ADHD Outpatient Program–Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
    2. Posgraduate Program in Biotechnology, Centro Universitário Univates, Lajeado, RS, Brazil
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  • Guilherme Bertuzzi,

    1. ADHD Outpatient Program–Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
    2. Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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  • Felipe A Picon,

    1. ADHD Outpatient Program–Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
    2. Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, SP, Brazil
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  • Rafael G Karam,

    1. ADHD Outpatient Program–Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
    2. Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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  • Paulo Belmonte-de-Abreu,

    1. ADHD Outpatient Program–Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
    2. Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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  • Luis A Rohde,

    1. ADHD Outpatient Program–Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
    2. Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
    3. Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, SP, Brazil
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  • Eugenio H Grevet,

    1. ADHD Outpatient Program–Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
    2. Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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  • Claiton HD Bau

    Corresponding author
    1. ADHD Outpatient Program–Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
    2. Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
    • Corresponding author:

      Dr. Claiton H.D. Bau

      Departamento de Genética

      Instituto de Biociências

      UFRGS

      Caixa Postal 15053

      Porto Alegre

      RS 91501-970

      Brazil

      Fax: 55-51-3308-7311

      E-mail: claiton.bau@ufrgs.br

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Abstract

Objective

The frequent comorbidity between attention-deficit hyperactivity disorder (ADHD) and bipolar disorder (BD) represents a challenge for disentangling specific impairments of each disorder in adulthood. Their functional impairments seem to be mediated by executive function deficits. However, little is known about the extent to which each executive function deficit might be disorder specific or explained by the comorbidity. The aim of the present study was to determine if comorbid BD could account for a significant share of executive function deficits when measured by the Wisconsin Card Sorting Test (WCST) in adults with ADHD.

Methods

Adult patients with ADHD and healthy subjects were evaluated in the ADHD outpatient Program at the Hospital de Clínicas de Porto Alegre. Psychiatric diagnoses were based on DSM-IV criteria. WCST scores were compared by multivariate analysis of covariance among three groups: ADHD with BD (n = 51), ADHD without BD (n = 278), and healthy subjects (n = 91).

Results

When compared to patients without BD and healthy subjects, patients with ADHD and comorbid BD showed lower scores in total correct answers (p = 0.003); higher scores in total errors (p = 0.004) and non-perseverative errors (p = 0.002); and completed fewer categories (p = 0.009). Patients with ADHD without BD did not differ from healthy subjects.

Conclusions

WCST impairments among patients with ADHD seem to be to a large extent attributable to comorbid BD. Although other executive function deficits (e.g., in the inhibitory control domain) have been demonstrated to accompany ADHD, the present findings suggest that set-shifting deficits are strongly related to comorbid BD.

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