Comorbidity of attention deficit hyperactivity disorder with early- and late-onset bipolar disorder.

OBJECTIVE: The relationship between attention deficit hyperactivity disorder (ADHD) and earlier age at onset of affective illness was examined in probands with a history of bipolar disorder. METHOD: The authors assessed 56 adult bipolar subjects. Those with a history of childhood ADHD (N=8) were age and sex matched with bipolar subjects without a history of childhood ADHD (N=8). RESULTS: The age at onset of the first affective episode was lower for the subjects with bipolar disorder and a history of childhood ADHD (mean=12.1 years, SD=4.6) than for those without a history of childhood ADHD (mean=20. 0 years, SD=11.3). CONCLUSIONS: ADHD in children of bipolar probands might identify children at highest risk for development of bipolar disorder.

Insight in seasonal affective disorder.

Lack of insight complicates the evaluation and treatment of patients with psychotic and affective disorders. No studies of insight in seasonal affective disorder (SAD) have been reported. Thirty patients with SAD diagnosed by the Structured Clinical Interview for DSM-III-R but no other axis I conditions were treated short-term with light-therapy. Insight was measured with the Scale to Assess Unawareness of Mental Disorder (SUMD) as modified by the authors to assess the self-report of insight into depressive symptoms. Increasing scores (1 to 5) indicated increasing unawareness of illness (i.e., less insight). SAD patients displayed a moderate amount of insight when depressed (mean SUMD score, 2.5). When recovered, they showed no significant change in insight into past depressive symptoms (mean SUMD score, 2.8). Greater insight into current depressive symptoms correlated with more depressive symptoms on the Hamilton Rating Scale for Depression score ([HRSD] r = .35, P < .05). In conclusion, SAD patients possess a moderate amount of insight into depressive symptoms that does not change after recovery, a result in agreement with studies of insight in psychosis and mania. Further, in SAD, increased severity of illness may be associated with increased insight into depressive symptoms, consistent with the hypothesis of depressive realism.

Acute treatment of bipolar disorder with adjunctive risperidone in outpatients.

OBJECTIVE: To test the hypothesis that, although typical neuroleptics are commonly used in the treatment of bipolar disorder, newer atypical antipsychotic agents, like risperidone, may be more effective and better-tolerated. METHOD: The effectiveness of risperidone was evaluated in 14 outpatients with bipolar disorder, type I, who received risperidone for 6.4 +/- 2.7 weeks at 2.75 +/- 1.8 mg/day. RESULTS: Nine (64%) patients were much improved based on Clinical Global Impression (CGI) scores, and mean Global Assessment of Functioning (GAF) scores improved from 48.2 +/- 4.9 to 58.8 +/- 7.3 (t = 4.49, P = 0.0006, paired t test). Treatment was well tolerated, and no patient experienced worsening of mood symptoms while receiving risperidone. CONCLUSION: This open series suggests risperidone is beneficial in the treatment of outpatients with bipolar disorder.

Akathisia: a review and case report following paroxetine treatment.

Although akathisia is most commonly associated with neuroleptic medication, few cases of paroxetine-induced akathisia have been reported. A review of the authors' charts (C.F.B., A.N., S.N.G., and G.S.S.) was conducted to determine an estimated incidence for paroxetine-induced akathisia. Three cases of akathisia were reported in 67 patients treated with paroxetine. A case of akathisia secondary to paroxetine in an 18-year-old female is presented. Given the potential untoward effects of this syndrome, early diagnosis is essential. Clinical presentations and differential diagnoses are discussed.