Adult ADHD and Its Association With Comorbid Disorders

Introduction:

Proper psychological well-being is necessary for a healthy lifestyle. It is necessary to do things properly. However, mental disorders like attention deficit hyperactivity disorder often cause psychological imbalances. Around 5 percent of children around the world suffer from ADHD or attention deficit hyperactivity disorder. Though the prevalence of ADHD among adults is less, it may be associated with other comorbid psychological conditions.

What Is ADHD?

ADHD, or attention deficit hyperactivity disorder, is a neurodevelopmental condition.. This primarily affects children and adolescents. It is characterized by cognitive and functional deficiencies resulting from brain function abnormalities. Individuals with ADHD often exhibit symptoms such as inattentiveness, hyperactivity, and impulsiveness. The cognitive and functional abnormalities seen in individuals with ADHD are linked to dysfunctioning of the anterior cingulate gyrus and dorsolateral prefrontal cortex of the brain. The smaller size of certain brain regions, such as the frontostriatal region, is believed to be attributed to the reduced activity in these areas. Additionally, smaller areas of the total cerebrum, cerebellum, and the four cerebral lobes can also be observed in individuals with ADHD.

This condition is most commonly observed in children between seven and seventeen. These symptoms typically appear at a young age, with behavioral patterns including lack of attention, difficulty concentrating, poor organizational skills, trouble completing tasks, forgetfulness, and misplacing belongings.

Environmental or genetic factors are the probable risk factors associated with this condition. Risk factors associated with this condition include viral infections during pregnancy, smoking or substance abuse during pregnancy, nutritional deficiencies, and alcohol exposure to the fetus, which is linked to the development of this psychological disorder.

As already discussed, ADHD is seen in young individuals and is diagnosed at an early age. However, in up to around 60 percent of cases, the symptoms may persist till adulthood. The clinical presentation of adult ADHD is different from childhood ADHD in terms of severity and intensity. The diagnostic criteria used for such conditions include the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR). These symptoms are;

1. Difficulty in getting started with different work or getting motivation for the work.

2. Difficulty in organizing things or planning things.

3. Impulsiveness.

4. Reduced concentration and difficulty in focusing on things.

5. Chaotic and disorganized lifestyle.

6. Development of deleterious habits like smoking, alcoholism, and consumption of drugs.

What Are the Comorbid Conditions Associated with ADHD?

Comorbid conditions are additional psychological disorders that are seen in patients suffering from ADHD. The following comorbid conditions are present in persons suffering from ADHD.

1. Major Depressive Disorder (MDD): Depression is a psychological condition of the mind that negatively affects feelings, thought processes, and daily activities. This is responsible for persistent feelings of sadness and emptiness. In a major depressive disorder, the signs of a depressed state of mind or lack of enthusiasm persist for a minimum of 14 days, which hampers one's regular routines.

2. Anxiety Disorders: The prevalence of anxiety disorder among adult persons suffering from ADHD is much higher. Anxiety is a complex cognitive, affective, physiological, and behavioral response system manifested due to negative thoughts. Dress is one of the main causes of anxiety in such persons.

3. Bipolar Disorder: Bipolar disorder is a major mental illness characterized by major or rapid shifts in emotions and mental emotions. The other names for this disorder are manic-depressive illness or manic depression. Almost 21 percent of individuals suffering from ADHD suffer from bipolar disorder. ADHD patients mainly suffer from bipolar disorder, where patients experience manic episodes lasting more than seven days.

4. Substance Use Disorder: This is also a common side effect of ADHD, where persons often indulge in habits like smoking, alcoholism, and consumption of illicit substances. The illicit substances include cannabis, sedatives, anxiolytics, opioids, hallucinogens, and stimulants.

What Are the Causes of Presence of Comorbidities in ADHD?

The exact causes of the presence of comorbid conditions are not known. However, the presence of neurobiological factors and genetic factors are commonly attributed as the reason behind the presence of comorbid conditions.

1. The primary neural pathway that regulates emotional function is based on limbic-cortical-striatal pallidal-thalamic (LCSPT) circuits. These circuits consist of connections between several regions in the brain like the orbital and medial prefrontal cortex (OMPFC), ventromedial striatum, ventral pallidum, hippocampal subiculum, mediodorsal and midline thalamic nuclei, and amygdala. They have reciprocal connections with cortical regions involved in the control of higher cognitive functions, as well as regions associated with the regulation of autonomic functions, such as the periaqueductal gray and the hypothalamus. Thus, dysfunctioning in the LCSPT circuits and its related neurotransmitter systems is related to the development of major depressive disorder (MDD).

2. According to neuroimaging studies, differences and dysregulation in the volume and activity in the frontal lobe are responsible for alteration in brain activity. This is associated with mood disorders.

3. Alteration in the levels of neurotransmitters like gamma-aminobutyric acid

(GABA), dopamine (DA) and norepinephrine (NE) are related to complications like anxiety and depression.

1. Stress and the presence of inflammatory mediators are closely associated factors with anxiety and ADHD. Stress leads to the secretion of inflammatory mediators like interleukins and cytokines. These substances act on the brain and disrupt the hypothalamic–pituitary–adrenal (HPA) axis. This disrupts the brain activity. As a result of which, anxiety and ADHD can be seen.

2. One of the most common causes of comorbid conditions is genetic and familial history. The genetic mutations are associated with hereditary connections between bipolar disorder and ADHD.

What Are the Treatment Options?

The diagnosis and identification of ADHD, along with other psychological disorders, is the most important thing. Psychological counseling is necessary for such cases. Apart from this, cognitive behavioral therapy can also be helpful. Antidepressants such as Venlafaxine and Bupropion can be used to treat depression. However, stimulant medications like Methylphenidate or long-acting non-stimulants like atomoxetine are the primary drugs used in the treatment of ADHD and comorbid conditions. These drugs increase intrasynaptic catecholamines by inhibiting the presynaptic reuptake mechanism and releasing presynaptic catecholamines. However, these drugs should be used cautiously due to their cardiac side effects.

Conclusion:

Adult ADHD is relatively rare. However, it can be seen in a significant population. In most of the cases, it is present with other comorbid psychological conditions. These conditions are depression, anxiety, bipolar disorder, and substance abuse. Psychological counseling and medications can treat such conditions.