Early childhood attention deficit hyperactivity disorder predicts poorer response to acute lithium therapy in adolescent mania

We compared the response to acute lithium therapy in 30 adolescents, 13-17 years of age, with mania and a prior history of early childhood attention d eficit hyperactivity disorder (ADHD) to a sex- and age-matched control grou p of adolescent manics without premorbid psychiatric illness. Response to t reatment was assessed daily over the course of 28 days using measures of gl obal clinical improvement and severity ratings on the Bech-Rafaelsen Mania Scale (BRMS). BRMS scores decreased by a mean of 24.3 in the subgroup witho ut prior ADHD compared to 16.7 in patients with ADHD (P = 0.0005). The aver age percent drop in BRMS scores over the study period in these two subgroup s was 80.6% and 57.7%, respectively (P = 0.0005). Time to onset of sustaine d global clinical improvement was also assessed using Kaplan-Meier survival methods and possible covariates of time to improvement were tested in a Co x proportional hazards model. Median time to onset of sustained improvement was lengthened significantly in patients with early ADHD (23 days) compare d to those without it (17 days; log rank chi(2) = 7.2, P = 0.007). The resu lts suggest that early childhood ADHD defines an important source of hetero geneity in bipolar illness with developmental, clinical, and neuropharmacog enetic implications. (C) 1998 Elsevier Science B.V; All rights reserved.