Adults with ADHD are at higher risk for a variety of physical diseases, including diseases of the nervous system, respiratory tract, musculoskeletal system, and metabolism, according to a large registry-based study by the Karolinska Institutet in Sweden published in The Lancet Psychiatry.
“Identifying concurrent physical illnesses can have important implications for the treatment of adults with ADHD and for the long-term health and quality of life of patients,” says first author Ebba Du Rietz, postdoc at the Institute for Medical Epidemiology and Biostatistics, Karolinska Institute.
ADHD is a common neuropsychiatric disorder characterized by inattentiveness, impulsiveness, and hyperactivity and is often treated with stimulant therapy (methylphenidate or amphetamine).
Previous studies suggest an increased risk for a number of physical health conditions in adults with ADHD, but only a limited number of these associations have been thoroughly studied. In addition, detailed treatment guidelines for adults with ADHD and concomitant physical illnesses are largely lacking. Now researchers at the Karolinska Institutet have investigated possible links between ADHD and a variety of physical illnesses in adulthood and whether genetic or environmental factors play a role.
Over four million people (full siblings and maternal half-sibling pairs) born between 1932 and 1995 were identified in Swedish registers and tracked between 1973 and 2013. Clinical diagnoses were obtained from the Swedish national patient registry. The researchers looked at the risk of 35 different physical conditions in people with ADHD compared to people without and in siblings of people with ADHD compared to siblings of people without ADHD.
People with ADHD had a statistically significant increased risk of all physical diseases examined except arthritis. The strongest associations were found for diseases of the nervous system, respiratory tract, musculoskeletal system and metabolism. The diagnoses most strongly associated with ADHD were alcohol-related liver disease, sleep disorders, chronic obstructive pulmonary disease (COPD), epilepsy, fatty liver, and obesity. ADHD has also been linked to a slightly increased risk of cardiovascular disease, Parkinson’s, and dementia.
“These results are important because stimulant therapy in ADHD patients with concomitant heart disease, high blood pressure and liver failure requires careful monitoring,” says senior author Henrik Larsson, professor at Örebro University and associate researcher at Karolinska Institutet.
The increased risk was largely explained by underlying genetic factors that contributed to both ADHD and the physical condition, with the exception of diseases of the nervous system and age-related conditions. Full siblings of people with ADHD had a significantly increased risk of most physical illnesses.
The researchers now want to investigate the underlying mechanisms and risk factors as well as the influence of ADHD on the management and prognosis of physical illnesses in adults.
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The study was sponsored by the Swedish Research Council, the Swedish Brain Foundation, the Swedish Research Council for Health, Working Life and Welfare, Stockholm Region, StratNeuro (Karolinska Institutet), the European Union’s Horizon 2020 research and innovation program and the National Institute. funded mental health. Ebba Du Rietz served as a speaker for Shire Sweden AB outside of the work submitted. Henrik Larsson has been a speaker for Evolan Pharma and Shire / Takeda and has received research grants from Shire / Takeda. Co-author Marica Leone is an associate of the Janssen Pharmaceutical Companies of Johnson & Johnson. For a full list of potential conflicts of interest, see the scientific article.
Publication: “Mapping Phenotypic and Etiological Associations between ADHD and Physical Disease in Adulthood in Sweden: A Genetically Informed Registry Study”. Ebba Du Rietz, Isabell Brikell, Agnieszka Butwicka, Marica Leone, Zheng Chang, Samuele Cortese, Brian M. D’Onofrio, Catharina A. Hartman, Paul Lichtenstein, Stephen V. Faraone, Ralf Kuja-Halkola, Henrik Larsson. The Lancet Psychiatry, online July 6, 2021, doi: 10.1016 / S2215-0366 (21) 00171-1.
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