ADHD comorbidity can matter when assessing cortical thickness abnormalities in patients with bipolar disorder

Catherine E. Hegarty, Lara C. Foland-Ross, Katherine L. Narr, Catherine A. Sugar, James J. McGough, Paul M. Thompson, Lori L. Altshuler

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objectives: Attention-deficit hyperactivity disorder (ADHD) is prevalent in patients with bipolar disorder (BP), but very few studies consider this when interpreting magnetic resonance imaging findings. No studies, to our knowledge, have screened for or controlled for the presence of ADHD when examining cortical thickness in patients with BP. We used a 2×2 design to evaluate the joint effects of BP and ADHD on cortical thickness and uncover the importance of ADHD comorbidity in BP subjects. Methods: The study included 85 subjects: 31 healthy controls, 17 BP-only, 19 ADHD-only, and 18 BP/ADHD. All patients with BP were subtype I, euthymic, and not taking lithium. Groups did not differ significantly in age or gender distribution. We used cortical thickness measuring tools combined with cortical pattern matching methods to align sulcal/gyral anatomy across participants. Significance maps were used to check for both main effects of BP and ADHD and their interaction. Post-hoc comparisons assessed how the effects of BP on cortical thickness varied as a function of the presence or absence of ADHD. Results: Interactions of BP and ADHD diagnoses were found in the left subgenual cingulate and right orbitofrontal cortex, demonstrating that the effect of BP on cortical thickness depends on ADHD status. Conclusions: Some brain abnormalities attributed to BP may result from the presence of ADHD. Diagnostic interactions were found in regions previously implicated in the pathophysiology of BP, making it vital to control for an ADHD comorbid diagnosis when attempting to isolate neural or genetic abnormalities specific to BP.

Original languageEnglish
Pages (from-to)843-855
Number of pages13
JournalBipolar Disorders
Issue number8
StatePublished - Dec 2012
Externally publishedYes


  • Anterior cingulate cortex
  • Attention-deficit hyperactivity disorder
  • Bipolar disorder
  • Comorbidity
  • Cortical pattern matching
  • Cortical thickness
  • Magnetic resonance imaging
  • Orbitofrontal cortex
  • Prefrontal cortex
  • Subgenual cingulate cortex


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