Psychiatr. praxi. 2025;26(3):143-150 | DOI: 10.36290/psy.2025.024

The diagnosis and pharmacotherapy of adult ADHD - part 2

MUDr. Michal Vodička
Psychiatrická ambulance, České Budějovice

The second part of the review article on ADHD focuses on the common comorbid disorders that co-occur with ADHD, their differential diagnosis and current pharmacotherapeutic approaches targeting ADHD and individual comorbidities. Furthermore, it addresses the issue of self-injurious and suicidal behaviours in patients with ADHD, along with pharmacological interventions for these conditions.

Keywords: ADHD, comorbidities, self-harm, bipolar disorder.

Accepted: October 15, 2025; Published: November 6, 2025  Show citation

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Vodička M. The diagnosis and pharmacotherapy of adult ADHD - part 2. Psychiatr. praxi. 2025;26(3):143-150. doi: 10.36290/psy.2025.024.
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References

  1. Asherson P, Buitelaar J, Faraone S, et al. Adult attentiondeficit hyperactivity disorder: key conceptual issues. Lancet Psychiatry. 2016;3(6):568-578. Go to original source... Go to PubMed...
  2. Katzman M, Bilkey T, Chokka P, et al. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry. 2017;17(1):302. Go to original source... Go to PubMed...
  3. Powell V, Agha SS, Jones RB, et al. ADHD in adults with recurrent depression. J Affect Disord. 2021;295:1153-1160. Go to original source... Go to PubMed...
  4. CADDRA. Canadian ADHD Practice Guidelines (4.1 Edition). Toronto ON: CADDRA; 2020.
  5. Chang Z, D'Onofrio BM, Quinn PD, et al. Medication for attentiondeficit/hyperactivity disorder and risk for depression: a nationwide longitudinal cohort study. Biol Psychiatry. 2016;80(12):916-922. Go to original source... Go to PubMed...
  6. Schiweck C, ArteagaHenriquez G, Aichholzer M, et al. Comorbidity of ADHD and adult bipolar disorder: a systematic review and metaanalysis. Neurosci Biobehav Rev. 2021;124:100-123. Go to original source... Go to PubMed...
  7. Perugi G, Pallucchini A, Rizzato S, et al. Current and emerging pharmacotherapy for the treatment of adult attention deficit hyperactivity disorder (ADHD). Expert Opin Pharmacother. 2019;20(12):1457-1470. Go to original source... Go to PubMed...
  8. Salvi V, Ribuoli E, Servasi M, et al. ADHD and bipolar disorder in adulthood: clinical and treatment implications. Medicina (Kaunas). 2021;57(5):466. Go to original source... Go to PubMed...
  9. Osser DN. ADHD in patients with bipolar disorder: genetics, diagnosis, and treatment. Psychiatr Times. 2021;38(1):25.
  10. Quenneville AF, Kalogeropoulou E, Nicastro R, et al. Anxiety disorders in adult ADHD: a frequent comorbidity and a risk factor for externalizing problems. Psychiatry Res. 2022;310:114423. Go to original source... Go to PubMed...
  11. D'Agati E, Curatolo P, Mazzone L. Comorbidity between ADHD and anxiety disorders across the lifespan. Int J Psychiatry Clin Pract. 2019;23(4):238-244. Go to original source... Go to PubMed...
  12. Brem S, Grünblatt E, Drechsler R, et al. The neurobiological link between OCD and ADHD. Atten Defic Hyperact Disord. 2014;6(3):175-202. Go to original source... Go to PubMed...
  13. MataixCol D, Fernández de la Cruz L, Beucke J, et al. Heritability of clinically diagnosed obsessivecompulsive disorder among twins. JAMA Psychiatry. 2024;81(6):631-632. Go to original source... Go to PubMed...
  14. Sharma E, Sharma L, Balachander S, et al. Comorbidities in obsessivecompulsive disorder across the lifespan: a systematic review and metaanalysis. Front Psychiatry. 2021;12:703701. Go to original source... Go to PubMed...
  15. Mersin K, Dondu A, Memis C, et al. The clinical characteristics of ADHD and obsessivecompulsive disorder comorbidity. J Atten Disord. 2020;24(12):1757-1763. Go to original source... Go to PubMed...
  16. Cabarkapa S, King J, Dowling N, et al. Comorbid obsessivecompulsive disorder and attention deficit hyperactivity disorder: neurobiological commonalities and treatment implications. Front Psychiatry. 2019;10:557. Go to original source... Go to PubMed...
  17. Tolin D, Villavicencio A. Inattention, but not OCD, predicts the core features of hoarding disorder. Behav Res Ther. 2011;49(2):120-125. Go to original source... Go to PubMed...
  18. Abramovitch A, Dar R, Mittelman A, et al. Comorbidity between attention deficit/hyperactivity disorder and obsessivecompulsive disorder across the lifespan: a systematic and critical review. Harv Rev Psychiatry. 2015;23(4):245-262. Go to original source... Go to PubMed...
  19. Yücens B, Kart A, Tümkaya S. Obsessive beliefs and clinical features in patients with comorbid obsessivecompulsive disorder and attentiondeficit/hyperactivity disorder. Psychiatry Clin Psychopharmacol. 2021;31(4):408-416. Go to original source... Go to PubMed...
  20. Araz Altay M. Atomoxetine induced obsessivecompulsive disorder. Hosp Pract Res. 2019;4(2):68-70. Go to original source...
  21. Pallanti S, Grassi G. Pharmacologic treatment of obsessivecompulsive disorder comorbidity. Expert Opin Pharmacother. 2014;15(17):2543-2552. Go to original source... Go to PubMed...
  22. Meszaros G, Horvath L, Balazs J. Selfinjury and externalizing pathology: a systematic literature review. BMC Psychiatry. 2017;17(1):160. Go to original source... Go to PubMed...
  23. de Kloet L, Starling J, Hainsworth C, et al. Risk factors for selfharm in children and adolescents admitted to a mental health inpatient unit. Aust N Z J Psychiatry. 2011;45(9):749-755. Go to original source... Go to PubMed...
  24. Bentley K, CassielloRobbins C, Vittorio L, et al. The association between nonsuicidal selfinjury and the emotional disorders: a metaanalytic review. Clin Psychol Rev. 2015;37:72-88. Go to original source... Go to PubMed...
  25. Ward J, Curran S. Selfharm as the first presentation of attention deficit hyperactivity disorder in adolescents. Child Adolesc Ment Health. 2021;26(4):303-309. Go to original source... Go to PubMed...
  26. Farkas BF, Takacs ZK, Kollárovics N, et al. The prevalence of selfinjury in adolescence: a systematic review and metaanalysis. Eur Child Adolesc Psychiatry. 2024;33(10):3439-3458. Go to original source... Go to PubMed...
  27. Balazs J, Kereszteny A. Attentiondeficit/hyperactivity disorder and suicide: a systematic review. World J Psychiatry. 2017;7(1):44-59. Go to original source... Go to PubMed...
  28. Agosti V, Chen Y, Levin F. Does attention deficit hyperactivity disorder increase the risk of suicide attempts? J Affect Disord. 2011;133(3):595-599. Go to original source... Go to PubMed...
  29. O'Grady S, Hinshaw S. Longterm outcomes of females with attentiondeficit hyperactivity disorder: increased risk for selfharm. Br J Psychiatry. 2021;218(1):4-6. Go to original source... Go to PubMed...
  30. Chang Z, Quinn P, O'Reilly L, et al. Medication for attentiondeficit/hyperactivity disorder and risk for suicide attempts. Biol Psychiatry. 2020;88(6):452-458. Go to original source... Go to PubMed...
  31. Björk A, Rönngren Y, Selander J, et al. Health, lifestyle habits, and physical fitness among adults with ADHD compared with a random sample of a Swedish general population. Society, Health & Vulnerability. 2018;9(1):1553916. Go to original source...
  32. DíazRomán A, Mitchell R, Cortese S. Sleep in adults with ADHD: systematic review and metaanalysis of subjective and objective studies. Neurosci Biobehav Rev. 2018;89:61-71. Go to original source... Go to PubMed...
  33. Becker S. ADHD and sleep: recent advances and future directions. Curr Opin Psychol. 2020;34:50-56. Go to original source... Go to PubMed...
  34. Wajszilber D, Santiseban J, Gruber R. Sleep disorders in patients with ADHD: impact and management challenges. Nat Sci Sleep. 2018;10:453-480. Go to original source... Go to PubMed...
  35. Xiao G, Shi H, Lan Q, et al. Association among attentiondeficit hyperactivity disorder, restless legs syndrome, and peripheral iron status: a twosample Mendelian randomization study. Front Psychiatry. 2024;15:1310259. Go to original source... Go to PubMed...
  36. Konofal E, Cortese S, Marchand M, et al. Impact of restless legs syndrome and iron deficiency on attentiondeficit/hyperactivity disorder in children. Sleep Med. 2007;8(78):711-715. Go to original source... Go to PubMed...
  37. Krahn LE, Zee PC, Thorpy MJ. Current understanding of narcolepsy 1 and its comorbidities: what clinicians need to know. Adv Ther. 2022;39(1):221-243. Go to original source... Go to PubMed...
  38. Stein M, Weiss M, Hlavaty L. ADHD treatments, sleep, and sleep problems: complex associations. Neurotherapeutics. 2012;9(3):509-517. Go to original source... Go to PubMed...
  39. van Emmerikvan Oortmerssen K, Konstenius K, Schoevers R, et al. ADHD and addiction. In: Cooccuring Addictive and Psychiatric Disorders. Springer; 2015. Go to original source...
  40. Wilens T, Kwon A, Tanguay S, et al. Characteristics of adults with attention deficit hyperactivity disorder plus substance use disorder: the role of psychiatric comorbidity. Am J Addict. 2005;14(4):319-327. Go to original source... Go to PubMed...
  41. McCabe SE, Pasman E, Wilens T, et al. Attentiondeficit/hyperactivity disorder symptoms and later ecigarette and tobacco use in US youths. JAMA Netw Open. 2025;8(2):e2458834. Go to original source... Go to PubMed...
  42. van Emmerikvan Oortmerssen K. ADHD & addiction: prevalence, diagnostic assessment and treatment of ADHD in substance use disorder patients. Groningen: Rijksuniversiteit Groningen; 2018.
  43. Aydin T, Parris B, Arabaci G, et al. Traitlevel nonclinical ADHD symptoms in a community sample and their association with technology addictions. Curr Psychol. 2024;43(12):10682-10692. Go to original source...
  44. Evren B, Evren C, Dalbudak E, et al. Relationship of internet addiction severity with probable ADHD and difficulties in emotion regulation among young adults. Psychiatry Res. 2018;269:494-500. Go to original source... Go to PubMed...
  45. Shuai L, He S, Zheng H, et al. Influences of digital media use on children and adolescents with ADHD during COVID19 pandemic. Global Health. 2021;17(1):48. Go to original source... Go to PubMed...
  46. Karaca S, Saleh A, Canan F, Potenza M. Comorbidity between behavioral addictions and attention deficit/hyperactivity disorder: a systematic review. Int J Ment Health Addict. 2016;15(3):701-724. Go to original source...
  47. Kalbag A, Levin F. Adult ADHD and substance abuse: diagnostic and treatment issues. Subst Use Misuse. 2005;40(13-14):1955-1981. Go to original source... Go to PubMed...
  48. Chang Z, Lichtenstein P, Halldner L, et al. Stimulant ADHD medication and risk for substance abuse. J Child Psychol Psychiatry. 2014;55(8):878-885. Go to original source... Go to PubMed...
  49. Kooij J, Bijlenga D, Salerno L, et al. Updated European consensus statement on diagnosis and treatment of adult ADHD. Eur Psychiatry. 2019;56:14-34. Go to original source... Go to PubMed...
  50. Biederman J, Ball SW, Monuteaux MC, et al. Are girls with ADHD at risk for eating disorders? Results from a controlled, fiveyear prospective study. J Dev Behav Pediatr. 2007;28(4):302-307. Go to original source... Go to PubMed...
  51. Reinblatt S. Are eating disorders related to attention deficit/hyperactivity disorder? Curr Treat Options Psychiatry. 2015;2(4):402-412. Go to original source... Go to PubMed...
  52. Levin R, Rawana J. Attentiondeficit/hyperactivity disorder and eating disorders across the lifespan: a systematic review of the literature. Clin Psychol Rev. 2016;50:22-36. Go to original source... Go to PubMed...
  53. Guerdjikova A, McElroy S. Adjunctive methylphenidate in the treatment of bulimia nervosa cooccurring with bipolar disorder and substance dependence. Innov Clin Neurosci. 2013;10(2):30-33.
  54. Shear M, Deliberto T, Kerrigan S, et al. Use of stimulants in patients with comorbid anorexia nervosa and attentiondeficit/hyperactivity disorder in a structured inpatient setting. J Dev Behav Pediatr. 2021;42(1):61-65. Go to original source... Go to PubMed...
  55. Levy E, Traicu A, Iyer S, et al. Psychotic disorders comorbid with attentiondeficit hyperactivity disorder: an important knowledge gap. Can J Psychiatry. 2015;60(3 Suppl 2):S48-52.
  56. Jeon SM, Lee DY, Cha S, Kwon JW. Psychiatric comorbidities and schizophrenia in youths with attentiondeficit/hyperactivity disorder. JAMA Netw Open. 2023;6(11):e2345793. Go to original source... Go to PubMed...
  57. Dalsgaard S, Mortensen PB, Frydenberg M, et al. Association between attentiondeficit hyperactivity disorder in childhood and schizophrenia later in adulthood. Eur Psychiatry. 2014;29(4):259-263. Go to original source... Go to PubMed...
  58. Klein M, Battagello D, Cardoso A, et al. Dopamine: functions, signaling, and association with neurological diseases. Cell Mol Neurobiol. 2019; 39(1):31-59. Go to original source... Go to PubMed...
  59. Opler L, Frank D, Ramirez P. Psychostimulants in the treatment of adults with psychosis and attention deficit disorder. Ann N Y Acad Sci. 2001;931(1):297-301. Go to original source... Go to PubMed...
  60. Matthies S, Philipsen A. Comorbidity of personality disorders and adult attention deficit hyperactivity disorder (ADHD) - review of recent findings. Curr Psychiatry Rep. 2016;18(4):33. Go to original source... Go to PubMed...
  61. O'Malley G, McHugh L, Mac Giollabhui N, et al. Characterizing adult attentiondeficit/hyperactivitydisorder and comorbid borderline personality disorder: ADHD symptoms, psychopathology, cognitive functioning and psychosocial factors. Eur Psychiatry. 2016;31:29-36. Go to original source... Go to PubMed...
  62. Pan N, Wang S, Qin K, et al. Common and distinct neural patterns of attentiondeficit/hyperactivity disorder and borderline personality disorder: a multimodal functional and structural metaanalysis. Biol Psychiatry Cogn Neurosci Neuroimaging. 2023;8(6):640-650. Go to original source... Go to PubMed...
  63. Ditrich I, Philipsen A, Matthies S. Borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD) revisited - a reviewupdate on common grounds and subtle distinctions. Borderline Pers Disord Emot Dysregul. 2021;8(1):22. Go to original source... Go to PubMed...
  64. Hours C, Recasens C, Baleyte J. ASD and ADHD comorbidity: what are we talking about? Front Psychiatry. 2022;13:837424. Go to original source... Go to PubMed...
  65. Antshel KM, ZhangJames Y, Wagner KE, et al. An update on the comorbidity of ADHD and ASD: a focus on clinical management. Expert Rev Neurother. 2016;16(3):279-293. Go to original source... Go to PubMed...




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