Applying EEG-based vigilance measurement in a case of adult attention deficit hyperactivity disorder (ADHD)

In adult attention deficit hyperactivity disorder (ADHD), reduction of externalizing symptoms and domination of disturbances of mood and affect often leads to the attribution to other psychiatric disorders. We here report of a patient who was diagnosed with a bipolar disorder and treated with valproic acid and citalopram. He had marked reduction in drive, feeling of inner tension, reduced ability to concentrate, depressed mood and recurrent suicidal ideation and also fulfilled all aspects of the Utah criteria of adult ADHD. Medication with valproic acid and citalopram were discontinued and methylphenidate was initiated. EEG-recording revealed unstable vigilance regulation in the sense of 'brain arousal' in the unmedicated state. Medication with methylphenidate led to stabilization of vigilance and improved performance in the CPT, with a concomitant reduction of clinical symptoms. Not only affective disorders but also ADHD should be considered in the diagnosis of young adults complaining of lability of mood, irritability and impulsivity. Previous medication regimes need to be reconsidered critically in terms of enhancement or masking of symptoms of ADHD. Therapies with psychostimulants can be monitored using determination of EEG-vigilance, since vigilance and wakefulness regulation may have a pathogenic role in ADHD as well as bipolar disorder. Schmidt F et al, Int J Neuropsychopharmacol 2012 [Epub ahead of print]