BackgroundAbnormalities in dopamine and norepinephrine signaling are implicated in cognitive impairments in bipolar disorder (BD) and attention‐deficit hyperactivity disorder (ADHD). This systematic review by the ISBD Targeting Cognition Task Force therefore aimed to investigate the possible benefits on cognition and/or ADHD symptoms and safety of established and off‐label ADHD therapies in BD.MethodsWe included studies of ADHD medications in BD patients, which involved cognitive and/or safety measures. We followed the procedures of the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) 2020 statement. Searches were conducted on PubMed, Embase and PsycINFO from inception until June 2023. Two authors reviewed the studies independently using the Revised Cochrane Collaboration's Risk of Bias tool for Randomized trials.ResultsSeventeen studies were identified (N = 2136), investigating armodafinil (k = 4, N = 1581), methylphenidate (k = 4, N = 84), bupropion (k = 4, n = 249), clonidine (k = 1, n = 70), lisdexamphetamine (k = 1, n = 25), mixed amphetamine salts (k = 1, n = 30), or modafinil (k = 2, n = 97). Three studies investigated cognition, four ADHD symptoms, and 10 the safety. Three studies found treatment‐related ADHD symptom reduction: two involved methylphenidate and one amphetamine salts. One study found a trend towards pro‐cognitive effects of modafinil on some cognitive domains. No increased risk of (hypo)mania was observed. Five studies had low risk of bias, eleven a moderate risk, and one a serious risk of bias.ConclusionsMethylphenidate or mixed amphetamine salts may improve ADHD symptoms in BD. However, there is limited evidence regarding the effectiveness on cognition. The medications produced no increased mania risk when used alongside mood stabilizers. Further robust studies are needed to assess cognition in BD patients receiving psychostimulant treatment alongside mood stabilizers.

中文翻译：

---

针对双相情感障碍认知障碍或注意力缺陷多动障碍症状的既定和标签外 ADHD 药物疗法的有效性和安全性：ISBD 目标认知工作组的系统评价

背景多巴胺和去甲肾上腺素信号异常与双相情感障碍（BD）和注意力缺陷多动障碍（ADHD）的认知障碍有关。因此，ISBD 目标认知工作组进行的这项系统综述旨在调查 BD 中既定的和标签外 ADHD 疗法对认知和/或 ADHD 症状的可能益处以及安全性。方法我们纳入了 BD 患者的 ADHD 药物研究，其中涉及认知功能和/或安全措施。我们遵循系统评价和荟萃分析首选报告项目 (PRISMA) 2020 声明的程序。从开始到 2023 年 6 月，在 PubMed、Embase 和 PsycINFO 上进行了检索。两位作者使用修订的 Cochrane 协作组织的随机试验偏倚风险工具独立审查了这些研究。结果确定了 17 项研究（氮=2136），调查阿莫达非尼（k= 4,氮= 1581), 哌醋甲酯 (k= 4,氮= 84), 安非他酮 (k= 4,n= 249），可乐定（k= 1,n= 70), 赖氨酸苯丙胺 (k= 1,n= 25), 混合安非他明盐 (k= 1,n= 30），或莫达非尼（k= 2,n= 97）。三项研究调查了认知能力，四项研究调查了多动症症状，十项研究调查了安全性。三项研究发现治疗相关的多动症症状减轻：两项涉及哌醋甲酯，一项涉及安非他明盐。一项研究发现莫达非尼对某些认知领域有促进认知作用的趋势。没有观察到（轻）躁狂的风险增加。5 项研究具有低偏倚风险，11 项研究具有中度风险，1 项研究具有严重偏倚风险。 结论 哌醋甲酯或混合安非他明盐可能会改善 BD 患者的 ADHD 症状。然而，关于认知有效性的证据有限。当与情绪稳定剂一起使用时，这些药物不会增加躁狂的风险。需要进一步开展强有力的研究来评估接受精神兴奋剂和情绪稳定剂治疗的双相情感障碍患者的认知能力。