ADHD and BIPOLAR DISORDER: Deciphering the Diagnostic Conundrum

Transcription

1 ADHD and BIPOLAR DISORDER: Deciphering the Diagnostic Conundrum Roberto Olivardia, Ph.D. Harvard Medical School

2 Bipolar I Disorder 6 million people (18 and over) Statistics on children vary 1% of the US population

3 Bipolar I Disorder Depressive Symptoms Persistent sad or irritable mood Loss of interest in activities once enjoyed Significant change in appetite or body weight Sleeping too little or too much Physical agitation or slowing Fatigue Feelings of worthlessness or inappropriate guilt Difficulty concentrating Recurrent thoughts of death or suicide

4 Bipolar I Disorder Manic/Hypomanic Symptoms Severe changes in mood, either extremely irritable or overly silly and elated Overly-inflated self-esteem, grandiosity Increased, Revved up energy Decreased need for sleep, sometimes for up to a week, without feeling tired Increased talking, talks too much, too fast; changes topics too quickly; cannot be interrupted

5 Bipolar I Disorder Manic/Hypomanic Symptoms Extreme Random Distractibility Hypersexuality Increased goal-directed activity or physical agitation Disregard of risk, excessive involvement in risky behaviors or illegal activities

6 Bipolar II Disorder 1%-2% of US population Hypomanic episodes More depressive episodes More common in women Marked by anxiety Rejection Sensitivity Personality Disorders Significant morbidity NOS: 2.4% subthreshold

7 Suicide and Bipolar Disorder 15 times greater than general population 20% of people with BD complete suicide 50% attempt suicide Suicides more likely in manic phase Bipolar II characterized by more lethal suicide attempts 10 years reduced life expectancy

8 Prevalence Rates of ADHD and BD 50%-90% of people with BD have ADHD 20% of people with ADHD have BD

9 The Diagnostic Conundrum: ADHD and Bipolar Disorder Impulsivity Irritability Hyperactivity Emotional Dysregulation/Lability Sleep problems Hyperverbal Rapid Speech Racing thoughts Attention Issues Increase Goal Directed Activity

10 Bipolar Disorder and ADHD Reasons for Association ADHD+BD may be a separate entity than BD alone ADHD can be a developmental marker for BD Dopamine D2 Receptor Mating?

11 Differential Diagnosis Bipolar Disorder vs. ADHD More likely to be Bipolar Disorder if: Symptoms are not apparent at birth Higher Chronicity of impairment Mood dysregulation is random or cyclical vs. contextual Mood is significantly different when not depressed or manic Mood shifts are rapid Moods are intense

12 Differential Diagnosis Bipolar Disorder vs. ADHD More likely to be Bipolar Disorder if: Duration of mood shifts are long. Family History of Bipolar Disorder Psychosis Destructiveness/Violence Regressive/Primitive behavior High Trigger sensitivity Grandiosity Respond well to mood stabilizers

13 The Bipolar Child Very precocious, giftedness Night Terrors (Gore, mutilation, dreams) Extreme fear of annihilation and death Obsessive talk about death, murder, suicide Harm to animals Hallucinations Paranoia

14 ADHD and Bipolar Disorder More ADHD symptoms than ADHD alone Earlier age of onset More additional psychiatric disorders than those with ADHD alone Higher morbidity More likely to be on disability Higher suicide rate Had poorer overall functioning

15 BD+ADHD vs. ADHD Elevated Mood Grandiosity Flight of Ideas Decreased need for sleep Hypersexuality

16 BD+ADHD vs. BD Male Earlier onset of BD (before 12) Presence of conduct disorder Presence of ODD/Conduct Disorder More irritability Increased antisocial traits Increased substance abuse Increase panic

17 Psychopharmacological Treatments: Bipolar Disorder Mood Stabilizers Lithium Anti-convulsants Divalproex Sodium (Depakote) Carbamazepine (Tegretol) Lamotrigine (Lamictal) Antipsychotics Olanzapine (Zyprexa) Ziprasidone (Geodon) Risperidone (Risperdal)

18 Psychopharmacological Treatments: ADHD Stimulants Methylphenidate (Ritalin) Amphetamine/Dextroamphetamine (Adderall) Non-Stimulants Atomoxefine (Strattera) Antidepressants Bupropion (Wellbutrin)

19 Psychopharmacological Issues: Treating Bipolar Disorder and ADHD Stimulants can make BD worse Treat the BD first then the ADHD Having ADHD no affect on BD medication except in cases of conduct disorder BD+ADHD: Higher attenuation of medications ADHD: Poor compliance consistently BD: Poor compliance when manic See a psychopharmacologist or psychiatrist who has expertise in both BD and ADHD DO NOT have your PCP prescribe

20 Psychological Treatment: Bipolar Disorder + ADHD Monitor and manage ADHD to prevent/minimize BD episodes Cognitive-Behavioral Therapy Health and Wellness (especially sleep) Self esteem Support

21 ADHD and BIPOLAR DISORDER: Deciphering the Diagnostic Conundrum Roberto Olivardia, Ph.D. Harvard Medical School