ADHD-juvenile bipolar disorder: mimics and chameleons!

Excerpt

Both attention-deficit/hyperactivity disorder (ADHD) and juvenile bipolar mood disorder (BP) share many clinical symptoms in common. Differentiating between both conditions is crucial, both for course and prognosis and to inform functional and therapeutic outcomes which differ considerably. Early identification and hence appropriate management may lead to improved functioning, prevention of impending emergence of comorbidities (e.g. “behavioural bouquet” of ADHD), and attenuation of the untreated course of BP [1]. If the emotional symptoms of BP are misattributed to demoralization associated with ADHD label, increased use of stimulants would expose patients to higher than needed dosing and can readily destabilize mood. On the other hand, if comorbidity with ADHD is not recognized in BP, inattention, distractibility, and talkativeness symptoms from ADHD could be inappropriately ascribed to residual symptoms of BP with subsequent unnecessary exposure to antipsychotics with neuro-hormonal and cardio-metabolic hazards. Moreover, presence of ADHD might plummet anti-manic response of thymoleptics [2]. Youth with BP are amongst the most highly impaired with psychiatric illness, with mood swings characterized by severe irritability, euphoria, and depression. ADHD in itself is associated with emotional, academic, work, and social disability, and its co-occurrence complicates both the accurate diagnosis and treatment of BP, especially in pediatric populations where ADHD is readily and commonly diagnosed. The comorbidity has remained neglected for long at both ends of life cycle due to past skepticism regarding the continuity of ADHD into adulthood and the now debunked notion that BP does not occur in childhood. To muddy it further are high rates of comorbidity between both disorders. Anywhere from 57 to 98% of children with BP also meet criteria for ADHD. Anywhere from 11 to 23% of children with ADHD also meet diagnostic criteria for BP [3]. Studies of adults report a similar bidirectional relationship between ADHD and BP. Biederman et al. [4] noted that BP occurred 3.5 times more often in adults with ADHD compared with their matched control subjects without ADHD. …