Comorbidity between ADHD and symptoms of bipolar disorder in
a community sample of children and adolescents.
Reich W,
Departments of Genetics and Psychiatry at Washington University
School of Medicine, St. Louis, Missouri, United States of
America, wendyr@wustl.edu.
The prevalence and frequency of comorbidity of possible bipolar
disorder was examined with attention-deficit hyperactivity
disorder (ADHD) in a nonreferred population of twins. Children
and adolescents aged 7 to 18 years with a history of manic
symptoms were identified from a population-based twin sample
obtained from state birth records (n = 1610). The sample was
enriched for ADHD; however, there was also a random control
sample (n = 466), which allowed a look at the population
prevalence of the disorder. Juveniles with threshold or below
threshold manic episodes were further assessed for comorbidity
with Diagnostic and Statistical Manual of Mental Disorders (4th
ed.; DSM-IV; American Psychiatric Association, 1994) and
population-defined ADHD subtypes (from latent class analysis)
using Fisher's exact test. Nine juveniles who exhibited DSM-IV
manic (n = 1), hypomanic (n = 2) or below threshold episodes (n
= 6) were identified. The population prevalence of broadly
defined mania in the random sample was 0.2%. The possible manic
episodes showed significant comorbidity with population-defined
severe combined and talkative ADHD subtypes. It can be concluded
that there is a significant association of bipolar symptoms with
two population-defined subtypes of ADHD. Episodes of possible
bipolar disorders as defined by DSM-IV are uncommon in this
nonreferred sample. Children and adolescents with ADHD appear to
be only modestly at increased risk for bipolar disorders.
PMID: 16212835 [PubMed - in process]
2 :
Curr Psychiatry Rep. 2005 Apr;7(2):98-103.
How to differentiate bipolar disorder from attention deficit hyperactivity
disorder and other common psychiatric disorders: a guide for clinicians.
Sood AB, Razdan A, Weller EB, Weller RA.
Division of Child and Adolescent Psychiatry, Virginia Commonwealth University
Health Systems, 515 North 10th Street, Richmond, VA 23298, USA. bsood@hsc.vcu.edu.
Bipolar disorder in children often is confused with attention deficit disorder,
substance-induced mood disorder, oppositional defiant disorder, and conduct
disorder. It is not uncommon for some of these disorders to be comorbid with
pediatric bipolar disorder. This article provides the reader with a review of
the existing literature on differentiating these illnesses and recognizing the
phenomenology of each disorder as it pertains to a psychiatric diagnostic
work-up of a child. Clinically helpful overlapping and unique characteristics of
each disorder are discussed and a practical approach to differentiate these
disorders is provided.
PMID: 15802085 [PubMed - in process]
3:
J Clin Psychiatry. 2005 Jan;66 Suppl 1:18-23.
Recognizing and managing bipolar disorder in children.
Wozniak J.
From the Pediatric Psychopharmacology Unit, Massachusetts General Hospital,
Boston.
Bipolar disorder affects people of all ages, including preschool-aged children.
Two major difficulties in diagnosing children with bipolar disorder are its
overlap with attention-deficit/hyperactivity disorder (ADHD) and its
developmentally distinct presentation from that in adults, with high rates of
irritability, chronicity, and mixed states. Comorbid conditions are common in
bipolar disorder and, in addition to ADHD, include depression, anxiety
disorders, oppositional defiant disorder, and conduct disorder. Family studies
have helped to confirm the validity of bipolar disorder in children. In terms
of treatment, children do not appear to respond well to conventional mood
stabilizers alone. However, using an atypical antipsychotic either alone or in
addition to another mood stabilizer has shown utility in treating manic
symptoms, depression in mixed states, and aggression. Amphetamine salts have
been helpful in treating bipolar children with comorbid ADHD, but no data are
available on treating comorbid depression in bipolar children. Because
childhood-onset mania is commonly chronic rather than episodic, highly
comorbid, and characterized by high rates of irritability, future clinical
trials should examine the overlap of mania with other disorders in children to
determine routes to accurate diagnosis and treatment.
