If you ask me “What is the most important thing you have learned in psychiatry over the last ten or twelve years?” I would say without hesitation that it is to identify and treat ADHD — with both medications and psychotherapy.
If you ask me, “What is the most important thing you have learned in psychiatry in 2014?”, it is that bipolar disorder and ADHD occur in the same person MUCH more commonly than I had thought and that I must continue to be very diligent in screening patients with bipolar disorder for ADHD.
I knew this comorbidity very well, have treated patients who had both disorders, spoke about it to the residents on several occasions, discussed the data on treatment of this comorbidity, and would share the article by Wingo and Ghaemi in Current Psychiatry 2007. You can get the PDF free at Current Psychiatry’s website by clicking on THIS LINK which will open the PDF in a separate window.
However, with increasing experience with this comorbidity and careful longitudinal assessment, I have been really surprised by how OFTEN these two occur together. Patient after patient after patient. That is what prompted me to write this post. Even if you are already aware of this comorbidity, I suggest looking for it more systematically in all your patients with bipolar disorder by asking the patient and family member about symptoms of ADHD — BEFORE the bipolar disorder episodes and when the person is NOT depressed or manic. It it not too difficult once we focus the conversation on this issue.
Thus, it is important to distinguish PRE-EXISTING ADHD from cognitive deficits that occur after onset of the bipolar disorder.
Copyright 2016, Rajnish Mago, MD. All rights reserved. May not be reproduced in any form without express written permission.
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