Bipolar Disorder and ADHD - Part 2
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- Опубликовано: 6 фев 2025
- One of the most common misdiagnoses given to adults with ADHD is Bipolar Disorder (BD). This is often due to practitioners having far more knowledge of BD and far less knowledge of ADHD and their differential diagnosis. Yet, these disorders can also coexist; more often in the case of people with BD also having ADHD than vice versa. In this three-part series of videos, I discuss the overlap of ADHD with bipolar disorder, give some tips on differential diagnosis, and highlight some key issues n the management of this comorbid condition.
Part 1 describes the overlap in the symptoms of both disorders that can often lead to confusion and even misdiagnosis of ADHD as being bipolar disorder, when it is not. However, the two disorders can coexist in a minority of cases of each. Here I discuss how one might distinguish the symptoms of ADHD that overlap with the BD symptom list, emphasizing the more extreme and episodic nature of these symptoms when they occur in BD.
In Part 2, I discuss the percentage of overlap between the two disorders, and explain that the degree of comorbidity is often age-related. I also point out some differential diagnostic tips in distinguishing the two disorders.
In Part 3, I describe some basic issues involved in the management of the disorders when they co-exist.
References:
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Comorbidity of ADHD and adult bipolar disorder: A systematic review and meta-analysis
C Schiweck, G Arteaga-Henriquez, M Aichholzer… - Neuroscience & Biobehavioral Reviews, 2021, 124, pp. 100-123.
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ADHD and bipolar disorder in adulthood: clinical and treatment implications
V Salvi, E Ribuoli, M Servasi, L Orsolini, U Volpe - Medicina, 2021, 57(5), 466.
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Development of bipolar disorder in patients with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis of prospective studies
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Clinical correlates of comorbid attention deficit hyperactivity disorder in adults suffering from bipolar disorder: a meta-analysis
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BP isn't relevant for me, thank god, but I watch EVERYTHING you put out Dr Barkley - it's so valuable. Thank you
My psychiatrist of 23 years emailed today announcing his retirement next week. A new psychiatrist will be assigned to me. I'm a bit discombobulated.. I only saw him 3 weeks ago. I was so nervous before the appointment; I wanted to ask for an ADHD assessment. I had to get ChatGPT to compose how I should ask him. I'm diagnosed Bipolar II since 2001. I read out my request, and he leaned over his desk and said, 'I completely agree.' What a relief. So used to being gaslit. Unfortunately, the way it works here in Ireland is that the assessment is carried out by psychologists, who cannot prescribe (should I decide to try medication), and there aren't enough psychiatrists here to prescribe. The public list is years long; private assessment is c€800 with a least a year's wait. In the meantime, thank you, Dr. Barkley, for helping me make sense of everything while I wait and save.
Regarding assesment: it is similar in Poland, but at least waiting list to non-public isn't that long. Psychologist is carrying something called "diagnostic opinion" that isn't yet an official diagnosis. You go with that opinion to psychiatrist that after general psychiatric assesment give final diagnosis and he/she may prescribe pharmatologic treatment.
Hello Dr. Barkley, just so you know, the slides are cut off a bit at the bottom! Thanks for all your work
Hi Dr. Barkley, I do appreciate all your videos, even if I don’t always fully understand everything you say. I think I need to rewatch a couple times to fully grasp what is said. I’m curious though if you could do a video about Borderline Personality disorder and ADHD, co-morbidity, misdiagnosis etc.
If you're listening to this on 1.5x or 2x speed, you're definitely ADHD 😂
Wow, I had no idea about all of this. Thank you very much, Dr. Barkley.
How do you know which came first, in order to determine the percentage of comorbidity? (Ex. If you have bi-polar you’re more likely to have ADHD, but those with ADHD aren’t as likely to have ADHD).I hope this makes sense. Thanks, Doc. You’re the best! Your voice is a perfect tempo and speed. Have a Happy Holiday.
It’s just a difference in calculation by using one or the other as the denominator. The “chance” of having one if you have the other is just a statement about the statistics of %comorbidity and doesn’t necessarily entail anything about development in an individual over time.
waiting for part 3 i hope there is some good advice in there, i need it lol
Is the lack of mania the only differentiator between BP and DMDD?
No, the degree of irritability, explosive anger, and even aggressive behavior is higher in DMDD, which also often has an earlier onset than most BD cases, but not all, among other factors.
I am autistic (ASD level1, previous Asperger) with ADHD (combined type) and I have meltdowns / shutdowns after days of work and social interaction overload, how do you differentiate between irritability, explosive anger..in BD and this?
I am aware of DMDD, as I had no sort of mania. But when I was a child, I had periods of depression and then put make-up on and feel empowered and confident + hypersexuality, which did not lead to anything in reality. Could’ve been just hormones and puberty. I discussed that my childhood hypersexuality with myself was due to dopamine seeking as this was the only way of me waking up/doing homework/getting outside/going to school.
My mom is schizophrenic triggered after she hit her head. She was diagnosed before having me. My dad (born at 7months old) was 1000% pure strong ADHD.
As well I had experienced for a few days depersonalisation/derealisation after drug misuse. As a child I never got social clues, as I grew up I got better. I believe I have an increased chance of BD or worse due to my experience with weed in the past. Which I no longer do after developing panic attacks. But I struggle to understand if I am an imposter and my autistic meltdowns/shutdowns might come from somewhere else…
As well there is an influence in my behaviour due to living only with my ADHD dad. So it makes it even harder to get if I have early BD (or had childhood BD) or if it would get BD worse in the future. I am afraid of the age peak as well. I am 25. Untreated cyclothemia leads to BD, can lead to BD 1 , or even with psychotic features. I don’t want to end up like my mom. 🥹
My current medication is amazing and stable 9months on methylfenidate 36 and sertraline 100. Will switch to lisdex at some point. No periods of mania/depression, unmedicated ADHD is very obvious and overall I seem like I am discovering and coping with my autism much better.
I don’t understand at all how autistic frustration is different to BD..
@@reetutI would consider autism, ADHD, and hormone cycle as the more fundamental, and if they explain periods of anger then don’t worry about the more severe conditions. I say that because imo over-diagnosing doesn’t empower you to cope better. Although he discusses in the video that BD does have some distinct genetic basis, a lot of it is overlapped with ADHD so the management is going to be mostly the same-good self-care with healthy food, exercise and sleep, and respecting your own limits vs expectations derived from comparison with others. I personally believe based on my own experience and anecdotes that bipolar manifestation can result from adhd/autism + chronic insufficient sleep. The “mania” is an adrenaline-fueled compensation for staying up too much to do whatever, and the “depression” a recovery response.
❤❤❤