Attention Deficit Hyperactivity Disorder Vs Bipolar disorder By Marjan Raad, Roshni Shah, Kapil Vij and Martin Bjoernsgaard

Bipolar disorder and ADHD, or attention deficit hyperactivity disorder, are two conditions that are increasingly being diagnosed in children and teens, often together. And interestingly, in children and teens, there are some similarities in the symptoms of the two conditions. But how can a doctor know for sure if the child has bipolar disorder or ADHD? Also, how does the treatment for these two conditions differ?

Key questions Are they 2 separate illnesses? Are they 2 overlapping syndromes? Are they sets of coexisting symptoms? How often ADHD is an early symptom or warning sign of bipolar disorder?

Diagnositc features persistent pattern of? 1.inattention 2.hyperactivity 3.impulsivity

Components of Attention arousal or alertness external or receptive attention: sensory processing and interpretation internal or reflective attention processing attention or selective attention focus filtering inhibition of sensation external or expressive attention working memory

ADHD Children with ADHD are not more active in play Only when asked to stop or sit still we see diminished ability to inhibit activity hyperactive (immaturity) ability to inhibit response to distractions inattentive co-existing condition is depression

ADHD and the brain Diminished arousal of some regions of the nervous system Decreased blood flow to the prefrontal cortex and pathways connecting to the limbic system ( caudate and striatum) PET scans show decreased glucose metabolism throughout the brain

Causes of ADHD Underlying causes of these differences is still unknown, theres is much conflicting data between studies Strong evidence of genetic component Predominant theory: catecholamine neurotransmitter dysfunction or imbalance Diet Constant over-stimulation

Bipolar Disorder (manic depression)

Features Episodes of an elevated or agitated mood known as mania Recurrent explosive, aggressive, irritable behaviours Aspergers disorder (autism) In adolescents: borderline personality disorder

Difficulties in diagnosing bipolar Variability in clinical presentation Severity, phase of the illness and subtype of bipolar disorder Highly comorbid with highly psychiatric disorders Child’s physical and behavioural problems may be expressions of his or her symptoms Effects of medication

Development of manifestations 1.Euporia/elation 1.giggling uncontrollably in class 2.dancing and laughing at home 3.finds everything funny and they don’t know why 2.Decreased need for sleep 1.up to 2am rearranging furniture, cleaning then awake at 6am dressed and ready for school 2.child awake at 4am during school vacation 3.Grandiosity 1.telling teacher to shut up 2.child stealing because he feels the rules don’t apply to him 3.child believing he is a superhero 4.Hypersexuality 1.drawing or preoccupied with pictures of naked people

Conditions that may preexist 1.Learning disabilities = 50% 2.Oppositional defiant disorder = 40% (ongoing pattern of anger-guided disobedience, hostility, and defiant behavior toward authority figures) 3.Anxiety = 35% 4.Conduct disorder = 35% (repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate norms are violated) 5.Depression = 35% 6.Tics/tourettes = 7%

Differentiation between ADHD and bipolar All start in childhood ADHD starts before age 7 Pediatric bipolar disorder starts before puberty Neurobehavioural disorders often prenatal or perinatal origin

Comparisons

The crossover 20% of ADHD patients may manifest bipolar disorder May have moods that change very rapidly for no reason

Thank you for your attention!