Dr Michael First: Challenges With Correctly Diagnosing ADHD, Bipolar Disorder

There are challenges with diagnosing attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder because of overlapping symptoms, explained Michael First, MD, professor of clinical psychiatry, Columbia University New York State Psychiatric Institute.

TranscriptWhat are the biggest challenges with correctly diagnosing ADHD and bipolar disorder?

The challenges of diagnosing ADHD and bipolar disorder have to do with the fact that the symptoms of bipolar disorder and ADHD overlap. So, for example, distractibility is one of the core symptoms of ADHD and it’s actually one of the core symptoms of both a major depressive episode and a manic episode. So, whenever you have overlapping symptoms—for instance, have a patient comes in with distractibility—which diagnoses are you supposed to give?

Other symptoms, hyperactivity, which is in ADHD, you see that in bipolar disorder in the form of psychomotor agitation. So, whenever you have overlapping symptoms, it makes it difficult to differentiate between the 2. The other thing that makes it challenging is the combination. It’s not really either or. It’s not like schizophrenia and schizoaffective disorder where you can’t have both schizophrenia and schizoaffective disorder. It’s one or the other.

ADHD and bipolar disorder can co-occur. In fact, they very commonly co-occur, and when you have the combination of ADHD and bipolar, it’s worse than having 1 by itself. So, trying to figure out which it is and whether it’s both is important, and the reason you need to figure out which it is is because the treatment of these 2 disorders is different. So, you want to be able to pick the right treatment by differentiating the 2 disorders.