Psychiatrists and Psychologists

Biography

Biography: M Wasi Mohamad

Abstract

The prevalence of bipolar is reported to be around 20-25% in adults with ADHD. Both conditions have several symptoms which can be difficult to differentiate and show symptoms of emotional lability, impulsivity and restlessness. It is reported that treating ADHD patients, who have comorbid bipolar, use of stimulant medication can cause mood instability and trigger hypomania or manic symptoms. Our service is commissioned by the NHS to diagnose and treat adults with ADHD in Shropshire, England. We undertook an audit to examine the treatment of the cases who also presented with features of a DSM-5 diagnosed Bipolar Spectrum condition. We also included cyclothymic disorders in Bipolar Spectrum group. 32 cases were identified with both conditions. We noted that when referred to ADHD service, 24 patients (84.4%) did not have the diagnosis of Bipolar Spectrum. Limited guidelines are available for treating such patients in adults but in adolescents group, some guidelines suggest use of mood stabilizers. At the point of diagnosis of Bipolar Spectrum in this group, we aimed that all patients should be offered the use of mood stabilizer. We noted that when prescribed stimulant medication in this group, 100% of cases had mood instability without mood stabilizers but only 32% of cases with mood stabilizers. Optimum response in ADHD symptoms was noted in 80% cases, 57% of cases showed stability in mood. No patient had any manic or significant hypomanic symptoms. Overall, 94% of patients on stimulants and mood stabilizers simultaneously, either did not continue to suffer from mood fluctuations, or did but with significant improvement. Our conclusion from this audit shows that mood stabilizers are important to consider in treatment of ADHD patients with comorbid Bipolar Spectrum Disorder and are effective optimizing treatment. Longer term studies are required to further evaluate treatment outcomes in this group.