"What's the best treatment for comorbid ADHD/bipolar mania?" by D rs . Nick C. Patel and Floyd R. Sallee (CURRENT P SYCHIATRY, April 2005 , p. 27 -37 ) was well-written and offers excellent treatment guidelines. However, the idea that patients can have comorbid bipolar disorder and attention-deficit/lhyperactivity disorder (ADHD) is a fallacy.
I challenge any colleague, from the leading expert to the most recent graduate, to present a bona fide case of "comorbid" ADHD/bipolar disorder. I can prove that only one diagnosis is correct because:
Bipolar disorder is more heritable than other psychiatric illnesses. Many patients labeled as having ''comorbid" bipolar disorder and ADHD have parents with bipolar disorder or schizophrenia or are in foster care and their biological parents' histories are unknown.
I've seen hundreds of patients enter full-blown psychosis after another clinician put them on amphetamines or antidepressants while being treated for ADHD.
Bipolar disorder can explain any so-called ADHD symptom.
ADHD does not include moodiness or predatory aggression.
Over 10 years, I have diagnosed three or four patients as having comorbid bipolar disorder and ADHD. After a few years and inpatient treatments, these patients proved the second diagnosis wrong. We can decrease costs and avoid patients' suffering by refining diagnostic criteria.