The following note (an introduction to a lecture) expands on my view of how wrong the psychiatric establishment is when it says things such as “more than 50% of bipolar patients have co-morbid ADHD.”
ADHD’s comorbidities: Where is the Evidence?
By Manuel Mota-Castillo, MD
With this presentation I would like to open a debate on the common practice of diagnosing ADHD in patients with serious mental illnesses such as Autism, bipolar disorder, Panic Disorder, Obsessive-Compulsive Disorder and others.
To spark an animated discussion I could start by quoting the director of MGH’s Autism clinic from a Podcast (2011) in which he says: “many of my autistic patients also meet the criteria for Social Anxiety Disorder and ADHD.”1
This could be followed by the reminder that DSM’s criteria clearly establishes that ADHD should not be diagnosed if the symptoms can be better explained by a “Pervasive Developmental Disorder, Psychotic Disorder, Mood Disorder…” but also to emphasize on the common sense observation that if a child ignores the presence of his or her parents how can we expect that he or she will pay attention to a teacher or somebody else. The same could be say about diagnosing Social Anxiety in an autistic child when, by definition, that individual is expected to be uncomfortable in social situations.
Another co-morbidity that I would like to discuss is the ADHD and bipolar and how the symptoms of this two conditions overlap but that is possible to differentiate them, in my experience, by the family history and the presence of aggressive behavior.
Finally, I would address one specific commentary made in a Letter to Editor2 (CNS Spectrum, 2010) in which the authors –from the University of Leipzig, Germany- claim to have abundant evidence proving that amphetamines do not worsen the course of bipolar disorder. This statement contradicts Dr. Kay Redfield-Jamison –world-famous expert- who considers the prescription of stimulants to bipolar children as “one of the worse things you can do to a child with this illness.”3
MGH Grand Rounds, 2011 Podcast.
Stimulants in Bipolar Disorder: Beyond Common Beliefs, Tilman Hensch, PhD, Hubertus Himmerich, MD, Ulrich Hegerl, MD and Roger S. McIntyre, MD CNS Spectr. 2010;15 (7):469-472
“Monitor on Psychology” (Volume 31, No. 9 October 2000) a report by Ken Krehbiel.