Mania attention deficit

Kim EY, Miklowitz DJ. Childhood mania, attention deficit hyperactivity disorder and conduct disorder a critical review of diagnostic dilemmas. Bipolar Disord 2002 4 215-225. 

Comorbid conditions must be addressed in order to maximize desired outcomes. For comorbid bipolar disorder and attention-deficit/hyperactivity disorder when stimulant therapy is indicated, treatment of mania is recommended before starting the stimulant in order to avoid exacerbation of mood symptoms by the stimulant. 

West, S., McElroy, S., Strakowski, S., Keck, R, and McConville, B. (1995) Attention deficit hyperactivity disorder in adolescent mania. Am J Psychiatry 152 271-274. 

Strober, M., DeAntonio, M., Schmidt-Lackner, S., Freeman, R., Lam-pert, C., and Diamond,/. (1998) Early childhood attention deficit hyperactivity disorder predicts poorer response to acute lithium therapy in adolescent mania. / Affect Disord 51 145-151. 

It included psychotropics approved for the following indications generalized anxiety disorder panic disorder attention-deficit hyperactivity disorder (ADHD) mania obsessive-compulsive disorder (OCD) schizophrenia and insomnia. 

Perhaps even more important in children is the issue of bipolar disorder. Mania and mixed mania have not only been greatly underdiagnosed in children in the past but also have been frequently misdiagnosed as attention deficit disorder and hyperactivity. Furthermore, bipolar disorder misdiagnosed as attention deficit disorder and treated with stimulants can produce the same chaos and rapid cycling state as antidepressants can in bipolar disorder. Thus, it is important to consider the diagnosis of bipolar disorder in children, especially those unresponsive or apparently worsened by stimulants and those who have a family member with bipolar disorder. These children may need their stimulants and antidepressants discontinued and treatment with mood stabilizers such as valproic acid or lithium initiated. 

State RC, Altshuler LI, Frye MA. Mania and attention deficit hyperactivity disorder in a prepubertal child Diagnostic and treatment challenges. Am J Psychiatry 2002 159 918-925. 

Several medical, medication-induced, or substance-related causes of mania and depression have been identified (see Table 68-2 for causes of mania and Table 67-1 in Chap. 67 on depressive disorders for causes of depression). " A complete medical, psychiatric, and medication history physical examination and laboratory testing are necessary to rule out any organic causes of mania or depression. An accurate diagnosis is important because some psychiatric and neurologic disorders present with manic-like symptoms. For example, attention-deficit/hyperactivity disorder and a manic episode have similar characteristics thus individuals with bipolar disorder may be misdiagnosed and prescribed central nervous system stimulants. Use of any substance that affects the central nervous system (e.g., alcohol, antidepressants, caffeine, central nervous system stimulants, hallucinogens, or marijuana) can worsen symptoms and decrease the... 

Drug treatment of childhood psychosis and other behavioral disorders of children is confused by diagnostic inconsistencies and a paucity of controlled trials. Antipsychotics can benefit children with disorders characterized by features that occur in adult psychoses, mania, autism, or Tourette s syndrome. Low doses of the more potent or modem atypical agents usually are preferred in an attempt to avoid interference with daytime activities or performance in school. Attention deficit disorder, with or without hyperactivity, responds poorly to antipsychotic agents, but... 

Much attention has been paid to the catecholamines noradrenaline and dopamine following the discovery that their depletion in the brain leads to profound mood changes and locomotor deficits. Thus noradrenaline has been implicated in the mood changes associated with mania and depression, while an excess of dopamine has been implicated in schizophrenia and a deficit in Parkinson s disease. 

Problems with attention are a component of most neuropsychiatric disorders. For example, poor concentration is a major symptom of depression, which may relate to insufficient monoamine stimulation in the PFC. Conversely, the concentration deficits and impulsivity in mania may be associated with a hyper-NE state, and... 

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