TDAH y TAB

Salud Mental 2008;31:19-22

Déficit de atención e hiperactividad y trastorno bipolar pediátrico

Trastorno por déficit de atención e hiperactividad
y trastorno bipolar pediátrico: ¿Comorbilidad o traslape
clínico? Una Revisión. PPrimera
rimera PParte*
arte*
Lino Palacios Cruz,1 Francisco Romo Nava,1 Luis Rodrigo Patiño Durán,1 Fernando Leyva Hernández,1
Eduardo Barragán Pérez,2 Claudia BecerraPalars,3 Francisco de la Peña Olvera4
Actualización

SUMMAR
Y
SUMMARY
Attention deficit/hyperactivity disorder (ADHD) can present itself with
a wide variety of comorbid psychiatric entities and can easily be
misdiagnosed with disorders such as the pediatric bipolar disorder
(PedBP), making early detection and treatment difficult.
The main objective of this review is to evaluate the relationshipbetween PedBP and ADHD. Several studies have addressed this
association, establishing a high rate of comorbidity, from 57% to 93%.
The risk of developing PedBP in ADHD population has also been
studied, documenting a ten-fold increase risk in both genders
compared with age-matched healthy controls.
Pediatric bipolar disorder is still a diagnostic entity which is hard
to recognize and differentiate fromother disorders, even with the
current international diagnostic criteria. Individuals with ADHD with a
current depressive episode, suicide attempts and/or substance abuse
and that carry a family load (mainly parents) for bipolar disorder are
at increased risk of actually having this disorder.
Several researchers have compared clinical symptoms expressed
in children with ADHD and PedBP. They havefound that children with
PebBP exhibit higher frequency of elated mood, increased energy,
thought disorder, flight of ideas, increased speed in speech and
irritability than those with ADHD. Other authors report higher rates of
thought disorders, anxiety, depression, aggression and delinquent
behavior amongst children with PedBP than those with ADHD. It has
also been reported that children withPedBP compared to those with
ADHD present higher rates of euphoria, grandiosity, racing thoughts
and decreased need for sleep. Yet another study found that euphoria
and increased energy distinguished youths with PedBP from those with
other psychiatric disorders, and found that with the group of depressed
patients exhibit higher rates of suicidal thoughts and behavior than
other diagnostic groups.Some cues to diagnose and differentiate PedBP and ADHD have
been proposed: ADHD symptoms appearing suddenly or later in life,
loss of therapeutic response to stimulants in a previous responder,

intermittent symptoms, emergence of elated mood and decreased need
for sleep, severe mood shifting, hallucinations or thought disorders,
family history of bipolar disorder and lack of response to adequatetreatment.
Three of the seven criteria for bipolar disorder are shared with
ADHD (distractibility, increased goal directed activity and talkativeness),
making the clinical distinction between ADHD and early onset PedBP
a difficult task. In fact, most children diagnosed with PedBP present
symptoms and behavior compatible with a simultaneous ADHD.
The role of ADHD as a prodromic, phenocopy, comorbidcondition and/or as a misdiagnosis for PedBP can be further clarified
by: 1. case follow-up to determine if comorbid diagnosis can predict
the course or determine a prognosis factor; and 2. family genetic
studies which are convenient for the evaluation of complex comorbid
conditions. Some studies have suggested that this comorbid syndrome
may possess a specific genotype, as well a particular course,a pattern
of treatment response and may represent a distinctive clinical condition.
High comorbidity BPD, both in adult and child and adolescent
populations, runs a similar pattern to that of other important diagnostic
categories in child and adolescent psychiatry. From a clinical
perspective, these findings support the notion of avoiding hierarchical
diagnoses. Furthermore, it questions the...