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A Diagnostic Dilemma: Co-Morbid Attention Deficit Hyperactivity Disorder and Bipolar Disorder in Geriatric Patients
2017 AAGP Annual Meeting (Dep-ABC, RECALL, or RAPID). Gain scores (change) between pre- and post-treatment scores were created for the sleep and mood outcomes. Pearson correlation coefficient were used to investigate the relation between changes in sleep and mood. Results: We investigated which interventions resulted in changes in sleep and compared sleep scores by time and treatment time. For PSQI Q6, the time x treatment condition interaction was significant, F (2,134) = 3.10, p = .048, η2 = .04. For Q3 of the PHQ-9, the time x treatment condition interaction was significant, F (2,133) = 3.77, p = .03, η2 = .05. We investigated which intervention resulted in changes in mood and compared depression scores by time and treatment type. For PHQ-9 minus Q3: time by treatment type controlling for study type is not significant: F (2,133) = .70, p = .50, η2 = .01. We investigated if changes in sleep and mood were correlated and found significant correlations between changes in sleep scores with changes in depression scores. Pearson correlation PHQ-9 Q3 x PHQ-9 minus Q3 = 0.195, sig (2-tailed) 0.023, N = 137 and PSQI Q6 x PHQ-9 minus Q3 = 0.188, sig (2-tailed) 0.029, N = 135 Conclusions: BBTI can be used to treat insomnia in older adults with various comorbidities such as pain, frailty and cognitive impairment. In this population of older adults, there were no significant differences in depression outcome between the different interventions. In older adults with depression, there is a positive association between sleep and mood changes and sleep problems should be identified and targeted when treating older adults at risk for depression. More research is needed to identify the mechanism by which treating sleep improves depression outcomes.
Poster Number: EI 4
A Diagnostic Dilemma: Co-Morbid Attention Deficit Hyperactivity Disorder and Bipolar Disorder in Geriatric Patients Erika N. Heard, MD; Cristina Poscablo-Stein, MD, MPH; Yousef Sohail, MD; Anusuiya Nagar, MD; Adriana P. Hermida, MD Emory University, Atlanta, GA Introduction: In the adult population, lifetime prevalence of comorbid Attention Deficit and Hyperactivity Disorder (ADHD) and Bipolar Disorder (BD) co-occur at rates of 17.6% [1]. Rates in the elderly population have not been well studied. Those who present with both disorders simultaneously present a diagnostic and treatment challenge. These challenges are present due to the overlapping symptomatology and the complications that can arise when treating these disorders inappropriately, with the major complication that treatment of ADHD with stimulants can induce mania. Methods: Review of the literature regarding ADHD and bipolar disorder comorbidity and the treatment of comorbid these illnesses. Results: A 64 year old Caucasian male presented to the outpatient clinic for treatment of ADHD and BD. During initial evaluation he endorsed symptoms most consistent with ADHD but not with BD. There was no family history of BD and no previous hospitalizations. He never had episodes of depression. His symptoms were not periodic, rather consistent since childhood. Neuropsychiatric testing was completed and confirmed the diagnosis of ADHD, thus mood stabilizer tapered off to discontinuation. He was eventually continued only on lisdexamfetamine (Vyvanse). He initially showed improvement in symptoms of hyperactivity, inability to focus, and was better able to complete tasks around the house. After a year of stimulant treatment, he presented with complaints of increased forgetfulness, decreased need for sleep, decreased concentration, worse distractibility, increased impulsivity, worsened irritability, and mood lability. On mental status exam he was hyperverbal, with mood lability, easily distracted, tangential, and psychomotor agitation. He did not have any delusions or hallucinations. He was recently started on opioids and these were discontinued. Medical work up was initiated due to a change in behavior. The work up, including a MRI of the brain, was negative. Vyvanse was tapered off and Divalproex Sodium was initiated with the plan to up titrate to symptom improvement. He was noted to have significant improvement of manic symptoms with these medication changes, however, hyperactivity and concentration again worsened. Additional neuropsychiatric testing was ordered. Conclusions: This case illustrates the diagnostic difficulty and treatment of comorbid ADHD and BD. It demonstrates the need for a longitudinal history of these patients and close monitoring when initiating treatment. Additionally, it is important to recognize the intersection of these two disease entities and the appropriate management of both, especially in the geriatric population. This research was funded by: none.
Am J Geriatr Psychiatry 25:3S, Supplement 1
S65
Poster Number: EI 4
A Diagnostic Dilemma: Co-Morbid Attention Deficit Hyperactivity Disorder and Bipolar Disorder in Geriatric Patients Erika N. Heard, MD; Cristina Poscablo-Stein, MD, MPH; Yousef Sohail, MD; Anusuiya Nagar, MD; Adriana P. Hermida, MD Emory University, Atlanta, GA Introduction: In the adult population, lifetime prevalence of comorbid Attention Deficit and Hyperactivity Disorder (ADHD) and Bipolar Disorder (BD) co-occur at rates of 17.6% [1]. Rates in the elderly population have not been well studied. Those who present with both disorders simultaneously present a diagnostic and treatment challenge. These challenges are present due to the overlapping symptomatology and the complications that can arise when treating these disorders inappropriately, with the major complication that treatment of ADHD with stimulants can induce mania. Methods: Review of the literature regarding ADHD and bipolar disorder comorbidity and the treatment of comorbid these illnesses. Results: A 64 year old Caucasian male presented to the outpatient clinic for treatment of ADHD and BD. During initial evaluation he endorsed symptoms most consistent with ADHD but not with BD. There was no family history of BD and no previous hospitalizations. He never had episodes of depression. His symptoms were not periodic, rather consistent since childhood. Neuropsychiatric testing was completed and confirmed the diagnosis of ADHD, thus mood stabilizer tapered off to discontinuation. He was eventually continued only on lisdexamfetamine (Vyvanse). He initially showed improvement in symptoms of hyperactivity, inability to focus, and was better able to complete tasks around the house. After a year of stimulant treatment, he presented with complaints of increased forgetfulness, decreased need for sleep, decreased concentration, worse distractibility, increased impulsivity, worsened irritability, and mood lability. On mental status exam he was hyperverbal, with mood lability, easily distracted, tangential, and psychomotor agitation. He did not have any delusions or hallucinations. He was recently started on opioids and these were discontinued. Medical work up was initiated due to a change in behavior. The work up, including a MRI of the brain, was negative. Vyvanse was tapered off and Divalproex Sodium was initiated with the plan to up titrate to symptom improvement. He was noted to have significant improvement of manic symptoms with these medication changes, however, hyperactivity and concentration again worsened. Additional neuropsychiatric testing was ordered. Conclusions: This case illustrates the diagnostic difficulty and treatment of comorbid ADHD and BD. It demonstrates the need for a longitudinal history of these patients and close monitoring when initiating treatment. Additionally, it is important to recognize the intersection of these two disease entities and the appropriate management of both, especially in the geriatric population. This research was funded by: none.
Am J Geriatr Psychiatry 25:3S, Supplement 1
S65