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MN Psychiatrist
MN Psychiatrist, Psychiatrist
Category: Mental Health
Satisfied Customers: 792
Experience:  Physician for 17 years, adult psychiatrist for 13 years working with a wide variety of patients.
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Hi, Thank you, in answer to your question she has not ever

Resolved Question:

Hi,
Thank you, XXXXX XXXXX to your question she has not ever formally been assessed for ADD. However, I have been an elementary teacher for many years and have always wondered whether she might have ADD. She never required much sleep, we always said she had a "butterfly brain", flitting from one thing to another and her teachers always commented she never fulfilled her true potential, due to a lack of concentration. The, when she had her first episode, at 17, basically not having slept for days, I thought the lack of concentratin was linked to her psychiatric illness, which wasn't diagnosed until her second hypomanic episode 3 years later, when she was hospitalised for 7 weeks.
Thanks
Submitted: 3 years ago.
Category: Mental Health
Expert:  MN Psychiatrist replied 3 years ago.
Hello, I am a psychiatrist.
I am a little confused by your question. Specifically, who is the girl you are describing? Is she your daughter? Also, do you have a specific question for which you were seeking an answer?
Customer: replied 3 years ago.

Hi,

Sorry to be confusing; I had already received a reply, within which the expert asked whether my daughter (aged 26, bipolar but stable for 6 years on lithium therapy and recently also on a small dose of prozac,whose CBT psychologist has just suggested may possibly also suffer from ADD) had ever been formally assessed for ADD. I thought I was replying in response to the expert's question. Hence, the lack of clarity and basic information in what I thought was a response.

I would be happy for your opinion and I would also like to know whether, as she is married and plans to have a family within the next couple of years, she would need to come off lithium and, if so, how risky to her mental health that may be.

Like many parents whose offspring have various conditions, I research, with fingers crossed, current developments on bipolar theories, and I have read that Ebsteins heart abnormality and its link to lithium is now being discredited, in some quarters. Also, I have read that there is an opinion now (university of Missouri study??) that bipolar in adolescence can actually run its course by the time sufferers reach their late 20's and lead more stable, settled lives.

I have learned recently from her that she led a very hectic lifestyle in her late teen/ university years with chaotic sleep patterns, excess alcohol use and a certain amount of drug use/ certainly cannabis an cocaine. Obviously, this wouldn't have helped her mental state.

I look forward to your response on thes issues.

Kind regards

A B

Expert:  MN Psychiatrist replied 3 years ago.
Hello again.
Regarding the question of ADHD (sometimes referred to as ADD), at times it is diagnosed in adults, especially if it is the predominantly inattentive type; as children, these kids are less apt to be disruptive in the classroom, and if they are otherwise bright they can manage to compensate for their attention/concentration problems enough to get by. That said, I see an awful lot of people who seem to think they have ADHD, but when I finish treating their depression/anxiety/whatever, their concentration problems are no longer an issue. For this reason, I insist on fully treating those problems first if they are present in an individual who is concerned they may have ADHD. Also, because there is a very high abuse potential risk with most of the medications used to treat ADHD, especially in patients with a history of substance abuse, caution must be used in diagnosing ADHD when there could be other motivation (i.e., substance-abuse) for seeking treatment for ADHD.

Regarding the use of lithium in pregnancy, I would be very cautious about this. At times, the risk of discontinuing a medication during pregnancy is very high and must be considered, but the general thinking is still along the lines that lithium can/does still increase the risk of Epstein's Anomaly in the heart.

Likewise, the accepted belief about bipolar disorder is that it is a lifelong illness.
Of course, patients commonly have more chaotic lives in their adolescence and young adulthood, for many reasons. I think the question is maybe not so much whether they outgrow bipolar disorder as it is whether or not they ever had it in the first place (versus having maturity issues, limited coping skills, substance abuse issues, hormonal fluctuations from puberty that haven't settled down, etc.) I hope this helps.
MN Psychiatrist, Psychiatrist
Category: Mental Health
Satisfied Customers: 792
Experience: Physician for 17 years, adult psychiatrist for 13 years working with a wide variety of patients.
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