psychscenehub.com Open in urlscan Pro
116.90.63.249  Public Scan

Form analysis
1 forms found in the DOM

GET https://psychscenehub.com/

<form class="search-form" method="get" action="https://psychscenehub.com/" role="search"><input class="search-form-input" type="search" name="s" id="searchform-1" placeholder="Search this website"><input class="search-form-submit" type="submit"
    value="Search">
  <meta content="https://psychscenehub.com/?s={s}">
</form>

Text Content

×Close

Psych Scene Hub

 * Authors List
 * PSYCH PEDIA
 * CONTACT US

 * PSYCH INSIGHTS
 * VIDEO GALLERY
 * PSYCHIATRY CONVERSATIONS


ADHD AND COMORBIDITIES – MANAGEMENT PRINCIPLES

Posted on:January 12, 2022

Last Updated: May 4, 2022
Time to read: 22–26 minutes

ADHD is a chronic neurodevelopmental condition that has a comorbidity prevalence
estimated to be as high as 90% of patients [Kessler et al., 2006]; [Sobanski,
2006]; [Jacob et al., 2007]

This review describes the common ADHD comorbidities and how their symptoms
overlap with ADHD [Canadian ADHD Practice Guidelines]

If a patient is suspected of having ADHD, then during a medical review, the
clinician should determine whether other medical and psychiatric disorders could
mimic the symptoms of ADHD.

In some cases, ADHD may co-exist with another psychiatric comorbidity that
influences the diagnosis and management.

You can go to the  following links for a refresher on ADHD:

 1. Diagnosis and Management of ADHD
 2. Diagnosis of ADHD in Females
 3. Clinical Evaluation of ADHD (Video)

GENERAL PRINCIPLES IN MANAGEMENT OF ADHD COMORBIDITIES


Click here to zoom image

1. BEHAVIOURAL PROBLEMS


Oppositional defiant disorder (ODD)

 * ODD is the most common comorbid disorder in children that can persist into
   adulthood. ODD is characterised by wilfully oppositional or defiant
   behaviours, i.e. deliberately refusing to comply with the rules and
   exhibiting spiteful and vindictive characteristics towards others. [Canadian
   ADHD Practice Guidelines]
 * ODD symptoms that overlap with ADHD include reactive, irritable, and
   aggressive symptoms; however, according to the DSM-5, mood-related,
   provocative or vindictive symptom clusters can differentiate ODD from ADHD.
 * The combination is associated with greater symptom severity, daily
   impairment, and a more at-risk prognosis than either disorder alone.
 * As the symptoms of ADHD can progress to ODD, ADHD treatment should be
   optimised to prevent the reactive and irritable dimensions of ODD from
   developing later. [Harvey et al., 2016]

Management of ADHD and ODD: 

 * Address core symptoms of ADHD and augmentation with other treatments to
   address the ODD.
 * Psychostimulants, alpha-2 agonists, and atomoxetine can be beneficial for
   disruptive and aggressive behaviours in addition to core ADHD symptoms;
   however, psychostimulants generally provide the most benefit. [Pringsheim et
   al., 2015]
 * Methylphenidate has the best evidence, followed by atomoxetine, guanfacine SR
   and clonidine for ADHD with behaviour problems. [Ghosh et al., 2017]
 * Psychosocial management via parental management training, functional family
   therapy, cognitive behaviour therapy either in individual or group format are
   treatment approaches that can be used with pharmacotherapy options. [Ghosh et
   al., 2017]

Mild:

 * May respond to behaviour management alone
 * Monotherapy with stimulant medication or atomoxetine.

Moderate to severe:

 * Combination pharmacotherapy (e.g. stimulant and clonidine) and behaviour
   management.

Severe or refractory cases

 * May require the introduction of an atypical antipsychotic such as
   risperidone. [Hazell, 2010]

Conduct disorder/aggression (CD)

 * CD is often preceded by ODD but is characterised as a more severe and
   persistent form of ODD whereby the patient exhibits higher levels of
   callousness and cruelty and an absence of remorse or empathy towards others.
   [Harpold et al., 2007]
 * It is characterised by symptoms of aggression toward people or animals,
   destruction of property, deceitfulness or theft, and serious violations of
   rules.
 * Aggressive behaviour, lying, stealing, fire-setting, and running away from
   home and school are the most frequent manifestations of CD. They are often
   accompanied by hyperactivity, impulsive behaviour, explosiveness, cognitive
   and learning problems, and poor social skills.
 * Moreover, patients with CD are more than likely to develop antisocial
   personality disorder in adulthood and substance abuse disorders and
   depression. [Barkley et al., 2004]

Management of Comorbid Conduct Disorder and ADHD: 

 * The most effective approach to treatment requires a multimodal strategy that
   incorporates stimulant/non-stimulant pharmacotherapies in conjunction with
   individual and family psychosocial interventions. [Canadian ADHD Practice
   Guidelines]
 * Psychostimulants are highly recommended. [Lillig, 2018]
 * Other drugs that may be useful include atomoxetine antidepressants
   (imipramine, desipramine, Selective Serotonin Reuptake Inhibitors (SSRIs),
   atypical antipsychotics such as risperidone, or mood stabilisers including
   lithium.  [Turgay, 2005]
 * Risperidone may benefit patients with conduct disorder who have severe
   aggression or explosive anger after comorbid ADHD is treated.
 * Some ADHD medications could increase irritability and aggressive symptoms;
   hence monitoring is needed.

2. PERSONALITY DISORDERS


Antisocial personality disorder (ASPD)

 * ASPD symptoms are characterised by deceitfulness and disrespectful,
   manipulative or reckless behaviour without regard for oneself or others. The
   patient is often irritable and aggressive with confrontation and physical
   fights, a persistent and repeated characteristic.[Canadian ADHD Practice
   Guidelines]
 * Patients with CD are more likely to develop ASPD; however, patients with ADHD
   are unlikely to develop ASPD. [Storebø and Simonsen, 2013]
 * Therefore, the development of ASPD with ADHD is a complex issue that may
   require specialised interventions.
 * Interventions include stimulants; however, ASPD is often associated with
   drug-seeking behaviours, and therefore clinicians should be wary of
   considering these treatments. [Biederman et al., 1995]
 * The provision of non-stimulant therapies has not been adequately researched
   at present.

Borderline personality disorder (BPD)

 * ADHD and BPD are common comorbid disorders with a lifetime prevalence of 34%
   in ADHD patients. [Dowson et al., 2004]
 * ADHD and BPD also share similar core symptoms, including impulsivity, mood
   lability, and emotional dysregulation.

The relationship between ADHD and BPD is multifaceted. [Storebø et al, 2014],
[Ditrich et al, 2021]

 * ADHD may be an early developmental stage of BPD
 * The same genes lead to two distinct disorders (genetic pleiotropy)
 * BPD and ADHD are overlapping, e.g. they are different presentations of the
   same underlying disorder
 * ADHD is associated with a higher risk of developing BPD.
 * They may be separate disorders co-occurring.

To distinguish patients with BPD from those with ADHD, BPD patients have rapid
changes to self-identity and self-image and an elevated risk of heightened
rejection sensitivity, suicidal threats, self-injury, depression, and anxiety.
[Canadian ADHD Practice Guidelines]

Management of ADHD and BPD: 

 * Psychotherapy is the primary treatment option for BPD, with dialectical
   behavioural therapy the most common. [van den Bosch et al., 2005]
 * Medications that target specific core symptoms such as impulsivity, which
   both ADHD and BPD share, are helpful.
 * Treatment of ADHD should always be considered when treating comorbid
   personality disorders as patients are more likely to engage and benefit from
   psychological treatment programs for BPD when comorbid ADHD is treated.
   [Asherson et al., 2014]
 * Systematic reviews and meta-analyses have shown Methylphenidate (MPH) as
   beneficial in treating emotional dysregulation in adult ADHD alone.
 * BPD-ADHD patients receiving MPH treatment showed a significantly improved
   response to DBT treatment for Trait-State Anger scores, motor impulsiveness,
   depression severity, and ADHD severity compared with those without stimulant
   medication. [Prada et al., 2015]
 * MPH may improve decision making in patients with BPD by addressing ADHD
   symptomatology. [Gvirts et al., 2018]

3. ADDICTION


Substance use disorder (SUD)

 * Substance abuse is a significant risk factor in patients with ADHD, and vice
   versa, with 50% of patients with SUD also diagnosed with ADHD. [Wilens et
   al., 2005]; [Molina et al., 2007]
 * Patients with ADHD-SUD comorbidity show more complex and chronic patterns of
   substance use, including more polysubstance use, than adults with SUD without
   comorbid ADHD and, have more difficulties remaining abstinent and report a
   reduced quality of life. [Crunelle et al., 2018]
 * They have more significant psychiatric comorbidity, such as antisocial
   personality disorder, borderline personality disorder, anxiety disorders,
   bipolar disorders and/or post-traumatic stress disorders.
 * The Conners’ Adult ADHD, Diagnostic Interview for the DSM-IV (CAADID) is
   often used as the gold standard for diagnosing adult ADHD in patients with
   SUD.

Management of Comorbid SUD and ADHD: 

 * Management should integrate the treatment of ADHD and SUD due to the
   bi-directional relationship between ADHD and SUD.
 * First start SUD treatment, followed by ADHD treatment as soon as possible
   after that.
 * Combined pharmacotherapy and psychotherapy is efficacious.
 * In SUD patients, treatment of ADHD can be helpful to reduce ADHD symptoms
   without worsening the SUD and should not be avoided.
 * From a pharmacological perspective, standard-dose pharmacotherapy for
   treating ADHD in patients with ADHD-SUD comorbidity shows lower efficacy and
   higher doses may be needed if patients do not respond. Higher doses, however,
   require close monitoring. [Crunelle et al., 2018]
 * Long-term drug use may down-regulate brain dopamine systems in chronic
   drug-dependent individuals necessitating higher stimulant doses.
 * At the same time, ADHD pharmacotherapy on its own is generally not effective
   in reducing substance use and is associated with a higher frequency of
   adverse effects and treatment discontinuation.
 * Although psychostimulants are prescribed, the potential abuse requires
   careful monitoring during follow-up.
 * Long-acting formulations, osmotic-release oral system formulations of
   methylphenidate (OROS-MPH) and lisdexamphetamine, have lower misuse and
   diversion rates than immediate-release preparations.
 * Stimulant treatment for ADHD does not precipitate the onset of SUD in adults
   without previous SUD.
 * Patients treated with MPH have better retention rates in treatment, and
   higher doses of MPH are also associated with more significant long term
   treatment adherence.

Alcohol Use Disorder and ADHD:

 * Atomoxetine is associated with reducing ADHD symptoms and decreasing alcohol
   craving and consumption.
 * In comorbid alcohol use disorder, Atomoxetine can also be used with
   naltrexone, nalmefene, acamprosate or topiramate. [Crunelle et al., 2018]

Stimulant Use Disorder (Cocaine, amphetamines) and ADHD:  

 * Higher doses of MPH (up to 180 mg/day) have shown a decrease in ADHD symptoms
   and the reinforcing effects and the use of cocaine and amphetamines (and
   other drugs) in adult stimulant-dependent ADHD patients. [Konstenius et al.,
   2014]
 * Extended-release mixed amphetamine (60 and 80 mg/day) with CBT showed
   substantial reductions in both ADHD and drug use in cocaine-dependent
   patients with ADHD. [Levin et al., 2015 ]
 * Psychotherapeutic options for this population has not been extensively
   studied.
 * Integrated CBT (iCBT) addressing ADHD and SUD resulted in significant extra
   improvement in ADHD symptoms in SUD + ADHD patients. [van Emmerik-van
   Oortmerssen et al., 2019]
 * Other options are individual coaching, structured skills training, dialectic
   behavioural therapy, and mindfulness-based therapy.

4. EATING DISORDERS


Eating Disorders (EDs)

 * The prevalence of ADHD in EDs ranges between 1.6% and 18%. Comorbid ADHD was
   more often reported in the AN-binge eating/purging subtype and BN than in the
   AN restrictive subtype. ADHD is also closely associated with Binge Eating
   Disorder (BED) with overlapping clinical (impulsivity) and neurobiological
   correlates. [Nickel et al., 2019]
 * Females with ADHD are 3.6x more likely to develop an eating disorder than
   females without ADHD. [Canadian ADHD Practice Guidelines] Eating disorders
   such as bulimia nervosa and anorexia nervosa (purging subtype) are the most
   commonly diagnosed.
 * ADHD and EDs may share common neurobiological mechanisms with dopamine
   dysregulation in frontostriatal areas underpinning both disorders. [Levin et
   al.,2016] 
 * ADHD is also a risk factor for obesity unless the patient has compensatory
   behaviours such as excessive exercise, purging, fasting, or misuse of
   laxatives, diet pills or other medications. [Cortese et al., 2016]
 * ADHD symptoms are inversely correlated with recovery in ED. [Svedlund et al.,
   2018]
 * Lisdexamfetamine (LDX) is FDA approved to treat moderate to severe Binge
   Eating disorder (BED) in adults.
 * Clinicians also need to be aware that some patients may feign ADHD to acquire
   stimulant medications to aid their weight loss. [Canadian ADHD Practice
   Guidelines]

5. ANXIETY AND AFFECTIVE DISORDERS


Anxiety disorder

 * Individuals with ADHD have higher rates of anxiety (up to 50%) than the
   general population. [Katzman et al., 2017]
 * Patients with ADHD are often forgetful, which can cause excessive
   over-compensatory mechanisms (e.g. checking and rechecking) that can induce a
   state of anxiety about forgetting something important. [Canadian ADHD
   Practice Guidelines]. This can give the impression of a primary anxiety
   disorder.
 * In childhood, the presence of generalised anxiety disorder (GAD) could
   prevent the typical inhibitory dysfunction present in ADHD. In adolescence it
   may increase the deficit of working memory. In adulthood it may enhance the
   presence of sleep problems.
 * Individuals with anxiety disorders who have comorbid ADHD tend to have more
   severe anxiety symptoms, earlier age of onset of anxiety, and more frequent
   additional comorbid psychiatric diagnoses and substance use than those who do
   not have ADHD. [Katzman et al., 2017]
 * The combination of ADHD and anxiety is associated with a very high risk of
   bipolar disorder. [Meier et al., 2018]
 * However, some signs and symptoms are distinct to ADHD that differentiate from
   anxiety. For example, ADHD symptoms such as inattention and restlessness
   occur in the absence of an emotional state, unlike what that with an anxiety
   disorder. Patients with anxiety will also exhibit physical symptoms such as
   elevated heart rate, nausea, and shortness of breath, all of which are
   usually absent in patients with ADHD. [Canadian ADHD Practice Guidelines]

Management of Anxiety and ADHD:

 * Treatment of anxiety and ADHD requires a strategy that treats the most
   impairing condition.
 * Individuals with comorbid ADHD and anxiety disorders would benefit from
   adjunctive psychosocial or adjunctive pharmacotherapy interventions to
   cognitive behavioural treatment. [D’Agati et al., 2019]
 * Individuals with ADHD can experience distress and state anxiety during
   cognitive tasks. MPH can reduce state anxiety and improve cognitive
   performance. [Bloch et al., 2017]
 * Psychostimulants can also increase anxiety and should be titrated upward
   slowly until symptoms are stabilised.
 * Some studies that evaluated MPH in anxiety showed that patients could respond
   less well and get more unpleasant arousal side-effects.
 * Low dose aripiprazole treatment in adolescents and adults may also provide
   benefits. [D’Agati et al., 2019]

Management of Anxiety and ADHD in children. 

 * Treating ADHD with stimulants can lead to improvement in ADHD-related anxiety
   symptoms.
 * Treating anxiety can reduce anxiety-related attentional problems and
   executive functioning.
 * Atomoxetine and alpha agonists may be suitable treatments that address both
   ADHD and anxiety.
 * Behavioural treatment should be part of the plan for ADHD co-occurring with
   anxiety disorders. [Janiczak et al.,2020] 

Major depressive disorder (MDD)

 * Patients with ADHD are at an increased risk of developing MDD with ADHD-MDD
   comorbidity, also increasing illness severity and functional impairments.
   [Miller et al., 2007]
 * Loss of motivation, restlessness, and irritability are common symptoms of
   both MDD and ADHD; however, feelings of sadness, hopelessness, tiredness and
   suicide indicate MDD rather than ADHD.
 * A clinician is encouraged to ask “since when?” if MDD-specific symptoms are
   reported. [Canadian ADHD Practice Guidelines]

ADHD and Comorbid MDD in children: 

True comorbid MDD is differentiated by :

 * Depressive cognitions (e.g., guilt, worthlessness, hopelessness, morbid or
   suicidal thoughts)
 * Severe anhedonia
 * Psychomotor retardation.

Symptoms such as irritability, poor concentration, anergia, sleep problems, and
psychomotor or appetite changes have overlap with ADHD and other frequent
comorbidities. They may be associated with the side effects of ADHD medications.
[Daviss, 2016]

Management of ADHD and Comorbid MDD.

 * Treat the most severe or functionally impairing condition first. [Daviss,
   2016].[McIntosh et al., 2009]

Click here to zoom image

If Depression more severe:

 * If moderate-severe MDD is the most pressing clinical issue, then treatment
   for Depression should be initiated first. [McIntosh et al., 2009]
 * Option to add a stimulant if the depressive but not the ADHD symptoms respond
   to the antidepressant. [Daviss, 2016]
 * Once the Depression has improved, the patient should be re-evaluated for
   symptoms of ADHD, and if necessary, treatment for ADHD should be initiated.
 * If the patient does not respond adequately to antidepressant medication,
   consideration should be given to re-evaluating both the Depression and ADHD
   diagnosis and, if appropriate, initiating ADHD treatment.
 * Consider concomitant psychotherapy.

If ADHD is the primary condition

 * Treat ADHD first with long-acting psychostimulant as first-line treatment
 * Atomoxetine and bupropion are indicated if a stimulant trial is
   contraindicated or has failed, or when a non-stimulant is preferred
 * Reassess if depressive symptoms are present and if AD is required.
 * Antidepressants may not always be needed.
 * Consider concomitant psychotherapy.

Management of ADHD and Comorbid MDD in Children and adolescents: [Turgay et al.,
2006]

ADHD symptoms more prominent: 

 * Treatment with psychostimulants for at least two weeks
 * If depressive symptoms do not improve, add SSRI.
 * Continue stimulant medication if the ADHD and depressive symptoms improve.
 * If the ADHD and/or depressive symptoms worsen, the stimulant should be
   discontinued.
 * Combining SSRI with psychostimulants can be considered when the risk of
   suicide and/or serious self-injurious behaviour is high. [Hughes et al.,
   1999]
 * Atomoxetine is also effective in treating ADHD in pediatric patients with
   ADHD and comorbid symptoms of depression or anxiety.

Depressive symptoms more prominent: 

 * Start with AD
 * If no response, switch to a different class of antidepressants.
 * Add psychostimulants if depressive symptoms improve with antidepressants, but
   ADHD symptoms do not respond.
 * Bupropion is a recommended antidepressant as it addresses both symptoms of
   Depression and ADHD.

Important Tips in Management

 * Antidepressants such as SSRIs can be combined with stimulant or non-stimulant
   medications for ADHD.
 * However, fluoxetine and paroxetine are potent inhibitors of the CYP450/2D6
   liver isoenzyme, and caution is advised when co-administering amphetamines or
   atomoxetine for ADHD as they can increase levels.
 * Children and adolescents, and patients should be monitored for indicators of
   potential suicidal ideation

Bipolar disorder (BD): 

 * ADHD often co-occurs with BD and BPD, characterised by symptoms that overlap
   with ADHD. [Asherson et al., 2014]
 * Approximately 20% of patients with BD or BPD will have comorbid ADHD, with
   research suggesting that this is true comorbidity that goes beyond the
   complexity of just symptom overlap. [Milberger et al., 1995]

The following table can help differentiate ADHD from Bipolar disorder:

Click here to zoom image

Management of ADHD and Comorbid Bipolar Disorder: 

 * The first goal of ADHD–BD treatment is mood stabilisation. In some cases,
   after mood is stabilised, some ADHD/BD patients may not fulfil diagnostic
   criteria for ADHD. [Salvi et al., 2021]
 * In patients who complain of residual cognitive symptoms, clinicians can add
   ADHD medications such as MPH, atomoxetine or amphetamine salts.
 * The use of stimulants in BPAD has been controversial, with the main concern
   being the risk of mania.
 * A large study of 145000 children with ADHD showed that MPH treatment for more
   than one year reduced the risk of new-onset BPAD compared to those not
   treated. [Wang et al., 2016]
 * Another study found no evidence for a positive association between MPH and
   treatment-emergent mania among those on concomitant mood stabilisers.
   However, those treated with MPH alone had a 6.7-times increased risk of manic
   episodes within three months of medication initiation. [Viktorin et al.,
   2017]
 * Lisdexamfetamine also showed benefits on ADHD and depressive symptoms in a
   4-week trial in adults with bipolar I/II disorder without inducing any
   treatment-emergent hypomanic or manic episode. [McIntyre et al., 2013]
 * Lisdexamphetamine is also evidence-based as an add on treatment in the
   treatment of treatment-resistant Bipolar Depression. [McElroy et al., 2015]
 * Bupropion SR may also be effective in ADHD/BD comorbidity without significant
   activation of mania. [Wilens et al., 2003]
 * Atomoxetine has been associated with mania and hypomania or mood
   dysregulation or irritability in 33% of children with ADHD. Atomoxetine
   carries the risk of induction of (hypo) mania even in stabilised patients
   with BD. Caution is therefore warranted when using atomoxetine in ADHD/BD
   comorbidity. [Kumar et al., 2017]
 * Alpha-2 agonists, such as clonidine and guanfacine, are useful agents in ADHD
   / BD comorbidity. Clonidine is also effective in the treatment of manic
   episodes. [Girard et al., 2017]

Disruptive mood dysregulation (DMDD)

 * DMDD is characterised by chronic and severe irritability with frequent
   out-of-proportion outbursts of temper. [Canadian ADHD Practice Guidelines]
 * There are many differential diagnoses, including BD, ODD, ADHD, and CD
   [Axelson et al., 2012]; however, patients with DMDD have an inter-episode
   mood that is still characterised as irritable/dysphoric. [Leibenluft et al.,
   2006]
 * DMDD is a relatively new DSM-5 diagnosis, and therefore only approximate
   pharmacological and psychosocial treatments can be recommended.
 * MPH treatment significantly improved mood and emotional symptoms associated
   with DMDD comorbid with ADHD. [Winters et al., 2018 ]

6. COMPULSIVE DISORDERS


Obsessive-compulsive disorder (OCD)

 * ADHD and OCD are both developmental disorders, and the comorbidity between
   these diagnoses are common despite inconsistent prevalence reports and their
   directly opposing neurobiology and clinical features. [Abramovitch et al.,
   2015]
 * For example, impulsivity and disinhibition are core symptoms of ADHD (which
   can be treated with stimulants). In contrast, obsessiveness and compulsivity
   are the core symptoms of OCD (which can be treated with SSRIs and
   neuroleptics).

> There has been increasing awareness of the cross-cutting nature of the symptom
> domains of impulsivity and compulsivity.  Impulsivity is characterised by an
> inability to resist impulses and urges, delaying gratification deficits,
> unreflective decision making and premature behaviour.  Compulsivity is
> characterised by perseverative and repetitive action and is ruminative and
> ridged in nature.  There is an overlap between the two conditions with
> features such as impulsivity observed in both groups but at markedly levels in
> those with ADHD.  A degree of frontostriatal hyperactivity or hypoactivity
> also appears to underpin symptoms in both OCD and ADHD. [Cabarkapa et al.,
> 2019]

Management of ADHD and Comorbid OCD: 

 * Treating OCD with SSRIs and cognitive behaviour therapy with exposure
   response prevention (CBT+ERP) improves attentional symptoms.
 * Treating ADHD with stimulants improves comorbid obsessive-compulsive
   symptoms.
 * Untreated comorbid ADHD diminishes treatment response on the OCD
 * Clinicians can start with SSRIs for OCD and psychostimulants such as
   methylphenidate and dexamphetamine for ADHD.
 * Medication should be introduced one at a time to assess response and improve
   tolerability. In addition, clinicians should be aware of the possibility of
   worsening OC symptoms with stimulants.
 * TMS is also an effective option for treating comorbid ADHD and OCD [Cabarkapa
   et al., 2019] 

Tourette’s syndrome

 * In a cohort study of Tourette syndrome patients, there were four subtypes
   identified: ‘pure’ Tourette syndrome (49.8%), Tourette syndrome and ADHD
   (22.2%), Tourette syndrome and OCD (21.5%), and Tourette syndrome, ADHD and
   OCD (6.5%). Rizzo et al., 2013]
 * Tourette syndrome and Tourette syndrome with comorbid ADHD are distinct from
   both a neurobiologically perspective and a neurobehaviourally perspective.
   For instance, patients with Tourette syndrome have prolonged prosaccade
   latencies, whereas patients with ADHD have impaired antisaccade accuracy.
   However, there are overlaps, including emotional lability.

Management of ADHD and Comorbid Tourette’s Syndrome 

 * Start with a non-stimulant agent such as guanfacine (long-acting preparations
   may be preferred) or clonidine as they effectively alleviate both symptoms of
   TS and ADHD. Rizzo et al., 2013]
 * If the TS is not severe, but the ADHD is disabling, one should consider
   treating the ADHD with a stimulant. Monitor for worsening tics with a
   reliable TS rating scale, such as The Yale Global Tic Severity Scale (YGTSS).
   Oluwabusi et al., 2016]
 * According to the Tourette’s Syndrome Study Group, the combination of
   methylphenidate and clonidine is effective for ADHD in children with comorbid
   tics. Prior recommendations to avoid methylphenidate because of concerns of
   worsening tics are unsupported [Tourette’s Syndrome Study Group, 2002]
 * Atomoxetine and Aripiprazole are useful in some cases. [Rizzo et al., 2013]

7. DEVELOPMENTAL DISORDERS


Autism spectrum disorder (ASD)

 * ASD was an exclusion criterion in the DSM-IV for ADHD; however, in the DSM-V,
   there is the possibility of a dual diagnosis. Analysis of the prevalence of
   ASD co-occurring with ADHD varies from 37% to 85%. [Gadow et al., 2006]; [Lee
   and Ousleey, 2006]
 * ASD is characterised by social dysfunction and restrictive-repetitive
   behaviours, although these psychosocial issues can be exacerbated by comorbid
   ADHD. Both ADHD and ASD include a spectrum of difficulties associated with
   attention, communication, impulsivity, restlessness, and/or hyperactivity.
 * Risperidone and aripiprazole are approved for the treatment of ASD, and both
   drugs effectively reduce irritability. Methylphenidate and atomoxetine are
   commonly administered for ADHD-related symptoms. However, there may only be
   an improvement in symptoms such as hyperactivity and impulsivity, which may
   not be associated with the patient’s ASD diagnosis. [Arnold et al., 2006];
   [Arnold et al., 2012]
 * ADHD and ASD are thought to be associated with (or defined by) executive
   dysfunction, although the specific executive domains that are negatively
   impacted may differ. For example, children with ASD have more planning, and
   cognitive flexibility difficulties and children with ADHD have more
   inhibition difficulties.
 * Atomoxetine and methylphenidate show evidence for treating ADHD symptoms
   within individuals with ASD. However, effect sizes from the ASD population
   are somewhat smaller than the non-ASD population, and side effects are more
   common in the ASD population. [Antshel et al., 2013]

SUMMARY


ADHD is associated with a high degree of comorbidity across the lifespan.

Comorbidities may make the diagnosis of ADHD challenging, and as a result, may
delay diagnosis for some patients.



Comorbidities also confound treatment and may require other therapies beyond
treatments for ADHD.  The presence of comorbidities is not a contraindication
for the use of stimulants, even in conditions such as anxiety, SUD and Bipolar
disorder.

In general, the more severe disorder should be addressed first.

Treating ADHD and comorbidities tends to have better outcomes than treating
either disorder alone.


REFERENCES

The prevalence and correlates of adult ADHD in the United States: Results from
the National Comorbidity Survey Replication
Kessler R et al., The prevalence and correlates of adult ADHD in the United
States: results from the National Comorbidity Survey Replication. Am J
Psychiatry. 2006;163(4):716-723.
Psychiatric comorbidity in adults with attention-deficit/hyperactivity disorder
(ADHD)
Sobanski E. Psychiatric comorbidity in adults with attention-deficit/
hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci. 2006;256(1
Suppl 1):i26–i31.
Co-morbidity of adult attention-deficit/hyperactivity disorder with focus on
personality traits and related disorders in a tertiary referral center
Jacob C, et al. Co-morbidity of adult attention-deficit/hyperactivity disorder
with focus on personality traits and related disorders in a tertiary referral
center. Eur Arch Psychiatry Clin Neurosci. 2007;257:309–317. 
Canadian ADHD Practice Guidelines
Canadian ADHD Practice Guidelines, 4th edition. 
Early development of comorbidity between symptoms of
attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant
disorder (ODD)

Harvey E et al., Early development of comorbidity between symptoms of
attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant
disorder (ODD). J Abnorm Psychol. 2016;125(2):154-167.

The pharmacological management of oppositional behaviour, conduct problems, and
aggression in children and adolescents with attention-deficit hyperactivity
disorder, oppositional defiant disorder, and conduct disorder: a systematic
review and meta-analysis. Part 1: psychostimulants, alpha-2 agonists, and
atomoxetine

Pringsheim, T., Hirsch, L., Gardner, D., & Gorman, D. A. (2015). The
pharmacological management of oppositional behaviour, conduct problems, and
aggression in children and adolescents with attention-deficit hyperactivity
disorder, oppositional defiant disorder, and conduct disorder: a systematic
review and meta-analysis. Part 1: psychostimulants, alpha-2 agonists, and
atomoxetine. Canadian journal of psychiatry. Revue canadienne de
psychiatrie, 60(2), 42–51. 

Oppositional defiant disorder: current insight
Ghosh A et al., Oppositional defiant disorder: current insight. Psychol Res
Behav Manag. 2017;10:353–367. 
Review of attention-deficit/hyperactivity disorder comorbid with oppositional
defiant disorder

Hazell P. Review of attention-deficit/hyperactivity disorder comorbid with
oppositional defiant disorder. Australas Psychiatry. 2010 Dec;18(6):556-9.

Is oppositional defiant disorder a meaningful diagnosis in adults? Results from
a large sample of adults with ADHD
Harpold T et al., Is oppositional defiant disorder a meaningful diagnosis in
adults? Results from a large sample of adults with ADHD. J Nerv Ment Dis.
2007;195(7):601-605. 
Young adult follow-up of hyperactive children: antisocial activities and drug
use

Barkley R et al., Young adult follow-up of hyperactive children: antisocial
activities and drug use. J Child Psychol Psychiatry, 2004;45(2):195-211.

Conduct disorder: recognition and management

[Lillig, M. (2018). Conduct disorder: recognition and management. American
family physician, 98(10), 584-592.]

Treatment of comorbidity in conduct disorder with attention-deficit
hyperactivity disorder (ADHD)

Turgay A. Treatment of comorbidity in conduct disorder with attention-deficit
hyperactivity disorder (ADHD). Essent Psychopharmacol. 2005;6(5):277-90.

The Association Between ADHD and Antisocial Personality Disorder (ASPD): A
Review

Storebø O and Simonsen E. The association between ADHD and antisocial
personality disorder (ASPD): a review. J Attention Disord. 2013;20(10):815-824.

Psychoactive substance use disorders in adults with attention deficit
hyperactivity disorder (ADHD): effects of ADHD and psychiatric comorbidity
Biederman J et al., Psychoactive substance use disorders in adults with
attention deficit hyperactivity disorder (ADHD): effects of ADHD and psychiatric
comorbidity. Am J Psychiatry. 1995;152(11):1652-1658. 
Impulsivity in patients with borderline personality disorder
Dowson, J., et al., Impulsivity in patients with borderline personality
disorder. Compr Psychiatry. 2004;45(1):29-36. 
Is ADHD an early stage in the development of borderline personality disorder?

Storebø OJ, Simonsen E. Is ADHD an early stage in the development of borderline
personality disorder? Nord J Psychiatry. 2014 Jul;68(5):289-95.

Borderline personality disorder (BPD) and attention deficit hyperactivity
disorder (ADHD) revisited - a review-update on common grounds and subtle
distinctions.

Ditrich, I., Philipsen, A., & Matthies, S. (2021). Borderline personality
disorder (BPD) and attention deficit hyperactivity disorder (ADHD) revisited – a
review-update on common grounds and subtle distinctions. Borderline personality
disorder and emotion dysregulation, 8(1), 22.

Sustained efficacy of dialectical behaviour therapy for borderline personality
disorder

van den Bosch, L.M., et al., Sustained efficacy of dialectical behaviour therapy
for borderline personality disorder. Behav Res Ther 2005;43(9):1231-1241.

Differential diagnosis, comorbidity, and treatment of
attention-deficit/hyperactivity disorder in relation to bipolar disorder or
borderline personality disorder in adults.

Asherson P, Young AH, Eich-Höchli D, Moran P, Porsdal V, Deberdt W. Differential
diagnosis, comorbidity, and treatment of attention-deficit/hyperactivity
disorder in relation to bipolar disorder or borderline personality disorder in
adults. Curr Med Res Opin. 2014 Aug;30(8):1657-72

Addition of methylphenidate to intensive dialectical behaviour therapy for
patients suffering from comorbid borderline personality disorder and ADHD: a
naturalistic study

Prada P, Nicastro R, Zimmermann J, Hasler R, Aubry JM, Perroud N. Addition of
methylphenidate to intensive dialectical behaviour therapy for patients
suffering from comorbid borderline personality disorder and ADHD: a naturalistic
study. Atten Defic Hyperact Disord. 2015

The effect of methylphenidate on decision making in patients with borderline
personality disorder and attention-deficit/hyperactivity disorder.

Gvirts HZ, Lewis YD, Dvora S, Feffer K, Nitzan U, Carmel Z, Levkovitz Y, Maoz H.
The effect of methylphenidate on decision making in patients with borderline
personality disorder and attention-deficit/hyperactivity disorder. Int Clin
Psychopharmacol. 2018 Jul;33(4):233-237.

Characteristics of adults with attention deficit hyperactivity disorder plus
substance use disorder: the role of psychiatric comorbidity

Wilens, T.E., et al., Characteristics of adults with attention deficit
hyperactivity disorder plus substance use disorder: the role of psychiatric
comorbidity. Am J Addiction. 2005; 14(4):319-327.

Attention-deficit/hyperactivity disorder risk for heavy drinking and alcohol use
disorder is age specific

Molina BS et al., Attention-deficit/hyperactivity disorder risk for heavy
drinking and alcohol use disorder is age specific. Alcohol Clin Exp Res.
2007;31(4):643-654.

International consensus statement on screening, diagnosis and treatment of
substance use disorder patients with comorbid attention deficit/hyperactivity
disorder.

Crunelle, C. L., van den Brink, W., Moggi, F., Konstenius, M., Franck, J.,
Levin, F. R., … & Matthys, F. (2018). International consensus statement on
screening, diagnosis and treatment of substance use disorder patients with
comorbid attention deficit/hyperactivity disorder. European addiction
research, 24(1), 43-51.

Extended-Release Mixed Amphetamine Salts vs Placebo for Comorbid Adult
Attention-Deficit/Hyperactivity Disorder and Cocaine Use Disorder: A Randomized
Clinical Trial

Levin, F. R., Mariani, J. J., Specker, S., Mooney, M., Mahony, A., Brooks, D.
J., Babb, D., Bai, Y., Eberly, L. E., Nunes, E. V., & Grabowski, J. (2015).
Extended-Release Mixed Amphetamine Salts vs Placebo for Comorbid Adult
Attention-Deficit/Hyperactivity Disorder and Cocaine Use Disorder: A Randomized
Clinical Trial. JAMA psychiatry, 72(6), 593–602.

Integrated cognitive behavioral therapy for ADHD in adult substance use disorder
patients: Results of a randomized clinical trial.

van Emmerik-van Oortmerssen K, Vedel E, Kramer FJ, Blankers M, Dekker JJM, van
den Brink W, Schoevers RA. Integrated cognitive behavioral therapy for ADHD in
adult substance use disorder patients: Results of a randomized clinical trial.
Drug Alcohol Depend. 2019 Apr 1;197:28-36

Systematic review: overlap between eating, autism spectrum, and
attention-deficit/hyperactivity disorder

Nickel, K., Maier, S., Endres, D., Joos, A., Maier, V., Tebartz van Elst, L., &
Zeeck, A. (2019). Systematic review: overlap between eating, autism spectrum,
and attention-deficit/hyperactivity disorder. Frontiers in psychiatry, 10, 708.

Methylphenidate for attention deficit hyperactivity disorder and drug relapse in
criminal offenders with substance dependence: a 24-week randomized
placebo-controlled trial

Konstenius, M., Jayaram-Lindström, N., Guterstam, J., Beck, O., Philips, B., &
Franck, J. (2014). Methylphenidate for attention deficit hyperactivity disorder
and drug relapse in criminal offenders with substance dependence: a 24-week
randomized placebo-controlled trial. Addiction (Abingdon, England), 109(3),
440–449.

Attention-deficit/hyperactivity disorder and eating disorders across the
lifespan: a systematic review of the literature.

Levin, R. L., & Rawana, J. S. (2016). Attention-deficit/hyperactivity disorder
and eating disorders across the lifespan: a systematic review of the literature.
Clinical psychology review, 50, 22-36.

Association Between ADHD and Obesity: A Systematic Review and Meta-Analysis

Cortese S et al., Association between ADHD and obesity: a systematic review and
meta-analysis. Am J Psychiatry. 2016;173(1):34-43.

Are treatment results for eating disorders affected by ADHD symptoms? A one-year
follow-up of adult females.

Svedlund NE, Norring C, Ginsberg Y, von Hausswolff-Juhlin Y. Are treatment
results for eating disorders affected by ADHD symptoms? A one-year follow-up of
adult females. Eur Eat Disord Rev. 2018 Jul;26(4):337-345. 

Adult ADHD and comorbid disorders: clinical implications of a dimensional
approach.

Katzman, M.A., Bilkey, T.S., Chokka, P.R. et al. Adult ADHD and comorbid
disorders: clinical implications of a dimensional approach. BMC
Psychiatry 17, 302 (2017).

Attention-deficit hyperactivity disorder and anxiety disorders as precursors of
bipolar disorder onset in adulthood.

Meier SM, Pavlova B, Dalsgaard S, Nordentoft M, Mors O, Mortensen PB, Uher R.
Attention-deficit hyperactivity disorder and anxiety disorders as precursors of
bipolar disorder onset in adulthood. Br J Psychiatry. 2018 Sep;213(3):555-560.]

Comorbidity between ADHD and anxiety disorders across the lifespan.

D’Agati, E., Curatolo, P., & Mazzone, L. (2019). Comorbidity between ADHD and
anxiety disorders across the lifespan. International journal of psychiatry in
clinical practice, 23(4), 238-244.

Methylphenidate Reduces State Anxiety During a Continuous Performance Test That
Distinguishes Adult ADHD Patients From Controls

Bloch Y, Aviram S, Segev A, Nitzan U, Levkovitz Y, Braw Y, Mimouni Bloch A.
Methylphenidate Reduces State Anxiety During a Continuous Performance Test That
Distinguishes Adult ADHD Patients From Controls. J Atten Disord. 2017
Jan;21(1):46-51.

Diagnosis and Management of Comorbid Anxiety and ADHD in Pediatric Primary Care.

Janiczak D, Perez-Reisler M, Ballard R. Diagnosis and Management of Comorbid
Anxiety and ADHD in Pediatric Primary Care. Pediatr Ann. 2020 Oct
1;49(10):e436-e439.

Axis I and II comorbidity in adults with ADHD

Miller T et al., Axis I and II comorbidity in adults with ADHD. J Abnorm
Psychol. 2007; 116(3):519-28. 

Comorbid ADHD and depression: assessment and treatment strategies

Daviss, W. B., & Bond, J. B. (2016). Comorbid ADHD and depression: assessment
and treatment strategies. Psychiatr Times, 33(9).

Adult ADHD and comorbid depression: A consensus-derived diagnostic algorithm for
ADHD.

McIntosh, D., Kutcher, S., Binder, C., Levitt, A., Fallu, A., & Rosenbluth, M.
(2009). Adult ADHD and comorbid depression: A consensus-derived diagnostic
algorithm for ADHD. Neuropsychiatric disease and treatment, 5, 137–150.

Major Depression with ADHD: In Children and Adolescents

Turgay, A., & Ansari, R. (2006). Major Depression with ADHD: In Children and
Adolescents. Psychiatry (Edgmont (Pa. : Township)), 3(4), 20–32.

The Texas Children's Medication Algorithm Project: Report of the Texas consensus
conference panel on medication treatment of childhood major depressive disorder

Hughes CW, Emslie GJ, Crismon ML, et al. The Texas Children’s Medication
Algorithm Project: Report of the Texas consensus conference panel on medication
treatment of childhood major depressive disorder. J Am Acad Child Adolesc
Psychiatry. 1999;38:1442–54

Differential diagnosis, comorbidity, and treatment of
attention-deficit/hyperactivity disorder in relation to bipolar disorder or
borderline personality disorder in adults

Asherson P et al., Differential diagnosis, comorbidity, and treatment of
attention-deficit/hyperactivity disorder in relation to bipolar disorder or
borderline personality disorder in adult. Curr Med Res Opin. 2014;1-18.

Attention deficit hyperactivity disorder and comorbid disorders: issues of
overlapping symptoms

Milberger S, et al. Attention deficit hyperactivity disorder and comorbid
disorders: issues of overlapping symptoms. Am J Psychiatry. 1995;152:1793-1799.

ADHD and Bipolar Disorder in Adulthood: Clinical and Treatment Implications

Salvi, V., Ribuoli, E., Servasi, M., Orsolini, L., & Volpe, U. (2021). ADHD and
Bipolar Disorder in Adulthood: Clinical and Treatment Implications. Medicina
(Kaunas, Lithuania), 57(5), 466.

Attention-deficit hyperactivity disorder, its pharmacotherapy, and the risk of
developing bipolar disorder: A nationwide population-based study in Taiwan

Wang LJ, Shyu YC, Yuan SS, Yang CJ, Yang KC, Lee TL, Lee SY. Attention-deficit
hyperactivity disorder, its pharmacotherapy, and the risk of developing bipolar
disorder: A nationwide population-based study in Taiwan. J Psychiatr Res. 2016
Jan;72:6-14.

The Risk of Treatment-Emergent Mania With Methylphenidate in Bipolar Disorder.

Viktorin A, Rydén E, Thase ME, Chang Z, Lundholm C, D’Onofrio BM, Almqvist C,
Magnusson PK, Lichtenstein P, Larsson H, Landén M. The Risk of
Treatment-Emergent Mania With Methylphenidate in Bipolar Disorder. Am J
Psychiatry. 2017 Apr 1;174(4):341-348.

The effect of lisdexamfetamine dimesylate on body weight, metabolic parameters,
and attention deficit hyperactivity disorder symptomatology in adults with
bipolar I/II disorder.

McIntyre RS, Alsuwaidan M, Soczynska JK, Szpindel I, Bilkey TS, Almagor D,
Woldeyohannes HO, Powell AM, Cha DS, Gallaugher LA, Kennedy SH. The effect of
lisdexamfetamine dimesylate on body weight, metabolic parameters, and attention
deficit hyperactivity disorder symptomatology in adults with bipolar I/II
disorder. Hum Psychopharmacol. 2013 Sep;28(5):421-7.

Adjunctive lisdexamfetamine in bipolar depression: a preliminary randomized,
placebo-controlled trial.

McElroy SL, Martens BE, Mori N, Blom TJ, Casuto LS, Hawkins JM, Keck PE Jr.
Adjunctive lisdexamfetamine in bipolar depression: a preliminary randomized,
placebo-controlled trial. Int Clin Psychopharmacol. 2015 Jan;30(1):6-13.

An open trial of bupropion for the treatment of adults with
attention-deficit/hyperactivity disorder and bipolar disorder

Wilens TE, Prince JB, Spencer T, Van Patten SL, Doyle R, Girard K, Hammerness P,
Goldman S, Brown S, Biederman J. An open trial of bupropion for the treatment of
adults with attention-deficit/hyperactivity disorder and bipolar disorder. Biol
Psychiatry. 2003 Jul 1;54(1):9-16.

Atomoxetine Induced Hypomania in a Patient with Bipolar Disorder and Adult
Attention Deficit Hyperactivity Disorder

Kumar, V., & Varambally, S. (2017). Atomoxetine Induced Hypomania in a Patient
with Bipolar Disorder and Adult Attention Deficit Hyperactivity Disorder. Indian
journal of psychological medicine, 39(1), 89–91.

Treatment of ADHD in patients with bipolar disorder

Girard, R., & Joober, R. (2017). Treatment of ADHD in patients with bipolar
disorder. Journal of psychiatry & neuroscience : JPN, 42(6), E11–E12.

Examining the proposed disruptive mood dysregulation disorder diagnosis in
children in the Longitudinal Assessment of Manic Symptoms study

Axelson D et al., Examining the proposed disruptive mood dysregulation disorder
diagnosis in children in the Longitudinal Assessment of Manic Symptoms study. J
Clin Psychiatry. 2012;73(10):1342-1350. 

Chronic versus episodic irritability in youth: a community-based, longitudinal
study of clinical and diagnostic associations
Leibenluft, E., et al., Chronic versus episodic irritability in youth: a
community-based, longitudinal study of clinical and diagnostic associations. J
Child Adolesc Psychopharmacol. 2006;16(4):456-466.
Improvements in Irritability with Open-Label Methylphenidate Treatment in Youth
with Comorbid Attention Deficit/Hyperactivity Disorder and Disruptive Mood
Dysregulation Disorder.

Winters DE, Fukui S, Leibenluft E, Hulvershorn LA. Improvements in Irritability
with Open-Label Methylphenidate Treatment in Youth with Comorbid Attention
Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder. J
Child Adolesc Psychopharmacol. 2018 Jun;28(5):298-305.

Comorbidity Between Attention Deficit/Hyperactivity Disorder and
Obsessive-Compulsive Disorder Across the Lifespan: A Review
Abramovitch A et al., Comorbidity Between Attention Deficit/Hyperactivity
Disorder and Obsessive-Compulsive Disorder Across the Lifespan: A Systematic and
Critical Review. Harv Rev Psychiatry 2015;23(4):245-262.
Co-Morbid Obsessive-Compulsive Disorder and Attention Deficit Hyperactivity
Disorder: Neurobiological Commonalities and Treatment Implications

Cabarkapa, S., King, J. A., Dowling, N., & Ng, C. H. (2019). Co-Morbid
Obsessive-Compulsive Disorder and Attention Deficit Hyperactivity Disorder:
Neurobiological Commonalities and Treatment Implications. Frontiers in
psychiatry, 10, 557.

Tourette Syndrome and comorbid ADHD: current pharmacological treatment options
Rizzo R et al., Tourette syndrome and comorbid ADHD: current pharmacological
treatment options. Eur J Paediatr Neurol. 2013;17(5):421-428.
Tourette syndrome associated with attention deficit hyperactivity disorder: The
impact of tics and psychopharmacological treatment options

Oluwabusi, O. O., Parke, S., & Ambrosini, P. J. (2016). Tourette syndrome
associated with attention deficit hyperactivity disorder: The impact of tics and
psychopharmacological treatment options. World journal of clinical
pediatrics, 5(1), 128–135.

Treatment of ADHD in children with tics: a randomized controlled trial.

Tourette’s Syndrome Study Group. Treatment of ADHD in children with tics: a
randomized controlled trial. Neurology. 2002 Feb 26;58(4):527-36.

ADHD symptom subtypes in children with pervasive developmental disorder
Gadow K et al., ADHD symptom subtypes in children with pervasive developmental
disorder. J Autism Dev Disord. 2006;36(2):271-283.
Attention-deficit hyperactivity disorder symptoms in a clinic sample of children
and adolescents with pervasive developmental disorders
Lee D and Ousleey O. Attention-deficit hyperactivity disorder symptoms in a
clinic sample of children and adolescents with pervasive developmental
disorders. J Child Adolesc Psychopharmacol. 2006;16(6):737-746.
Atomoxetine for hyperactivity in autism spectrum disorders: placebo-controlled
crossover pilot trial

Arnold L et al., Atomoxetine for hyperactivity in autism spectrum disorders:
placebo-controlled crossover pilot trial. J Am Acad Child Adolesc Psychiatry.
2006;45(10):1196-205.

Research Units of Pediatric Psychopharmacology (RUPP) autism network randomized
clinical trial of parent training and medication: one-year follow-up

Arnold L et al., Research Units of Pediatric Psychopharmacology (RUPP) autism
network randomized clinical trial of parent training and medication: one-year
follow-up. J Am Acad Child Adolesc Psychiatry. 2012;51(11):1173-1184.

The comorbidity of ADHD and autism spectrum disorder.

Antshel, K. M., Zhang-James, Y., & Faraone, S. V. (2013). The comorbidity of
ADHD and autism spectrum disorder. Expert review of neurotherapeutics, 13(10),
1117-1128.

5/5 - (1 vote)




ABOUT THE AUTHOR

 * Dr Sanil Rege
   MBBS, MRCPsych, FRANZCP
   
   
   Dr. Sanil Rege is a Consultant Psychiatrist and founder of Psych Scene and
   Vita Healthcare. He currently practices on the Mornington Peninsula.
   
   Read More


Number of Views: 3,436



DOWNLOAD CATALOGUE



LATEST


 * TREATMENT-RESISTANT DEPRESSION & THE BURDEN ON PATIENTS, GPS, THEIR FAMILIES
   AND THE HEALTHCARE SYSTEM
   
   May 16, 2022


 * CAN POO TREAT PSYCHIATRIC DISORDERS? | HOW DOES THE GUT TALK TO THE BRAIN? |
   ROLE OF PROBIOTICS
   
   May 6, 2022


 * WHAT ARE THE DIFFERENT TYPES OF ANTIDEPRESSANTS AND HOW DO THEY WORK? |
   MECHANISMS OF ACTION
   
   May 6, 2022



CATEGORY

 * Psychopharmacology
 * Psychotic Disorder Spectrum
 * Mood Disorder Spectrum
 * Expert Interviews
 * Organic Spectrum
 * Child and Developmental Psychiatry
 * Exams and CPD
 * Technology in Psychiatry
 * Addiction Spectrum
 * Miscellaneous
 * Women's Mental Health
 * Psychology and Psychotherapy
 * 
   Attention Deficit Hyperactivity Disorder (ADHD)- All You Need to Know
 * Leadership and Management
 * Trauma Related Disorders
 * Research and Statistics
 * Eating Disorders
 * GP Mental Health Bites
 * Anxiety Disorders
 * Forensic Psychiatry
 * General Mental Health Education
 * Case Files
 * COVID-19 and Psychiatry
 * Educational Resources
 * Personality Disorders
 * Wellbeing Section



LATEST TWEETS




 * Contact Us
 * Privacy Policy
 * Terms and Conditions