Posted by SLS on March 23, 2006, at 7:54:53
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 22, 2006, at 15:03:39
> I think there are two possibilities. I think that a drug can certainly activate preexisting mental health issues in people. But on the other hand, the drugs are strong, and they have side effects. So I think it is possible for some of those side effects to mimick other conditions.
>
> Linkadge
I agree.
I think we need some numbers here.1. What percentage of ADHD childen being treated with a stimulant develop this manic/psychotic syndrome?
2. What percentage of children diagnosed as ADHD are bipolar?
3. What percentage of ADHD adults treated with stimulants develop this manic/psychotic syndrome?
4. What percentage of non-ADHD adults treated with stimulants develop this manic/psychotic syndrome?
• There might be a difference between #1 and #3. Perhaps the young brain is more susceptible to this manic/psychotic reaction to stimulants.• There might be a diffence between #3 and #4. Perhaps ADHD confers greater susceptibility to the manic/psychotic reaction.
• If #1 = 5%, then the rate of occurrence of the manic/psychotic reaction is equal to the occurrence of bipolar disorder in the general population. If this is true, then it is possible that the only children who react this way to stimulants are those who have a comorbid bipolar disorder.
• If #2 > 5%, then there is a positive association between ADHD and bipolar disorder. One might then expect a rate of occurrence of the manic/psychotic reaction to be greater in these children than that seen in the general population.
• Etcetera...
Problems arise with:1. The accurate diagnosis of pediatric ADHD versus bipolar disorder versus comorbidity.
2. The lack of differentiation between mania and a non-manic psychosis.
The same question arises: Does a manic/psychotic reaction to stimulants in pediatric ADHD indicate comorbid bipolar disorder?I'm sure that this is true of a certain percentage of these reactions.
Is this association exclusive? Probably not. My guess is that a certain percentage of these reactions occur in the absence of bipolar disorder. The question is, does it happen more frequently in children than in adults? Is there something about the young developing brain that is still in the process of pruning that confers a greater risk of hosting this manic/psychotic reaction?
I have a bunch more questions and possible scenarios conceived, but not the mental energy to list them. Maybe you can track down some of the statistics I mentioned.
My guess is that the published report exaggerates the risk or conveys the wrong message about the potential risk of the manic/psychotic reaction occurring in ADHD children because it does not take into account the comorbid occurrence of bipolar disorder. Nor does the report specify how common or uncommon this reaction really is. If the rate of occurrence approaches the rate of bipolar disorder, then stimulants cannot be blamed for anything other than unmasking a disorder that already existed in those affected. This might not always be a bad thing.
We need those statistics.
- Scott
poster:SLS
thread:620137
URL: http://www.dr-bob.org/babble/20060322/msgs/623587.html