distracted, hyperactive, irritable, impulsive.

Wait a minute, is this a list of DSM symptoms for ADHD or hypomania?

How about we find out?

Welcome to the Carlet Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Aiken, the editor-in-chief of the Carlatte Psychiatry podcast, keeping psychiatry honest since 2003. I'm Chris Sagan, the editor-in-chief of the Carlatte Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of every issue.

Your patient is a 24-year-old woman with bipolar 2, who recently came out of a mixed episode.

Although her mood symptoms have cleared, she is still easily distracted, has difficulty organizing

her work, and often unforgets important tasks. She's read about ADHD online and asked if

she can have a stimulant to help a focus.

ADHD and hypomania share many symptoms in common.

Distraction, hyperactivity, impulsivity, irritability, and excessive talking.

So how do you tell them apart?

The usual advice is that the symptoms are episodic in bipolar disorder and continuous in ADHD. And while that makes great for a theoretical construct, it's a little harder

to apply in practice. It's not always clear-cut when episodes of bipolar disorder begin and end. Cognitive problems are common

in bipolar, even when the mood problems go away, and moody or affective temperaments are common in ADHD.

And these can look a lot like bipolar. But the stakes are high here because stimulants are used as the animal model for mania.

So we don't want to give them out on a whim.

So come along with us on this deep dive and by the end of it,

you'll have a much better idea of what to do when patients present with symptoms

of bipolar and ADHD.

There are four possibilities in these cases.

...