Neuropsychological assessment in differential diagnosis between bipolar disorder and adhd in adults
Published:
Jun 15, 2019
Keywords:
adult ADHD bipolar disorder neuropsychological profile neuropsychological deficits differential diagnosis
Abstract
The clinical phenomenologic similarities between residual Attention Deficit-
Hyperactivity Disorder in adults (ADHDa) and Bipolar Disorder (BD) often create
difficulties in distinguishing them during diagnosis. The two disorders do not benefit from the same medication; therefore, limiting a possible diagnostic error is of particular importance for the therapeutic intervention too. The present paper, based on research and bibliographic observations according to which the two entities present certain specific neuropsychological (NP) characteristics that are involved in the functional and psychosocial deficits of the patients, aims to outline the possibilities of employing the neuropsychological assessment (NPA) in the clinical procedure of differential diagnosis. The main conclusion drawn from this critical review is that, despite the difficulty in identifying and quantifying clear differential neurocognitive criteria through research and, thus, in standardizing characteristic NP models that could contribute to the clinical distinction of the two disorders, the NP examination as a detailed analysis, understanding and description of the cognitive problems, can indeed be of use in differential diagnosis of ADHDa and BD, yet individually and always as part of a thorough interdisciplinary clinical evaluation.
Hyperactivity Disorder in adults (ADHDa) and Bipolar Disorder (BD) often create
difficulties in distinguishing them during diagnosis. The two disorders do not benefit from the same medication; therefore, limiting a possible diagnostic error is of particular importance for the therapeutic intervention too. The present paper, based on research and bibliographic observations according to which the two entities present certain specific neuropsychological (NP) characteristics that are involved in the functional and psychosocial deficits of the patients, aims to outline the possibilities of employing the neuropsychological assessment (NPA) in the clinical procedure of differential diagnosis. The main conclusion drawn from this critical review is that, despite the difficulty in identifying and quantifying clear differential neurocognitive criteria through research and, thus, in standardizing characteristic NP models that could contribute to the clinical distinction of the two disorders, the NP examination as a detailed analysis, understanding and description of the cognitive problems, can indeed be of use in differential diagnosis of ADHDa and BD, yet individually and always as part of a thorough interdisciplinary clinical evaluation.
Article Details
- How to Cite
-
Τζιράκη Σ. Χ. (2019). Neuropsychological assessment in differential diagnosis between bipolar disorder and adhd in adults. Psychology: The Journal of the Hellenic Psychological Society, 24(1), 227–247. https://doi.org/10.12681/psy_hps.22422
- Issue
- Vol. 24 No. 1 (2019)
- Section
- RESEARCH PAPERS
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The journal PSYCHOLOGY adopts a Platinum open-access policy. Submission, processing or publication costs are waived by the Hellenic Psychological Society. Papers published in the journal PSYCHOLOGY are licensed under a 'Creative Commons Attribution-ShareAlike 4.0 International' licence. The authors reserve the copyright of their work and grant the journal the right of its first publication. Third-party licensees are allowed to use the published paper immediately after publication as they wish, provided they retain the defined by the license copyright formalities, regarding the reference to its author(s) and its initial publication in the journal PSYCHOLOGY. Moreover, any adjusted work should be shared under the same reuse rights, so with the same CC license.
Downloads
Download data is not yet available.
References
Agarwal, N., Bellani, M., Perlini, C., Rambaldelli, G., Atzori, M., Cerini, R., … Brambilla, P. (2008). Increasedfronto-temporalperfusioninbipolardisorder. J Affect Disord, 110, 106-114.
Angst, J., Gamma, A., Benazzi, F., Ajdacic, V., Eich, D., & Rossler, W. (2003). Toward a re-definition of subthreshold bipolarity: Epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. J Affect Disord,73(1-2), 133-146.
Arts, B., Jabben, N., Krabbendam, L., & van Os, J. (2008). Meta-analysis of cognitive functioning in euthymic bipolar patients and their first degree relatives. Psychol Med, 38, 771-785.
Bálint, S., Czobor, P., Komlósi, S., Mészáros, A., Simon, V., & Bitter, I. (2009). Attention-deficit/hyperactivity disorder (ADHD): Gender- and age-related differences in neurocognition. Psychol Med, 39(8), 1337-1345.
Bálint, S., Czobor, P., Mészáros, A., Simon, V., & Bitter, I. (2008). Neuropsychological impairments in adult attention-deficit/hyperactivity disorder: A literature review. Psychiatr Hung, 23(5), 324-335.
Barkley, R.A. (1997). Behavioral inhibition, sustained attention and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65-94.
Barkley, R.A., & Murphy, K.R. (2010). Impairment in occupational functioning and adult ADHD: The predictive utility of executive function (EF) ratings versus EF tests. Arch Clin Neuropsychol, 25(3), 157-173.
Barkley, R.A., Murphy, K.R., Dupaul, G.I., & Bush, T. (2002). Driving in young adults with attention-deficit/hyperactivity disorder: Knowledge, performance, adverse outcomes and the role of executive functioning. J Int Neuropsychol Soc, 8, 655-672.
Barkley, R.A., Murphy, K.R., & Kwasnik, D. (1996). Motor vehicle driving competencies and risks in teens and young adults with attention-deficit/hyperactivity disorder. Pediatrics, 98(6 Pt1), 1089-1095.
Bearden, C.E., Hoffman, K.M., & Cannon, T.D. (2001). The neuropsychology and neuroanatomy of bipolar affective disorder: A critical review. Bipolar Disord, 3, 106-153.
Benton, A.L., (1992). Benton Visual Retention Test (5th ed.). San Antonio, TX: The Psychological Corporation.
Benton, A.L., Hamsher, K., & Sivan, A.B. (1994). Multilingual Aphasia Examination (3rd ed.). Iowa City, IA: AJA Associates.
Blumberg, H.P., Stern, E., Ricketts, S., Martinez, D., de Asis, J., White, T., … Silbersweig, D.A. (1999). Rostral and orbital prefrontal cortex dysfunction in the manic state of bipolar disorder. Am J Psychiatry, 156(12), 1986-1988.
Booksh, R.L., Aubert, M.J., & Andrews, S.R. (2007). Should the retention trial of the Test of Memory Malingering be optional? A reply. Arch Clin Neuropsychol, 22(1), 87-89.
Bora, E., Yucel, M., & Pantelis, C. (2009). Cognitive endophenotypes of bipolar disorder: A meta-analysis of neuropsychological deficits in euthymic patients and their first degree relatives. J Affect Disord, 113, 1-20.
Bourne, C., Aydemir, Ö., Balanzá-Martínez, V., Bora, E., Brissos, S., Cavanagh, J.T.O., … Goodwin, G.M. (2013). Neuropsychological testing of cognitive impairment in euthymic bipolar disorder: An individual patient data meta-analysis. Acta Psychiatr Scand, 128, 149-162.
Brassett-Harknett, A., & Butler, N. (2007). Attention-deficit/hyperactivity disorder: An overview of the etiology and a review of the literature relating to the correlates and life course outcomes for men and women. Clin Psychol Rev, 27, 188-210.
Cardy, J.E., Tannock, R., Johnson, A.M., & Johnson, C.J. (2010). The contribution of processing impairments to SLI: Insights from attention-deficit/hyperactivity disorder. J Commun Disord, 43(2), 77-91.
Davidson, M.A. (2008). ADHD in adults: A review of the literature. J Attent Disord, 11, 628-641.
Dockstader, C., Cheyne, D., & Tannock, R. (2010). Cortical dynamics of selective attention to somatosensory events. Neuroimage, 49(2), 1777-1785.
Dubois, B., Slachevsky, A., Litvan, I., & Pillon, B. (2000). The FAB: a Frontal Assessment Battery at bedside. Neurology, 55(11), 1621-1626.
Emond, V., Joyal, C., & Poissant, H. (2009). Structural and functional neuroanatomy of attention-deficit/hyperactivity disorder (ADHD). Encephale, 35(2), 107-114.
Epstein, J.N., Conners, C.K., Sitarenios, G., & Erhardt, D. (1998). Continuous performance test results of adults with attention deficit hyperactivity disorder. Clin Neuropsychol, 12, 155-168.
Faraone, S.V., Biederman, J., Spencer, T., Wilens, T., Seidman, L.J., Mick, E., & Doyle, A.E. (2000). Attention-deficit/hyperactivity disorder in adults: An overview. Biol Psychiatry, 48(1), 9-20.
Federman, R. (2014, December 20). Cognitive deficit in bipolar disorder [Web blog post]. Retrieved from https://www.psychologytoday.com/blog/bipolar-you/201412/cognitive-deficit-in-bipolar-disorder
Ferrier, I.N., Stanton, B.R., Kelly, T.P., & Scott, J. (1999). Neuropsychological function in euthymic patients with bipolar disorder. Br J Psychiatry, 175, 246-251.
Gallagher, R. (2013, February 5). The role of neuropsychological assessment in the evaluation and treatment of ADHD. Retrieved from https://www.addrc.org/assessment-in-evaluation-and-treatment/
Gallagher, R., & Blader, J. (2001). The diagnosis and neuropsychological assessment of adult attention-deficit/hyperactivity disorder: Scientific study and practical guidelines. Ann N Y Acad Sci, 931, 148-171.
Geller, B., Tillman, R., Bolhofner, K., Zimerman, B., Strauss, N.A., & Kaufmann, P. (2006). Controlled, blindly rated, direct-interview family study of a prepubertal and early-adolescent bipolar I disorder phenotype: Morbid risk, age at onset, and comorbidity. Arch Gen Psychiatry, 63(10), 1130-1138.
Golden, C.J. (1978). Stroop Color and Word Test: A manual for clinical and experimental uses. Wood Dale, IL: Stoelting.
Grant, D.A., Berg, E.A. (1993). Wisconsin Card Sorting Test (WCST). Los Angeles: Western Psychological Services.
Haavik, J., Halmøy, A., Lundervold, A.J., & Fasmer, O.B. (2010). Clinical assessment and diagnosis of adults with attention-deficit/hyperactivity disorder. Expert Rev Neurother, 10(10), 1569-1580.
Halmøy, A., Halleland, H., Dramsdahl, M., Bergsholm, P., Fasmer, O.B., & Haavik, J. (2010). Bipolar symptoms in adult attention-deficit/hyperactivity disorder: A cross-sectional study of 510 clinically diagnosed patients and 417 population-based controls. J Clin Psychiatry, 71(1), 48-57.
Hervey, A.S., Epstein, J.N., & Curry, J.F. (2004). Neuropsychology of adults with attention-deficit/hyperactivity disorder: A meta-analytic review. Neuropsychology, 18, 485-503.
Huxley, N., & Baldessarini, R.J. (2007). Disability and its treatment in bipolar disorder patients. Bipolar Disord, 9, 183-196.
Javadapour, A., Malhi, G.S., Ivanovski, B., Chen, X., Wen, W., & Sachdev, P. (2010). Hippocampal volumes in adults with bipolar disorder. J Neuropsychol Clin Neurosci, 2, 55-62.
Joffe, R.T., MacDonald, C., & Kutcher, S.P. (1988). Lack of differential cognitive effects of lithium and carbamazepine in bipolar affective disorder. J Clin Psychopharmacol, 8, 425-428.
Judd, L.L., Akiskal, H.S., Schettler, P.J., Coryell, W., Endicott, J., Maser, J.D., … Keller, M.B. (2003). A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry, 60, 261-269.
Kooij, J., & Francken, M. (2010). Entretien diagnostique pour le TDAH chez l’adulte (DIVA). The Netherlands: DIVA Foundation.
Koziol, L.F., & Stevens, M.C. (2012). Neuropsychological assessment and the paradox of ADHD. Appl Neuropsychol Child, 1(2), 79-89.
Kurtz, M.M., & Gerraty, R.T. (2009). A meta-analytic investigation of neurocognitive deficits in bipolar illness: Profile and effects of clinical state. Neuropsychology, 23(5), 551-562.
Lange, K.W., Hauser, J., Lange. K.M., Makulska-Gertruda, E., Takano, T., Takeuchi, Y., … Tucha, O. (2014). Utility of cognitive neuropsychological assessment in attention-deficit/hyperactivity disorder. Atten Defic Hyperact Disord, 6(4), 241-248.
Larson, E.R., Shear, P.K., Krikorian, R., & Welge, J. (2005). Working memory and inhibitory control among manic and euthymic patients with bipolar disorder. J Int Neuropsychol Soc, 11(2), 163-172.
Lee, R.S.C., Hermens, D.F., Naismith, S.L., Lagopoulos, J., Jones, A., Scott, J., … Hickie, I.B. (2015). Neuropsychological and functional outcomes in recent-onset major depression, bipolar disorder and schizophrenia-spectrum disorders: A longitudinal cohort study. Transl Psychiatry, 5, 555.
Levent, N., Tümkaya, S., Atesci, F., Tüysüzoglu, H., Varma, G., & Oguzhanoglu, N. (2014). A neuropsychological comparison of bipolar disorder and adult attention-deficit/hyperactivity disorder. Turk Psikiyatri Derg, 25(1), 1-8.
Lin, P.Y., Wang, P.W., Chen, C.S., & Kaohsiung, C.F.Y. (2017). Neurocognitive function in clinically stable individuals with long-term bipolar I disorder: Comparisons with schizophrenia patients and controls. J Med Sci, 33, 260-265.
Malhi, G.S., Ivanovski, B., Szekeres, V., & Olley, A. (2004). Bipolar Disorder: It’s all in your mind? The neuropsychological profile of a biological disorder. Can J Psychiatry, 49, 813-819.
Malhi, G.S., Ivanovski, B., Hadzi-Pavlovic, D., Mitchell, P.B., Vieta, E., & Sachdev, P. (2007). Neuropsychological deficits and funtional impairment in bipolar depression, hypomania and euthymia. Bipolar Disord, 9(1-2), 114-125.
McLean, A., Dowson, J., Toone, B., Young, S., Bazanis, E., Robbins, T.W., & Sahakian, B. (2004). Characteristic neurocognitive profile associated with adult attention-deficit/hyperactivity disorder. J Psychol Med, 34(4), 681-692.
Monks, P.J., Thompson, J.M., Bullmore, E.T., Suckling, J., Brammer, M.J., Williams, S.C., … Curtis, V.A. (2004). A functional MRI study of working memory task in euthymic bipolar disorder: Evidence for task-specific dysfunction. Bipolar Disord, 6, 550-564.
Múller, B.W., Gimbel, K., Keller-Pliessnig, A., Gastpar, M., & Davids, E. (2007). Neuropsychological assessment of adult patients with attention-deficit/hyperactivity disorder. Eur Arch Psychiatry Clin Neurosci, 257(2), 112-119.
Murphy, F.C., & Sahakian, B.J. (2001). Neuropsychology of bipolar disorder. Br J Psychiatry, 178(suppl.41), 120-127.
Najt, P., Perez, J., Sanches, M., Peluso, M.A., Glahn, D., & Soares, J.C. (2007). Impulsivity and bipolar disorder. Eu Neuropsychopharmacol, 17, 313-320.
Narvaez, J.C., Zeni, C.P., Coelho, R.P., Wagner, F., Pheula, G.F., Ketzer, C.R., … Rohde, L.A. (2014). Does comorbid bipolar disorder increase neuropsychological impairment in children and adolescents with ADHD? Rev Brasileira Psiquiatria, 36, 53-59.
Oberlin, B.G., Alford, J.L., & Marrocco, R.T. (2005). Normal attention orienting but abnormal stimulus alerting and conflict effect in combined subtype of ADHD. Behav Brain Res, 165(1), 1-11.
Oncü, B., & Olmez, S. (2004). Neuropsyhological findings in adults with attention deficit hyperactivity disorder. Turk Psikiyatri Derg, 15(1), 41-46.
Pålsson, E., Figueras, C., Johansson, A.G.M., Ekman, C.J., Hultman, B., Östlind, J., & Landén, M. (2013). Neurocognitive function in bipolar disorder: a comparison between bipolar I and II disorder and matched controls. BMC Psychiatry, 13, 165.
Partington, J.E., & Leiter, R.G. (1949). Partington’s pathway test. The Psychological Center Bulletin, 1, 9-20.
Pazvantoğlu, O., Aker, A.A., Karabekiroğlu, K., Akbaş, S., Sarisoy, G., Baykal, S., … Şahin, A.R. (2012). Neuropsychological weaknesses in adult ADHD; Cognitive functions as core deficit and roles of them in persistence to adulthood. J Int Neuropsychol Soc, 18(5), 819-826.
Pettersson, R., Söderström, S., & Nilsson, KW. (2015). Diagnosing ADHD in adults: An examination of the discriminative validity of neuropsychological tests and diagnostic assessment instruments. J Attend Disord,1-13.
Quraishi, S., & Frangou, S. (2002). Neuropsychology of bipolar disorder: A review. J Affect Disord, 72(3), 209-226.
Rey, A. (1941). L’examen psychologique dans les cas d’encéphalopathie traumatique. Archives de Psychologie, 28, 286-340.
Robinson, L.J., Thompson, J.M., Gallagher, P., Goswami, U., Young, A.H., Ferrier, I.N., & Moore, P.B. (2006). A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord, 93, 105-115.
Schoechlin, C., & Engel, R.R. (2005). Neuropsychological performance in adult attention-deficit/hyperactivity disorder: Meta-analysis of empirical data. Arch Clin Neuropsychol, 20, 727-744.
Schretlen, D.J., Cascella, N.G., Meyer, S.M., Kingery, L.R., Testa, M., Munro, C.A., … Pearlson, G.D. (2007). Neuropsychological functioning in bipolar disorder and schizophrenia. Biol Psychiatry, 62(2), 179-186.
Seidman, L.J. (2006). Neuropsychological functioning in people with ADHD across lifespan. Clin Psychol Rev, 26(4), 466-485.
Seidman, L.J., Biederman, J., Weber, W., Hatch, M., & Faraone, S.V. (1998). Neuropsychological function in adults with attention-deficit/hyperactivity disorder. Biol Psychiatry, 44(4), 260-268.
Seidman, L., Valera, E., & Bush, G. (2004). Brain function and structure in adults with attention-deficit/hyperactivity disorder. Psychiatric Clinics N A, 27, 323-347.
Silva, K.L., Rovaris, D.L., Guimaraes-da-Silva, P.O., Victor, M.M., Salgado, C.A., Vitola, E.S., … Bau, C.H. (2014). Could comorbid bipolar disorder account for a significant share of executive function deficits in adults with attention-deficit/hyperactivity disorder? Bipolar Disord, 16(3), 270-276.
Smith, A. (1982). Symbol digit modalities test: Manual. Los Angeles, CA: Western Psychological Services.
Spencer, T., Biederman, J., Wilens, T., Prince, J., Hatch, M., Jones, J., … Seidman, L. (1998). Effectiveness and tolerability of atomoxetine in adults with attention-deficit/hyperactivity disorder. Am J Psychiatry, 155, 693-695.
Strakowski, S.M., DelBello, M.P., Adler, C., Cecil, D.M., & Sax, K.W. (2000). Neuroimaging in bipolar disorder. Bipolar Disord, 2, 148-164.
Sweeney, J.A., Kmiec, J.A., & Kupfer, D.J. (2000). Neuropsychological impairments in bipolar and unipolar mood disorders on the CANTAB neurocognitive battery. Biol Psychiatry, 48(7), 674-684.
Szmulewicz, A.G., Samamé, C., Martino, D.J., & Strejilevich, S.A. (2015). An updated review on the neuropsychological profile of subjects with bipolar disorder. Arch Clin Psychiatry, 42(5), 139-146.
Tillman, C.M., Bohlin, G., Sorensen, L., & Lundervold, A.J. (2009). Intellectual deficits in children with ADHD beyond central executive and non-executive functions. Arch Clin Neuropsychol, 24(8), 769-782.
Torralva, T., Gleichgerrcht, E., Torrente, F., Roca, M., Strejilevich, S.A., Cetkovich, M., … Manes, F. (2011). Neuropsychological functioning in adult bipolar disorder and ADHD patients: A comparative study. Psychiatry Res, 186(2-3), 261-266.
Udal, A.B.H. (2012). Beyond diagnoses: Attention-deficit/hyperactivity disorder vs. early onset bipolar disorder. A study of neurological diversity behind symptoms. Series of dissertations. Faculty of Medicine, University of Oslo, 1287.
Valera, E.M., Brown, A., Biederman, J., Faraone, S.V., Makris, N., Monuteaux, M.C., … Seidman, L.J. (2010). Sex differences in the functional neuroanatomy of working memory in adults with ADHD. Am J Psychiatry, 167(1), 86-94.
Wechsler, D. (1987). Manual for the Wechsler Memory Scale – Revised. San Antonio, TX: The Psychological Corporation.
Wender, P.H., Wolf. L.E., & Wasserstein, J. (2001). Adults with ADHD: An overview. Ann N Y Acad Sci, 931, 1-16.
Wingo, A.P., & Ghaemi, S.N. (2007). A systematic review of rates and diagnostic validity of comorbid adult attention-deficit/hyperactivity disorder and bipolar disorder. J Clin Psychiatry, 68, 1776-1784.
