![]() Adults with ADHD may present with these psychiatric conditions as comorbidities 8 therefore, timing of the onset of symptoms is essential in making an accurate diagnosis. 7 Patients with major depressive, anxiety, or bipolar disorder, or any of the previously mentioned personality disorders may show signs of inattention or hyperactivity, but many other cardinal signs of those disorders are also usually present. 7, 8 Certain substances, such as steroids, antihistamines, anticonvulsants, caffeine, and nicotine, may have adverse effects that impact attentiveness. 7, 8 Psychiatric conditions include anxiety, mood, obsessive-compulsive, substance use, antisocial personality, borderline personality, and learning disorders, and intellectual disability. Medical conditions include hearing impairment, thyroid disease, lead toxicity, hepatic disease, sleep apnea, and drug interactions. To monitor for misuse or diversion of stimulants, family physicians should consider using a controlled substances agreement and random urine drug screening in addition to regular follow-up visits.Ī number of conditions have symptoms similar to those of ADHD and should be considered in the differential diagnosis. For adults with coexisting depression, the combination of an antidepressant and stimulants has been shown to be safe and effective. Cognitive behavior therapy has also been shown to be helpful as adjunctive treatment with medication. Clinical guidelines recommend stimulants and the nonstimulant atomoxetine as first-line treatments, followed by antidepressants. Diagnosis relies on a thorough clinical history, supported by a number of rating scales that take five to 20 minutes to complete, depending on the scale. Proper diagnosis and treatment can improve daily functioning. ![]() Steroids, antihistamines, anticonvulsants, caffeine, and nicotine also can have adverse effects that mimic attention-deficit/hyperactivity disorder symptoms. A number of conditions, such as thyroid disease, mood disorders, and substance use disorders, have symptoms similar to those of attention-deficit/hyperactivity disorder and should be considered in the differential diagnosis. Attention-deficit/hyperactivity disorder in childhood can persist into adulthood in at least 30 percent of patients, with 3 to 4 percent of adults meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., diagnostic criteria.
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