CO-MORBIDITY OR MASKING

Bipolar disorder can be masked or be co-morbid with conduct disorder (Kovacs et al 1995), ADHD, alcohol abuse, cocaine abuse, other substance abuse (Regier et al, 1990), psychotic symptoms, obsessional or panic symptoms, borderline personality disorder or traits and post-traumatic stress disorder. ADHD and Conduct Disorder commonly have an earlier age of onset, often before age 8, than bipolar disorder. Episodicity with periods of asymptomatic good functioning, especially in the presence of a family history of bipolar disorder, may suggest an underlying bipolar disorder. However, all the above conditions can be truly comorbid with bipolar disorder, making both diagnosis and management difficult. Whereas the clinicians should attempt to rule out bipolar disorder, particularly rapid cycling and mixed states, in the presence of the above conditions, s/he should also guard against unwarranted speculative overdiagnosis of bipolar disorder. This can be done by employing systematic, structured and standardized algorithms for both diagnosis and treatment. The value of longitudinal monitoring using mood diaries and a meticulous study of family history of psychiatric illnesses are of immense value, especially where there is high suspicion of but no clear picture, initially, to make a diagnosis of bipolar disorder.

References
Kovacs M, Pollock M. Bipolar Disorder and Comorbid Conduct Disorder in Childhood and Adolescence. J Am Acad Child Adolesc Psychiatry, 1995. 34: 6. 715-723.

Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK. Comorbidity of Mental Disorders with Alcohol and other Drug Abuse: results from the ECA Study. JAMA. 1990. 264: 2511-2518.