Diagnostic Complications: Comorbid Psychiatric Disorders



Theresa Cerulli, MD: What are some of the psychiatric comorbidities that you’re seeing with ADHD [attention deficit/hyperactivity disorder], Frank?

Frank Lopez, MD: In my practice, the typical things that I see are anxiety and tics. I do see a lot of oppositional defiant behavior. It is as prevalent or maybe more prevalent than even the MTA study described some years ago. So it is really significant. In the adolescents, the young adult population, I see the movement more toward generalized anxiety, and even performance anxiety, as well as depression.

Theresa Cerulli, MD: And certainly depression, mood disorders.

Frank Lopez, MD: Oh yeah. And so there’s much overlap between the symptomatology that we see in anxiety, depression, and ODD [oppositional defiant disorder]—many times the irritability, the anger. You know, the lack of interest. There are pieces that really have to be teased out. This allows us to do that.

What I don’t see in my practice is substance use disorder. Most of the kids I treat haven’t gotten to that point. Although, as we know, cigarettes are the gateway to opening that door. We take a lot of time and make sure that the kids are well educated. And I’ve seen a significant number of parents stop smoking, and that’s an example that the children will follow. So it’s very critical.

Theresa Cerulli, MD: Some of the top 2 comorbidities I probably end up seeing in my practice are the anxiety comorbidity. I do see some of my adolescents and particular patients with some substance-use issues. Marijuana is 1 of the ones that comes up commonly, and probably because I’m in Massachusetts. Not only do we have medical marijuana approved, but marijuana is legalized. Certainly not in the adolescent population; however, it seems to find its way into the adolescent treatment options in their own mind, shall we say. Some will claim it’s helped with focus . It really does complicate not only the diagnostic process but the treatment process when the comorbidities, the substance use disorder—so I’m just planting that seed. From state to state this may vary, but we are seeing that in Massachusetts.

Frank Lopez, MD: It’s interesting that you bring that up. Here [in Florida], it’s not so much the child and the adolescent; it’s actually the parents.

Theresa Cerulli, MD: Yes.

Frank Lopez, MD: So we’re having the discussion about treatment options. We’re presenting them with the typical approach. It’s not unusual, and I would say in the last 2 years it’s probably doubled in frequency with the parent saying, “What about marijuana?” “What about CBD [cannabidiol] oil?” That question keeps cropping up. I actually have asked the parents, “Are you asking for yourselves or for your child?”

Theresa Cerulli, MD: Very, very important point for clinicians to hear. You’re right, it can be both.

Frank Lopez, MD: Exactly.

Transcript Edited for Clarity

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