Student Researcher Sheds Light on New Ways to Help People with Mental Illness and ADHD

Presenter:  Luke MacDonald

Affiliation:  Dalhousie, Saint John

It’s everyday practice for doctors to diagnose and treat multiple medical conditions. With various tests at their fingertips—blood tests, urine analysis, CT scans, and so on—they can easily recognize when someone has diabetes and heart disease, for instance, or hypothyroidism and lung cancer.

But psychiatrists have a hard time helping people who suffer from more than one mental health concern, even though this circumstance is not unusual. With “complex patients,” especially those who live with borderline personality disorder (BPD) or bipolar disorder (BD), psychiatrists may suspect other conditions. However, because overlapping conditions tend to be studied separately, few guidelines exist for treating them at the same time.

Luke MacDonald, a second-year medical student at Dalhousie University’s Saint John campus, has helped to change that. With his supervisor Dr. Joseph Sadek, he has created the first definitive knowledge base for practitioners working with patients who have both BPD or BD and ADHD (attention-deficit/hyperactivity disorder).

Shining light on an underserved population

BPD and BD are notoriously challenging illnesses. Both conditions cause extreme emotional instability, and many patients eventually find themselves in the emergency room or admitted to hospital.

Logically, then, psychiatrists tend to focus on stabilizing mood as the priority. In so doing, however, they may overlook problems due to ADHD, such as trouble paying attention at work or school, restlessness, and impatience.   Or if they do recognize issues related to ADHD, chances are that they don’t know how to address them without derailing treatment for BPD or BD.

“These patients need a lot of light shone on them,” says MacDonald.

Practical insights for psychiatrists

MacDonald conducted an extensive review of existing research. He then summarized this information and drew on it to create “management recommendations” for practitioners.

MacDonald estimates that he combed through about 200 articles from the past 24 years, looking for specific keywords related to the conditions he was studying. Using specialized research software that vetted documents for quality and relevance, he narrowed this search down to 31 articles, which he then examined in depth.

From these, he and Dr. Sadek assembled suggestions and guidelines to help psychiatrists navigate the complex interplay of ADHD with BD or BPD. Some of these suggest answers to the perplexing question about possible drug treatments. Drugs commonly prescribed for ADHD can have a destabilizing effect on someone with BD or BPD, so finding a pharmaceutical intervention for both conditions can be challenging.

The results of the research by MacDonald and Sadek appear in the September 2023 issue of Brain Sciences, and MacDonald is hopeful that psychiatrists will use recommendations from the article during patient visits. For example, easy-to-read flowcharts provide tools a practitioner can use when assessing a patient and considering different approaches and therapies as well as drug choices.

Much is left to learn about helping patients manage ADHD along with BPD or BD, but MacDonald has given psychiatrists access to what we know so far, and New Brunswick patients will benefit directly from those insights.