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ADHD in Adults Cherinet Seid, PGY II.

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Presentation on theme: "ADHD in Adults Cherinet Seid, PGY II."— Presentation transcript:

1 ADHD in Adults Cherinet Seid, PGY II

2 OUT LINE History of ADD Etiology/Risk factors Diagnosis
Introduction History of ADD Etiology/Risk factors Diagnosis Comorbid disorders Management

3 Introduction The only psych disorder 1st recognized in children
Under recognized in adults Affects 4-5% adults “Persistent ADHD” 15-28% P-ADHD male predominant, A-ADHD not Psychiatric comorbidities

4 History of ADD 1930 - Minimal Brain Damage
Minimal Brain Dysfunction Hyper-kinetic reaction of childhood ADD with/without hyperactivity ADHD Amphetamines used in 1937 Methylphenidate has been on market since 1955

5 Myths of ADHD

6 Common Scenarios Adults diagnosed in childhood & stopped rx
Adolescents progressing to adult services Undiagnosed adults with rx-resistant comorbid Psych disorders Undiagnosed self referred adults Undiagnosed adults recognized by others(fam members, health professionals)

7 Effects of ADHD 1. Social & Work impairment $19.5 billion lost human capital/yr in US Increased risk to be arrested (>2x controls) 2. Marital & Parental impairment Rate of divorce & separation double that of general population 3. Accident Proneness Hospital visits & Admissions 26 % vs 18%

8 4.Driving Impairment

9 Effects cont’d 5. Substance use

10 Case 43 yr female, chemist, married, 3 kids
Noticed similar characters as her 10 yr old son who is recently diagnosed with ADHD Has trouble concentrating, disorganized, impulsive & forgetful Frequently misplaces or loses objects Procrastinates and has difficulty with punctuality Feels overwhelmed by house hold chores although husband is supportive and calls her home ‘a disaster area’

11 Three sub types Predominantly inattentive type
Predominantly hyperactive-impulsive type Combo

12 DSM-IV criteria Careless mistakes Not listening Not finishing projects
At least 6 symptoms of inattention Careless mistakes Not listening Not finishing projects Forgetful Not following through Being disorganized Impulsive & forgetful Frequently losing/misplacing objects

13 DSM IV cont’d Hyperactivity-impulsivity Not able to sit still
At least 6 symptoms of hyperactivity Hyperactivity-impulsivity Not able to sit still Inner feeling of restlessness Always on the go Talking too much Being impatient Interrupting Blurting things out

14 DSM-IV cont’d Sxs must be present before age 7
Interfere with ability to function Persist for more than six months Manifest in multiple settings Not be accounted for by other disorders

15 Risk Factors Biologic cause Environmental
More genetic link than asthma, breast ca & schizophrenia. Environmental Frontal cortex hypometabolism Dopaminergic pathways

16 Screening for ADHD Adult Self -Report Scale (ASRS) 18 questions
Assesses DSM-IV symptoms of ADHD

17 Assessment Process Assess current ADHD symptoms (assessment scales)
Establish a childhood hx of ADHD Assess devt’al & functional impairement R/o other psychiatric disorders Obtain family hx of psych disorders Perform a physical exam, r/o medical causes Assess pt’s insight (?same with collateral hx)

18 DDx of A-ADHD Learning disabilities Mood disorders Anxiety disorders
Mixed anxiety/depression Secondary ADHD syndromes due to brain injury Other causes of impaired cognitive & executive function

19 Treatment Need to treat is always based on functional impairment.

20 Multimodal Treatment Psychoeducation Rx of comorbid conditions
Pharmacological Rxs Therapy (marital, individual, social skills, CBT) Light therapy Env’tal restructuring & appropriate physical & special interest activities


22 Pharmacotherapy Class Dose Adverse effects Stimulants Non-stimulants
Methylphenidate Short acting Intermediate acting Extended release 10-60 mg 2-4x 10-60mg 1-2x mg od Insomnia Headache Decreased appetite wt loss Nausea Bp & pulse changes Palpitations Non-stimulants Atomoxetine mg 1-2 x Constipation Dry mouth Decreased appetite Insomnia Sexual dysfunction Dysmenorrhea Antidepressants Bupropion Desipramine 100 mg 2-3x mg od mg od Anxiety Insomnia Decreased appetite Risk of Sz Irritability Agitation

23 just remember… It is worth identifying A-ADHD
Substantial burden of illness Potential for improvement with rx

24 Assessment Scales

25 References Approach to ADD in adults,Canadian Family Physician, vol 52;Aug 2006 Understanding the nature of adult ADHD, Schulich school of Medicine, CME booklet 2007


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