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Cherinet Seid, PGY II. OUT LINE Introduction History of ADD Etiology/Risk factors Diagnosis Comorbid disorders Management.

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Presentation on theme: "Cherinet Seid, PGY II. OUT LINE Introduction History of ADD Etiology/Risk factors Diagnosis Comorbid disorders Management."— Presentation transcript:

1 Cherinet Seid, PGY II

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

3 Introduction The only psych disorder 1 st 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 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


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 contd 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 I. Predominantly inattentive type II. Predominantly hyperactive-impulsive type III. Combo

12 DSM-IV criteria 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 contd 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 contd 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 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 1. Assess current ADHD symptoms (assessment scales) 2. Establish a childhood hx of ADHD 3. Assess devtal & functional impairement 4. R/o other psychiatric disorders 5. Obtain family hx of psych disorders 6. Perform a physical exam, r/o medical causes 7. Assess pts 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 Envtal restructuring & appropriate physical & special interest activities


22 Pharmacotherapy ClassDoseAdverse effects Stimulants Methylphenidate Short acting Intermediate acting Extended release 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 Short acting Extended release 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 1. Approach to ADD in adults,Canadian Family Physician, vol 52;Aug Understanding the nature of adult ADHD, Schulich school of Medicine, CME booklet


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