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Adults and Attention-Deficit Hyperactivity Disorder-Diagnostics Treatments Challenges PowerPoint Presentation

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Description : Check out this medical presentation on Neurology, which is titled "Adults and Attention-Deficit / Hyperactivity Disorder (ADHD): Diagnostics, Treatments, Challenges", to know about ADHD, diagnosing ADHD in adults, common treatments for ADHD, and challenges in working with adults who present with ADHD symptoms.

Tags : Neurology, Adults, Attention-Deficit, Hyperactivity Disorder, ADHD, Diagnostics, Treatments, Challenges

Published on : Aug 18, 2021 | Views : 896 | Downloads : 8

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Adults and Attention-Deficit / Hyperactivity Disorder (ADHD): Diagnostics, Treatments, Challenges Edward Thomas Lewis III, M.D. Clinical Assistant Professor Attending Physician, Institute of Psychiatry Associate Director, Forensic Psychiatry Fellowship Medical University of South Carolina Department of Psychiatry and Behavioral Sciences Division of Community and Public Safety Psychiatry
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Acknowledgments & Disclosures Addiction Psychiatry background Not subspecialty trained in child and adolescent psychiatry No relevant financial disclosures
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Goals and Objectives Explore background information about ADHD Diagnosing ADHD in Adults Discuss common treatments for ADHD Understand challenges in working with adults who present with ADHD symptoms
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What is ADHD? Consistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning and/or development. Inattention Hyperactivity Impulsivity
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Inattention Wandering off task Lacking persistence Difficulty sustaining focus Disorganized Not due to defiance or lack of comprehension
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Hyperactivity Excessive motor activity Fidgeting Tapping Talkativeness Extreme restlessness (in adults) Frustrating peers due to elevated activity
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Impulsivity Hasty actions that occur in the moment Minimal forethought High potential for harm to the individual Social Intrusiveness Major Life Decisions
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ADHD: How Common? Global population surveys suggest ADHD occurs in about 5% of children and 2.5% of adults. More frequent in males than females 2:1 M:F in children 1.6:1 M:F in adults 50% of children with ADHD will experience attenuation of symptoms as they progress into adulthood
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Adult ADHD: How Common? 2.5 – 4.0% of the population Hyperactive / Impulsive presentation is more common in males Adults with ADHD have 4 – 9x higher prevalence of comorbid mental health diagnoses Bipolar Disorder Anxiety Disorders
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ADHD: Risk Factors Very low birth weight Smoking during pregnancy History of child abuse, neglect, multiple foster placements, neurotoxin, infection, or alcohol exposure in utero First degree biological relative with ADHD
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ADHD: Progression of Symptoms Begins in childhood Hyperactivity predominates in preschool-aged children Most often identified in elementary school Inattention is often predominant
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ADHD: Progression of Symptoms Hyperactivity may improve into adolescence and adulthood, but restlessness, inattention, poor planning, and impulsivity persist Substantial number of children with ADHD will remain relatively impaired into adulthood
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Negative Consequences of ADHD Reduced educational performance Social rejection Poorer occupational performance Higher probability of unemployment Interpersonal conflict More likely to be injured Traffic accidents Obesity Incarceration Conduct Disorder Substance Use Disorders
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Diagnosing Adult ADHD https://www.advancingadhd.com/diagnosis
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Diagnosing Adult ADHD https://www.advancingadhd.com/diagnosis
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Emotional Dysregulation (ED) Deficiency in executive or cognitive management of emotions Self-regulation of frustration, impatience, anger Emotional Impulsivity Mesolimbic Circuitry (“Bottom Up”) Deficient Emotional Self-Regulation Prefrontal Cortex (“Top Down”) Not in DSM-5 35-70% adults with ADHD experience ED
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Testing for ADHD: Behavior Rating Scales https://www.jaacap.org/article/S0890-8567(09)62182-1/fulltext
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Testing for ADHD: Behavior Rating Scales https://www.jaacap.org/article/S0890-8567(09)62182-1/fulltext
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Adult ADHD: Scales and Testing Role for Neuropsychological Testing Continuous Performance Test (CPT) World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS) Brown Attention-Deficit Disorder Scale (BADDS)
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Adult ADHD: ASRS Six question scale Designed for community samples Positive results require follow-up diagnostic assessment by trained a clinician Score of four or greater is positive
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Adult ADHD: ASRS https://www.hcp.med.harvard.edu/ncs/asrs.php
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Adult ADHD: ASRS https://www.hcp.med.harvard.edu/ncs/asrs.php
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Adult ADHD: BADDS 40-item screening instrument Designed for primary/preschool, school-age, adolescent, and adult populations Based on Thomas Brown’s model of cognitive impairment in ADHD
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Treating Adult ADHD: Pharmacotherapy Stimulant medications are front-line management National Comorbidity Survey Replication (NCS-R) FDA approved medications for Adult ADHD Extended release mixed amphetamine salts (Adderall XR) Lisdexamfetamine dimesylate (Vyvanse) Atomoxetine (Strattera) Bupropion (Wellbutrin)
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Treating Adult ADHD: Psychosocial Treatments CBT Negative Thoughts Perfectionism Over-estimation of one’s competence Comorbid Depression, Anxiety Organizational Skills Training Data for CBT in children vs. adults with ADHD http://namirockland.org/cbt.html
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Treating Adult ADHD: Substance Use Disorders (SUD)
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Neurobiology of Addiction https://www.google.com/search?q=hijacking+of+limbic+system&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj3t97R9IvfAhWoTd8KHckaCl0Q_AUIDigB&biw=1920&bih=934#imgrc=-V6hjWyv2C_tUM:&spf=1544123599719
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Neurobiology of Addiction: Hijacking of Limbic System https://www.google.com/search?q=hijacking+of+limbic+system&rls=com.microsoft:en-US:IE-Address&source=lnms&tbm=isch&sa=X&ved=0ahUKEwimnp_M-ovfAhVikuAKHbQlCaQQ_AUIDigB&biw=1920&bih=934#imgrc=UDv2lr0cOu8gXM:&spf=1544125201097
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Neurobiology of Addiction Wanting Liking Repeated use over time Needing
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Treating Adult ADHD: Substance Use Disorders (SUD) ADHD has a prevalence of 22% in adults with SUD More severe disease burden Higher comorbidity Dopamine System Reward Pathways Prefrontal Cortex Medication Management Strategies Psychotherapy Integrative CBT
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Treating Adult ADHD: Psychiatric Comorbidities Bipolar Disorder Anxiety Disorders Depressive Disorders
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References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. Faraone, S. V., & Antshel, K. M. (2008). Diagnosing and treating attention-deficit/hyperactivity disorder in adults. World psychiatry : official journal of the World Psychiatric Association (WPA), 7(3), 131–136. Giulio Perugi, Alessandro Pallucchini, Salvatore Rizzato, Vito Pinzone & Pietro De Rossi (2019) Current and emerging pharmacotherapy for the treatment of adult attention deficit hyperactivity disorder (ADHD), Expert Opinion on Pharmacotherapy, DOI: 10.1080/14656566.2019.1618270 Lopez PL, Torrente FM, Ciapponi A, Lischinsky AG, Cetkovich‐Bakmas M, Rojas JI, Romano M, Manes FF. Cognitive‐behavioural interventions for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database of Systematic Reviews 2018, Issue 3. Art. No.: CD010840. DOI: 10.1002/14651858.CD010840.pub2. Scrandis, Debra. Diagnosing and treating ADHD in adults. The Nurse Practitioner. 43(1):8–10, JANUARY 15, 2018 DOI: 10.1097/01.NPR.0000527741.90830.97. PMID: 29240618. Van der Burg, D., Crunelle, CL, Matthys, F, Van den Brink, W. diagnosis and treatment of patient with comorbid substance use disorder and adult attention-deficit and hyperactivity disorder: a review of recent publications. Curr Opin Psychiatry. 2019 Jul;32(4):300-306.
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Questions? Contact: Lewiset@musc.edu