1 / 17

Attention deficit hyperactivity disorder in adults

Attention deficit hyperactivity disorder in adults. NURLIYANA BINTI DZULKARNAIN. ADHD-DEFINITION. Based on DSM-1V-TR criteria,defined as developmentally inappropriate poor attention span or age-inappropriate features of hyperactivity and impulsivity or both

eve
Download Presentation

Attention deficit hyperactivity disorder in adults

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Attention deficit hyperactivity disorder in adults NURLIYANA BINTI DZULKARNAIN

  2. ADHD-DEFINITION • Based on DSM-1V-TR criteria,defined as developmentally inappropriate poor attention span or age-inappropriate features of hyperactivity and impulsivity or both • At least for 6 months, occur before 7 years old • Cause impairment in academic or social functioning • Considered a childhood disorder

  3. ADHD-CLASSIFICATION • The DSM-IV, or Diagnostic and Statistical Manual of Mental Disorders, 2000 edition, defines three types of ADHD: • Aninattentivetype • A hyperactive/impulsivetype • A combinedtype

  4. Adult ADHD-Symptoms Inattentive type (ADHD-I) • Procrastination • Indecision, difficulty recalling and organizing details required for a task • Poor time management, losing track of time • Avoiding tasks or jobs that require sustained attention • Difficulty initiating tasks • Difficulty completing and following through on tasks • Difficultymultitasking • Difficulty shifting attention from one task to another

  5. Adult ADHD-Symptoms Hyperactive/Impulsive-type (ADHD-H) • Chooses highly active, stimulating jobs • Avoids situations with low physical activity or sedentary work • May choose to work long hours or two jobs • Seeks constant activity • Easily bored • Impatient • Intolerant to frustration, easily irritated • Impulsive, snap decisions and irresponsible behaviors • Loses temper easily, angers quickly

  6. Adult ADHD-Diagnosis • DSM-IV-TR criteria were developed for children and adolescents-cannot always applied to adults-alteration to criteria to fit adult symptoms • Symptoms stated in criteria not appropriate in adults-rely on observations to childhood activities • Under report the severity of symptoms • Impairment also include social and leisure activities,parenting,and intimate relationships

  7. Adult ADHD-Diagnosis • Establishing whether the symptoms were also present in childhood, even if not previously recognized • Combination of a careful history of symptoms up to early childhood, including corroborating evidence from family members, previous report cards, etc. along with a neuropsychiatricevaluation • Also screening tests,ruling out depression,substanceabuse,anxiety,hyperthyroidism

  8. Adult ADHD-Neurobiology • Structural differences(neuroimaging methods) • Significant reductions in Total cortical grey matter,prefontal and anterior cingulate volumes and right putamen/globuspallidus grey matter • Thinning of cerebral cortex in networks that mediate attention and executive fxRight hemisphere involving the inferior parietal lobule,dorsolateralprefontal anterior cingulate cortices

  9. Adult ADHD-Neurobiology • Neurochemistry Near infrared spectroscopy • Increases oxygenated Hb in ventrolateralprefontalcortex,indicating reduced activation of this area in task related actvtsmarked in working memory • Higher N-acetyl-aspartate/creatine ratios in the prefrontal corticosubcotical region and left centrumsemiovale.

  10. ADULT ADHD-Neurobiology • Neurochemistry Positron emission tomography (PET) • Involvement of dopamine transporter • Lower dopamine D2/D3 receptor activity in caudate ,hippocampus and amygdala Magnetic Resonance Imaging (MRI) • Reduced activation of the ventral prefontalcortex,anteriorcingulate cortex and striatum

  11. IMPACT OF ADULT ADHD • Professional and economic impact -More likely to change jobs -Work productivity is lowerconcentrationdifficulties,disorganization and reduced ability to cope with large workload • Social problems -Lack of friendships & poor relationship with parents -Relationship difficulties -Problems adjusting after marriage -Parenting-more likely to have lack of parental discipline,-ve parent child interactions

  12. IMPACT OF ADULT ADHD • Comorbidities -Mood disorders and anxiety disorders occur with greater frequency in adults with ADHD -Bipolar disorder -Substance abuse disorder • Sleep and activity disturbances -Difficulty in falling asleep and numerous waking throughout the nightdaytime fatigue -Driving accidents-attributed to impulsivity,inattention,loss of concentration and fatigue

  13. ADULT ADHD-TREATMENT • Current guidelines by AACAP,CADDRA and BAP-combination therapy recommended:- • Psychoeducation, • An initial trial medication with titration to an individual effective dose, • Assesment of residual symptoms • Long term community follow-up • NICE Guidelines • Methylphenidate is first line drug • If ineffective or unacceptable-Atomoxetineor Dexamfetamine

  14. ADULT ADHD-Treatment • First line-Pharmacotherapy -1st choice-Methylphenidate(psychostimulant) • Mechanism-Reuptake inhibition of monoamine transportersincreases levels of dopamine and norepinephrine in the brain • Available as immediate release (IR),extended release (ER),OROS MPH -2nd choice • Atomoxetine(non psychostimulant) -inhibit norepinephrine transporter

  15. ADULT ADHD-TREATMENT • Pharmacotheraphy-Concerns • Methylphenidate -Abuse-esp short acting prescriptions risk of being injected or snorted -Risk of adverse cardiovascular events-MI and hypertension -Amphethamine-better side effect profile,better tolerated • Atomoxetine(non-stimulant medications) -Rare-increase potential for liver damage and suicidal ideation

  16. ADULT ADHD-TREATMENT • Psychosocial treatment • As adjunctive treatment • CBT(15 weeks) -Motivational interviewing and practice -Repetition and review of skills such as organizing and planning,reducingdistractibility,problemsolving,adaptive thinking in times of stress. • Dialectic behavioural therapy(3 months) -Sessions discussing mindfullness,emotion regulation and impulse control -Also undertake daily exercises and reading educational materials regarding ADHD.

  17. Thank you For your attention 

More Related