ADHD and Mood Disorders

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Mind mazeAttention Deficit Hyperactivity Disorder

Things you should know

  • Affects children and adolescents
  • Symptoms must occur in multiple settings and continue for at least 6 months.
  • 30–50% of people diagnosed in childhood continue to have symptoms into adulthood

I came in to see my physician assistant today because of…

  • Inattentive Symptoms
    • Fails to give close attention to details or makes careless mistakes in schoolwork
    • Has difficulty keeping attention during tasks or play
    • Does not seem to listen when spoken to directly
    • Does not follow through on instructions and fails to finish things
    • Has problems organizing tasks and activities
    • Avoids or dislikes tasks that require sustained mental effort
    • Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
    • Is easily distracted
    • Is often forgetful in daily activities
  • Hyperactivity Symptoms
    • Fidgets with hands or feet or squirms in seat
    • Leaves seat when remaining seated is expected
    • Runs about or climbs in inappropriate situations
    • Has problems playing or working quietly
    • Talks excessively
  • Impulsivity Symptoms
    • Blurts out answers before questions have been completed
    • Has difficulty awaiting turn
    • Interrupts or intrudes on others’ conversations

Diagnosis

  • Diagnosis is made clinically with input from teachers and parents.
    • At least 6 separate symptoms for at least 6 months.
  • An adult must have had symptoms as child for this diagnosis to be applied

Treatment

  • Psychosocial
    • Behavioral Therapy
    • Psychoeducational Input
    • Cognitive Behavioral Therapy
    • Interpersonal Psychotherapy
    • Family Therapy
    • School-based Interventions
    • Social skills training
    • Parent management training
    • Neurofeedback
  • Medications
    • Stimulant Medications
      • Ritalin (methylphenidate)
    • Non-stimulant medications that can be used as alternatives
      • Atomoxetine
      • Bupropion
      • Guanfacine
      • Clonidine
  • To help a child with ADHD, the following is advised:
    • Talk regularly with the child’s teacher
    • Consistent schedule
    • Limit distractions
    • Healthy diet
    • Sleep
    • Provide clear and consistent communication

Adjustment Disorder

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Eating Disorders and Autism

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Eating DisordersAnorexia Nervosa

Things you should know

  • Key features
    • Refusal to maintain a healthy body weight
    • Intense fear of gaining weight
    • A Distorted body self-perception
    • Females make up 90% of cases
    • Ego syntonic
  • Risks associated with Anorexia Nervosa
    • Iron-deficiency anemia
    • Compromised immune system
    • Abdominal pain, constipation, diarrhea
    • Loss or disturbance of menstruation
    • Increased risk of infertility in men and women
    • Kidney failure
    • Osteoporosis
    • Bradycardia and other arrhythmias
    • Death

I came in to see my physician assistant today because of…

  • Anorexia is ego syntonic
  • Physical Signs
    • Rapid weight loss or frequent weight changes
    • Disturbance of menstruation in girls and women
    • Decreased libido in men
    • Dizziness, fainting
    • Feeling cold most of the time
    • Constipated
    • Feeling tired
    • Difficulty sleeping
  • Psychological Signs
    • Intense fear of gaining weight
    • Preoccupation with eating, food, body shape and weight
    • Feeling anxious and irritable around meal times
    • Unable to maintain a normal body weight for their age and height
    • Depression and anxiety
    • Reduced capacity for thinking and increased difficulty concentrating
    • Rigid thoughts about food being ‘good’ or ‘bad’
    • Distorted self-perception
    • Low self esteem and perfectionism
    • Increased sensitivity to comments relating to food, weight, body shape, exercise
    • Extreme body image dissatisfaction
  • Behavioral Signs
    • Deliberate misuse of laxatives, appetite suppressants, enemas and diuretics
    • Repetitive or obsessive behaviours relating to body shape and weight
    • Binge eating
    • Eating in private and avoiding meals with other people
    • Anti-social behaviour
    • Secrecy around eating
    • Compulsive or excessive exercising
    • Radical changes in food preferences
    • Obsessive rituals around food preparation and eating
    • Preoccupation with preparing food for others, recipes and nutrition
    • Self harm, substance abuse or suicide attempts
  • Physical exam
    • Height and weight measurement → 20% below expected is a bad sign
    • Vital signs, such as heart rate, blood pressure and temperature
    • Assessment of skin and nails for dryness or other problems

Treatment

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Anxiety Disorders

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Anxiety Generalized anxiety disorder

Things you should know

  • Characterized by excessive, uncontrollable and often irrational fear about everyday issues and not about a specific thing or at specific time
  • Symptoms have been occurring for more than 6 months.

Symptoms

  • More than 6 months of excessive worry
  • More days are spent worrying than worry free
  • Restless,
  • Easy Fatigability
  • Muscle tension
  • Sleep issues
  • Irritability
  • Difficulty concentrating
  • Nausea and diarrhea
  • Chest pain
  • Dizziness
  • Trembling
  • Dry mouth
  • Hypervigilance

Treatment

  • Cognitive and Behavioural therapy
  • Medications
    • SSRIs (Selective Serotonin Reuptake Inhibitors)
      • fluoxetine (Prozac)
      • sertraline (Zoloft)
    • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
      • Duloxetine (Cymbalta)
      • Venlafaxine (Effexor)
    • Tricyclic antidepressants (TCAs)
      • Imipramine (Tofranil)
      • Clomipramine (Anafranil)
    • Benzodiazepines – may be used for short term therapy
      • Alprazolam (Xanax)
    • Pregabalin – Lyrica
    • Gabapentin – Neurontin

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