IS ADHD A REAL MEDICAL CONDITION OR NOT?

Is ADHD a real medical condition that justifies treatment with medication? The popular media quite also describe it as a questionable diagnosis, or overdiagnosed, or treated with unnecessary medication. Critics suggest the symptoms of hyperactivity, inattention, and impulsivity are merely extreme variations of normal human traits. Their criticism further attributes the cause to over demanding parents, poor teachers skills, and an over competitive society.
In scientific literature the majority view ADHD as a valid and common psychiatric disorder of childhood. A set of criteria for establishing in a psychiatric condition as a valid psychiatric disorder was established by Robins and Guze in 1970. This became the framework for how all diagnoses get included in the American Psychiatric Association’s diagnostic manual. These criteria all require that scientific studies have had been done and support every one of the six criteria.
Following are the six criteria required to make a classification of a cluster of signs and symptoms as a valid psychiatric condition:
1. CLINICAL CORRELATES
“A valid diagnosis needs to be reliably identified through a consistent pattern of signs and symptoms demarcating it from other disorders and from psychiatric wellness.”
This means that if a group of doctors independently evaluated the same group of patients and use the same test to diagnose the patients, there is high agreement as to which patients did have the disorder and which did not have ADHD. Numerous scientific studies have established the high reliability of different rating scales for the diagnosis of ADHD.

Also, a diagnosis of a condition cannot be made if the symptoms of that condition do not cause significant impairments. Studies have documented inferior academic performance, reduced social skills, inattention in the duration of focus on a single task, impulsivity disrupting schoolwork, and hyperactivity causing fidgeting and talking excessively. Impairments continue into adolescence with high rates of delinquency, more arrests, and higher risk of substance abuse disorders. Other studies document higher rates of injury, cycling injuries, and pedestrian injuries. Driving performance impairment leads to higher accident rates and traffic citations.

2. DELIMITATION FROM OTHER DISORDERS
This means that ADHD is a condition that is separate from other diagnoses. It isn’t a cluster of signs and symptoms and impairments that is actually part of another diagnosis. Symptoms of major depression, generalized anxiety, and bipolar disorder often include symptoms that overlap with ADHD. For example, hyperactivity and reduced concentration are common in major depression. However, when patients that are diagnosed with major depression and ADHD have the symptoms that are part of major depression subtracted from their ADHD diagnosis, the majority of these dual diagnosed patients still meet the criteria for ADHD. Also, when the symptoms of ADHD were removed from patients with a dual diagnosis that included major depression, most of them still met the criteria for major depression.

This overlapping or comorbid occurrence of two or more psychiatric diagnoses in an individual is common. Interestingly, when family studies are done, some conditions such as ADHD and depression tend to run together in families. Other conditions as anxiety disorders and ADHD run independent of each other.

Impairments and other negative consequences in ADHD patients cannot be all explained away by coexisting conditions of conduct disorder, major depression, and learning disabilities. For example, rates of arrest, drug abuse, and executive dysfunction are elevated in ADHD. These problems are further elevated it conduct disorder is also present.

3. COURSE AND OUTCOME
A valid psychiatric disorder needs to have a characteristic course and outcome. Long-term studies showed childhood ADHD is a chronic disorder that survived into adulthood in a significant number of patients. While many fail to meet the full strict criteria for the condition in adulthood, 90% retained significant symptoms to have persistent significant clinical impairments. Numerous studies report that ADHD has a natural course that provides another method ofdelimiting it from other disorders. For example, if symptoms of ADHD occur intermittently along with episodes of another disorder, this would not be viewed as evidence of ADHD because of lack of chronic persistence of symptoms.

4. EVIDENCE FOR HERITABILITY FROM FAMILY AND GENETIC STUDIES
ADHD meets the criteria for being a scientifically based disorder on neurologic grounds of being heritable. Numerous family studies and genetic studies provide evidence.

Family studies found parents and siblings of ADHD children have a 2-8 fold increased risk of being ADHD. All 15 twin studies showed increased risk in the twin of an ADHD child. The risk was 75% for familial status of having ADHD. Consequently, only 25% of this is due to environmental factors. The studies came from families from around the world (US, UK, Australia and Sweden). Studies from all of these countries are in agreement that there is an inherited risk for ADHD.

Adoption studies provide further evidence of the genetic influence on risks for ADHD. Biologic relatives of ADHD children have higher rates of ADHD than adopted relatives.

Molecular genetics studies found strong association between several neurotransmitter genes and ADHD. These neurotransmitters are dopamine, norepinephrine, and serotonin. They are implicated in causing ADHD and are involved in the therapeutic effects of ADHD medications.

5. LABORATORY STUDIES
Another method of developing evidence to support a neurobiological connection of ADHD diagnoses is laboratory studies. PET scan studies found evidence of defective dopamine transporter function in the striatal region of the brain of ADHD patients. These were performed on live patients with real-time images of metabolic activity. Scientifically controlled studies of the physical structure of brain of ADHD patients compared to normal found evidence of abnormal structures in parts of the brain. Ten controlled studies of brain function found abnormalities in multiple areas of the brain of ADHD patients. While the particular parts of the brain were not consistently involved in the different ADHD patients, the findings were consistent with their knowledge of brain pathways and systems involved in the regulation of complex behaviors that may be involved in the motor control, in attention, and executive function deficits seen in ADHD.

6. TREATMENT RESPONSE
The validity of a diagnosis is bolstered if patients with a defined condition respond to a particular medication treatment. Many controlled studies provide evidence of the high rate of treatment response of methylphenidate in reducing overactivity, impulsiveness, and inattentiveness. In addition to improving ADHD symptoms, many studies provide strong evidence of the medication effectiveness in reducing ADHD-related impairments in children and adults. Other medications besides stimulants have been proven to be effective in ADHD patients. These include tricyclics and atomoxetine(Strattera). All of these medications have been shown to block norepinephrine and/or dopamine reuptake at receptor site. While this data provides additional evidence of the validity of the ADHD diagnosis, they do not mean that this treatment response should be used as a method to make the diagnosis. Stimulant medications can improve cognition and attention in non-ADHD individuals just as high blood pressure medicine may reduce blood pressure in people with normal blood pressure .

DISCUSSION
Numerous studies provide enough evidence that ADHD meets the six criteria of Robinson and Guze standard criteria:
“.........
1) ADHD patients show a characteristic pattern of hyperactivity, inattention, and impulsivity that lead to adverse outcomes.
2) ADHD can be distinguished from other psychiatric disorders including those with which it is frequently comorbid.
3) Longitudinal studies show ADHD is not an episodic disorder. It is always chronic and sometimes remits in adolescence or adulthood.
4) Twin studies show ADHD is a highly heritable disorder, as heritable as schizophrenia or bipolar disorder. And molecular genetic studies have discovered genes that explain some of the disorder’s genetic transmission.
5) Neuroimaging studies show that ADHD patients have abnormalities in the motor control frontal-cortical-cerebellar pathways involved in the control of attention, inhibition, and motor behavior.
6) Most ADHD patients show a therapeutic response to medications that block the dopamine or norepinephrine transporter.
.......”

One concern is that most studies have been done with the most severe examples of ADHD who are referred to doctors and clinics.Thus, the studied populations may not represent the whole spectrum of severity of symptoms and impairments. Therefore, it would not be valid to generalize the facts about these patients to nonreferred ADHD patients in the community. However, two of the criteria for the diagnosis of ADHD are based on wide population studies. (1) Several epidemiologic studies have been supportive because they found the clinical features of ADHD in these community population samples. (2) and several studies were done with population samples demonstrating the high heritability of ADHD in cases that are not necessarily the most severe cases.

Another group of critics argue that ADHD signs and symptoms are better viewed as a normal continuous varying spectrum of traits rather than a disorder. The problem with this argument is that even normal variation can be a disorder if the more extreme cases suffer distress or disability. An example is how the normal variations of blood pressure and serum cholesterol level become medically urgent disorders in the more extreme levels.

Other critics argue that because there is not 100% agreement of results among different studies, a diagnosis is not valid. However, the preponderance of the evidence is overwhelmingly supports that ADHD is a valid diagnosis, especially when careful reviews of the different studies and meta-analysis studies were done.

Some critics hold the opinion that ADHD impairments are due to a highly competitive society, failure of parenting and teaching, or societal intolerance of extreme but normal symptoms. However, the genetic and neurobiological evidence is too strong to totally discount. There obviously are environmental factors that contribute to whether or not a person develops ADHD. There Is much evidence that ADHD’s causes are multifactorial, caused by the addition and interplay of genes and environmental risk factors.

Parents and patients with ADHD often have misgivings about accepting help and medication for ADHD. When they encounter misunderstanding about the diagnostic validity of ADHD, their resistance grows. Corrective education from medical and mental-health professionals may be the first step in helping distressed ADHD patients to get help that will bring them relief and success in their lives.

Written by Dr. Darvin Hege, M.D. on January 8, 2010 with content drawn heavily from the following article:

The scientific foundation for understanding attention-deficit/hyperactivity disorder as a valid psychiatric disorder. Faraone SV. Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY 13210, USA. faraones@upstate.edu

Dr. Darvin Hege has 25 years of experience dealing with patients who may fit the criteria for ADHD and may need a medication like Adderall for ADHD. He offers evening and weekend office hours at his Atlanta, GA practice. Call today at 770-458-0007 to discuss getting an ADHD evaluation and for help deciding the most effective and safest treatment.

Vyvanse_How It Works November 5, 2009

Adderall For ADHD

Currently, 4.4% of the adult population has ADHD (Attention Deficit Hyperactivity Disorder). This disorder is present from childhood, but many times it is not diagnosed until the person reaches adulthood and takes on more responsibility such as what is required when managing finances and jobs, and when interacting with spouses or significant others or their children. Under these additional demands, the attributes of ADHD (inattention, distractibility, and impulsivity) may become more prevalent.

Dr. Darvin Hege, an Atlanta psychiatrist, says it is important for people who have become depressed, overly anxious, or have turned to alcohol, drug, or medication abuse to help them deal with the stresses of life, be evaluated for ADHD. Many times if a patient seeks help for these concerns, " the overlying problem of depression, anxiety, or substance abuse may be diagnosed and treated. However, the foundational problem of ADHD may be missed. Unless the ADHD is successfully treated, the person may improve temporarily but still struggle unnecessarily and be more prone to relapsing to another bout of depression, anxiety, or substance abuse".

How could it be that the foundational problem of ADHD may be missed? Dr. Hege advises that the symptoms of ADHD can change from childhood to adulthood. Since the hyperactivity portion of ADHD tends to diminish in adults, the diagnosis of ADHD may be missed in an adult. Inattentiveness generally remains from childhood, however, and this is the predominant symptom of adult ADHD. The medications that are prescribed for ADHD help the inattentiveness of ADHD more than the hyperactivity of the disorder, so these medications can be very successful in helping with core symptoms. One of the medications he commonly prescribes for ADHD is Adderall.

Adderall has been around for about 20 years and was first marketed as a weight loss and diet control drug called Obetrol. In 1996, the FDA approved Adderall for ADHD treatment and it has since become one of the more widely prescribed medications for the treatment of the disorder. Doctors and patients who use the drug say it has less "peaks and valleys" than Ritalin, so it is more user-friendly.

Adderall is a psychostimulant. In other words, it is a central nervous system stimulant or an amphetamine. It affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control.

One reason Dr. Hege uses Adderall for ADHD is that it is a mixture of four drugs from the amphetamine family that provides a broad spectrum of coverage. He notes that there are several pros to this group of drugs:

• they take effect quickly (in about one hour).


• they leave the blood quickly (in about 4-12 hours). Because of this, you do not need to take the medication every day so you can take them on a day when you'll need the extra assistance.


• 75-80% of people who have ADHD improve when taking Adderall for ADHD or something from the psychostimulant group of medications.

Anything with a "pro" has to have a "con" and there are some cons to consider when taking Adderall for ADHD:

• Because the medicine only works for 4-12 hours, work or study in the afternoon or evening may require additional doses.


• Because it takes about one hour for the medication to take effect, if you have trouble getting up for the alarm clock or getting organized in the morning, you will have to wait for the medication to take effect.


• If you have used an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam) within the past 14 days, you should not take Adderall. Serious, life-threatening side effects can occur if you take Adderall before the MAO inhibitor has cleared from your body.


• It has a significant risk for abuse and/or addiction.

The most common side effects of Adderall are restlessness, dizziness, insomnia, headache, dryness of the mouth, and weight loss.

Dr. Hege recommends an ADHD evaluation if you or those around you have concerns about your inattention, impulsiveness, and distractibility.



Dr. Darvin Hege has 25 years of experience dealing with patients who may fit the criteria for ADHD and may need a medication like Adderall for ADHD. He offers evening and weekend office hours at his Atlanta, GA practice. Call today at 770-458-0007 to discuss getting an ADHD evaluation and for help deciding the most effective and safest treatment. 

AFFORDABLE/CHEAP SUBSTITUTES FOR VYVANSE, ADDERALL XR, CONCERTA, FOCALIN XR, AND DEXEDRINE SPANSULES FOR ADULT ADHD.

Dramatic savings can be achieved with this strategy if you're willing to accept some inconvenience and a period of adjustment. Vyvanse, Adderall XR, Concerta, Focalin XR, and Dexedrine Spansules cost at least $125 per month if you are on one pill a day because they cost about four dollars per pill. If you need 2 or 3 pills per day, that costs $250 or $375 per month. Generic Adderall costs $.35 per pill at Costco. If you take 2 or 3 Adderalls per day, that's $.70 to $1 per day or about $20 to $30 per month. Here's how I implement this strategy for the most consistent focusing all day.
I have my patients set a daily alert in their cell phone to go off at a time in the morning soon after they arise each day. They promptly take their first dose of generic Adderall, Ritalin, Dexedrine, or Focalin for the day. Then they note how long it is until the benefit of the first dose starts to decline. The next day they set their second daily alert for each day at a time that is 30 minutes before their focus begins to decline. This way they take the next dose to be replacing the falling brain concentrations of the previous dose. This prevents a dip in focus between doses. Alerts are then set for the third and fourth doses of the day, as necessary, with the same interval between alerts as between the first and second alerts. My patients are reporting significant improvement in their work and school performance, more consistent and improved mood, and avoiding daytime crashes between doses. Crashes are the periods of tiredness, sleepiness, irritability, or easy crying from a rapid drop-off in ADHD medication brain concentrations.
When switching my patients from a more expensive, longer acting ADHD medication to the cheap, shorter acting, generic substitute, we start out on very low doses and then move up the doses gradually. This way we avoid side effects, find the most effective dose, adjust the period between doses, and adjust the size and time of the last dose of the day to prevent difficulty falling asleep.
For more information on how to save money on psychiatric medications, see my blog about affordable psychiatric medications http://www.eveningpsychiatrist.blogspot.com To make an appointment with Dr. Hege for evaluation and treatment for adult ADHD,
Call 770-458-0007.

Vyvanse Approved For Adults

Shire PLC announced today that Vyvanse has won US approval to treat adults. I have prescribed it for 275 patient since the FDA approved it for children and adolescents in August of 2007. 95% of these patients are adults. Only a few of my patients were afraid to take it because it was not FDA approved for adults.
This information was reported in the Wall Street Journal today, April 24, 2008, in an article on page D4, titled "ADHD Drug Is Approved for Adult Use".
Included in the article was this statement that Adderall XR will not lose patent protection until April 2009. I had been informed and was telling my patients that Adderall XR went off patent this year.

Additional information about Vyvanse may be found in three prior blogs on this blog site.
Additional information about Adult ADHD and women with adult ADHD may be found on my web pages, http://www.eveningpsychiatrist.com/aadd.htm , http://www.eveningpsychiatrist.com/aaddforwomen.htm .

Darvin Hege, M.D.
http://www.eveningpsychiatrist.com/index.html

Vyvanse Update On First 100 Patients Treated

I have now prescribed Vyvanse for 105 patients. My patient's responses have been better than I expected. The majority of the patients prefer or much prefer Vyvanse over Adderall XR. The chief advantage is the consistently improved concentration. The second most frequent benefit is that it lasts longer. Some patients report it lasts all day and they experience no "fade" before bedtime. Patients frequently say they just feel normal all the time. Many patients report no more of the "crash" that they experienced when their Adderall XR levels dropped later in the day.

The most frequent reason that patients want to change back to Adderall or Adderall XR is that their insurance doesn't cover it. Other patients feel it doesn't work as effectively as Adderall. As I get more experience, I am using higher doses and having fewer of these complaints. When I started prescribing Vyvanse I started at a dose similar to the total daily dose of Adderall the patient had been taking. Now I am aiming for approximately double that dose and I am getting better results.

Few patients complain of jitteriness even when I raise the dose significantly. Usually, each raise only prolongs the duration of benefit to a later point in the day. A few patients have had to stop Vyvanse because of abdominal distress, headache, or insomnia.

Call us today at 770-458-0007 for an appointment if you would like to be evaluated for Vyvanse.

Dr. Hege
January 05, 2007

For more information :
http://eveningpsychiatrist.blogspot.com/search/label/Vyvanse
and http://www.eveningpsychiatrist.com/aadd.htm

Dr Hege - Affordable Medications for Psychiatric Diagnoses

You’ve gone through the sometimes difficult process of being diagnosed with Adult ADHD, bipolar disorder, anxiety or depression. Now you have to figure out how to pay for the medication. Whether or not you have insurance to help with costs—you may find some of these tips helpful.

Generics are Affordable Medication

Choosing a generic over a brand medication is a great way to save money. Generic Adderall immediate release costs 90% less than brand Adderall XR. All of the antidepressants except Lexapro and Cymbalta are generic now.

The only atypical antipsychotic, dopamine blocking, mood stabilizer that is generic is Risperdal. The other most frequently prescribed mood stabilizers also have generics. They are lithium, valproic acid (Depakote), oxcarbezine (Trileptal), Keppra (levetiracetam), and carbamazepine (Tegretol). At this time, Zonegran(zonisamide) has no generic available.

A lot of prescription sleeping pills have generics including Ambien. All of the benzodiazepines are now generic, including the extended release Xanax (alprazolam ER).

However, often the newer, brand-only medications offer superior effectiveness and/or fewer side effects than the older generics. Consult your doctor or pharmacist about generic versus brand medications.

Where to Buy Affordable Medications

Patients tell me that the cheapest places to buy their psychiatric medicines are at Costco or Sam's Club. The biggest savings are in generic medication. (The spread between different stores’ prices on brand medications is not nearly as great as for generic medications.)

Patients report paying $.75 to $1.25 per pill at retail pharmacies for generic, short-acting Adderall. At Costco, they pay about $. 40 per pill. The pharmacies in Kroger and Target match prices. When you get a lower price at Costco or Sam’s Club, keep the receipt and present it at the most convenient, price-matching participating pharmacy when you fill your prescriptions the next time and ask for a matching price. An option is to go online at the Costco website and check out their price for your medication. Print it out for evidence to take to your price matching pharmacy. However, that list is not comprehensive and you may have to go to the store to get a price. Some patients have been able to call Costco to get a price, while others have been told they have to come in to the store to get a quote on their medication price.

By the way, you don't need a membership card to go to the pharmacy at Costco or Sam's Club. It is illegal for membership stores to require membership fees to access their pharmacies.

Other Tips for Affordable Medication

Another great way to save money is pill splitting. Most tablets can be split. A pill splitter costs $3-$5 and can be purchased in most pharmacies. Pill splitters are even available for $1 at the dollar stores.

The most dramatic cost savings are for patients who are on Abilify. If prescribed 2 mg per day, it is possible to split a 20 mg tablet into eighths, which is approximately 2.5 mg per day. Since Abilify has such a long half-life, the blood levels swing only a small amount from high to low each day. Patients are unlikely to experience any side effects if they get 1 mg one day and 4 mg another day.

A 30 day supply of the 2 mg size may cost around $400. By cutting the 2 milligram tablets into eighths, it only requires 4 tablets per month. At $13 per tablet, this is only $52 per month.

Other pills I frequently have patients cut are Lamictal 200 mg, Seroquel 400 mg, Trileptal 600 mg, gabapentin 600 mg, Adderall and Ritalin (both in the immediate release form), Provigil 200 mg, and Suboxone 8 mg.

You should discuss pill splitting with your doctor before you do it to make sure it is safe and will still be effective for your particular medication.

Call 770-458-0007 today to schedule an appointment for an evaluation to see if you are getting the most affordable and effective medications for your psychiatric diagnoses, such as Adult ADHD, depression, anxiety or bipolar disorder.

Darvin Hege, M.D.
http://www.eveningpsychiatrist.com/

New Stop Smoking Methods Available Now

Pharmaceutical solutions as stop smoking methods have been popular for a long time and include the nicotine patch, nicotine gum, or Wellbutrin.

What new Stop Smoking Methods are Available?

A relatively new drug, Chantix is having a profound effect on the smoking population in this country. Most of my patients say using Chantix is the easiest and most effective way to come off cigarettes or wet tobacco.

In fact, Chantix is starting to dent the business of the stop-smoking clinics because results are so much more effective than other methods. I noticed a stop-smoking clinic in a strip shopping center near my office has closed. It reminds me of what happened to the impotence clinics when Viagra came out—most clinics closed.

Stay Informed About New Stop Smoking Methods

Chantix has been out over a year but many people don’t even know about it yet. As a professional psychiatrist, I strive to keep abreast of any new forms of treatment and pass that information along to my patients.

A month ago, I had a patient that I was treating for depression. She felt well informed about how to quit smoking and had tried numerous ways to come off cigarettes over the years. When I mentioned Chantix, she’d never heard of it. She is now celebrating over a month of abstinence on Chantix and is delighted with how easy it was.

Will New Stop Smoking Methods Work for You?

Of course, not everyone is successful with Chantix. Many patients just don’t know how to quit smoking. Others are so discouraged from so many previous failures that they are reluctant to even try another method.

There is usually some clinical reason for failure to quit smoking that can be uncovered if the patient is willing to explore it with me. Some of the most common hurdles are other psychiatric conditions. When these conditions are defined and treated, patients are often successful with Chantix.

The most common obstacles to successfully quitting smoke are depression, anxiety, and/or other co-occurring substance abuse or dependence, such as alcohol, Xanax, or cocaine addictions. (Cigarette smoking is substance dependence. If a person becomes dependent on one substance, they are at high risk of becoming addicted to another substance as well). Untreated ADHD and bipolar disorder are also common contributors. When these conditions are successfully relieved with proper medication, stop smoking success rates improve significantly.

Possible side effects include nausea, headache, and irritability. Rare reports of violence may be related to associated alcohol or drug abuse.

Call 770-458-0007 or make an appointment to discuss using Chantix as a method to stop smoking and/or explore with you what treatable problem may be the root cause of your failure to stop smoking.

New ADHD Medicine

http://www.eveningpsychiatrist.com/aadd.htm
Vyvanse is a new form of Adderall that may have advantages for some patients. The advantages may be a more consistent improvement in ADHD symptoms throughout the day and may last longer than the extended release Adderall. There may be less abuse potential as well.

Vyvanse is a prodrug. A prodrug is not an active medication until it is metabolized in the body. Vyvanse is a compound of a protein and amphetamine. In the body amphetamine is split off from the protein and becomes active and goes to the brain. This splitting off is a chemical reaction that is rate limited. Therefore the amphetamine is released at a consistent, controlled rate that prevents spikes and dips of brain amphetamine concentrations throughout the day. When there is a spike, side effects of jitteriness, tremor, or edginess occur. When there is a dip, focus and productivity decrease. The brain level of the medication falls only after all the Vyvanse has been metabolized. The duration of the benefits lasts for 12 hours or longer if the dose given is high enough for the patient.

The risk of abuse is reduced because the amphetamine is bound to the protein. It is very difficult for drug abusing individuals to free the amphetamine and get it into the bloodstream by snorting or injecting it.

The FDA approved Vyvanse this summer for the indication of ADHD based on studies done in children and adolescents. We expect it to be effective and safe for adults with ADHD as well.

Vyvanse comes in 30, 50, and 70 mg dosages. We expect patients to benefit most and tolerate it best if their dosage of Vyvanse approximates 2-2.5 times their current total daily dosage of extended release and/or immediate release Adderall, especially for patients who have been taking multiple doses per day to have at least 12 hours of therapeutic blood levels per day.

If you are not already one of our patients, please call for an appointment to be evaluated so we can discuss these potential benefits for you.

Darvin Hege, M.D.

For more information about Vyvanse:
http://eveningpsychiatrist.blogspot.com/2008/01/vyvanse-update-on-first-100-patients.html and
http://www.eveningpsychiatrist.com/aadd.htm

WOMEN, ADULT ADHD, SUMMERTIME, AND CO-CCURRING CONDITIONS

Summertime can be an especially hard time for mothers, especially if they have adult ADHD. The usual multitasking responsibilities of motherhood are further strained by the additional hours of the emotionally draining, child care. The children require sustained attention and patient reactivity for their structure, nurturance, teaching, and discipline. If the mother is working as well, she has to juggle another competitor for her time, attention, and emotional and physical energy.

Women with adult ADHD are also at significantly higher risk of having children with ADHD. ADHD is one of the most highly heritable psychiatric conditions. Children with ADHD are difficult enough to deal with if the mother doesn't have ADHD. The combination of mother and child with ADHD can only exhaust the mother further.

Summertime is a great time for mothers who suspect they have ADHD to come in and get relief with medication. And if a child is suspected of having ADHD, it is a good time to bring in the child for evaluation when they're not in school. If they have ADHD and are treated effectively, a mother's summer may improve dramatically.

Co-occurring conditions are common with adult ADHD. Two recent studies now have shown significant improvement in bulimia and fibromyalgia when ADHD is present as well and the ADHD is effectively treated. The abstracts of the two articles can be viewed below.

Women are getting help for adult ADHD at a faster pace than men now. The third abstract below describes this trend. Join the ranks of your colleagues and call for help today.

Darvin Hege M.D. June 10, 2007
http://www.eveningpsychiatrist.com/aaddforwomen.htm


J Womens Health (Larchmt). 2005 May;14(4):345-50
Bulimia nervosa and attention deficit hyperactivity disorder: a possible role for stimulant medication.
Dukarm CP.
Department of Pediatrics, Sisters of Charity Hospital, Buffalo, New York 14214-2692, USA. dukharm@buffnet.net
BACKGROUND: Bulimia nervosa and attention deficit hyperactivity disorder (ADHD) share several key features, including impulsivity and low self-esteem. Stimulant medications have been highly effective in the treatment of ADHD. However, medication management of bulimia with antidepressants has demonstrated only partial resolution of bulimic symptoms. To date, there are no published reports of controlled trials evaluating the efficacy of stimulants for bulimia. The purpose of this paper is to report 6 patients with comorbid bulimia and ADHD who were treated with the stimulant medication, dextroamphetamine. RESULTS: All 6 patients described reported complete abstinence from binge eating and purging after treatment with psychostimulants, and none of the patients discontinued taking the medication because of side effects. The side effect of decreased appetite proved beneficial in decreasing the desire to binge eat. However, all 6 patients remained within a healthy weight range. CONCLUSIONS: Data from these case reports suggest a possible benefit of screening for ADHD as part of the overall evaluation of bulimia. In addition, these cases suggest the potential role of psychostimulants in the management of bulimia because of the high rate of abstinence from bulimic symptoms and the low rate of adverse side effects. Clinical trials are needed to fully evaluate the efficacy and tolerability of psychostimulants in the treatment of bulimia nervosa.
PMID: 15916509 [PubMed - indexed for MEDLINE]


Fibromylagia, chronic fatigue, and adult attention deficit hyperactivity disorder in the adult: a case study.
Psychopharmacol Bull. 2007;40(1):118-26


Young JL, Redmond JC.
Rochester Center for Behavioral Medicine, Rochester Hills, MI. judithcredmond@aol.com
Adult attention deficit hyperactivity disorder (ADHD) may share common features with fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS). In an outpatient psychiatric clinic, a number of adult patients who presented primarily with symptoms of ADHD, predominately inattentive type, also reported unexplained fatigue, widespread musculoskeletal pain or a pre-existing diagnosis of CFS or FMS. As expected, ADHD pharmacotherapy usually attenuated the core ADHD symptoms of inattention, distractibility, hyperactivity, and impulsivity. Less expected was the observation that some patients also reported amelioration of pain and fatigue symptoms. The utility of ADHD medications in FMS and CFS states may be their innate arousal and enhanced filtering properties. This model supposes that FMS and CFS are central processing problems rather than peripheral disorders of muscles and joints.
PMID: 17285103 [PubMed - indexed for MEDLINE]

J Atten Disord. 2007 May;10(4):335-42
Trends in medication treatment for ADHD.
Castle L, Aubert RE, Verbrugge RR, Khalid M, Epstein RS.
Medco Health Solutions. lon_castle@medco.com.
Objective: This study examines demographic trends in the use of medications to treat ADHD in adult and pediatric populations. Method: Using pharmacy claims data for a large population of commercially insured Americans, the study measures ADHD treatment prevalence and drug use from 2000 to 2005. Results: In 2005, 4.4% of children (ages 0 to 19) and 0.8% of adults (ages 20 and older) used ADHD medications. Treatment rates were higher in boys (6.1%) than in girls (2.6%), but the rates for men and women were approximately equal (0.8%). During the period of the study, treatment prevalence increased rapidly (11.8% per year) for the population as a whole. Treatment rates grew more rapidly for adults than for children, more rapidly for women than for men, and more rapidly for girls than for boys. Conclusion: Improved identification of ADHD in adult and female patients has contributed to rapid growth in ADHD medication use. (J. of Att. Dis. 2007; 10(4) 335-342).
PMID: 17449832 [PubMed - in process]

Darvin Hege, M.D.
<http://www.eveningpsychiatrist.com/aaddforwomen.htm>

Women, adult ADHD, summertime, bulimia, fibromyalgia

WOMEN, ADULT ADHD, SUMMERTIME, AND CO-OCCURRING CONDITIONS

Summertime can be an especially hard time for mothers, especially if they have adult ADHD. The usual multitasking responsibilities of motherhood are further strained by the additional hours of the emotionally draining, child care. The children require sustained attention and patient reactivity for their structure, nurturance, teaching, and discipline. If the mother is working as well, she has to juggle another competitor for her time, attention, and emotional and physical energy.

Women with adult ADHD are also at significantly higher risk of having children with ADHD. ADHD is one of the most highly heritable psychiatric conditions. Children with ADHD are difficult enough to deal with if the mother doesn't have ADHD. The combination of mother and child with ADHD can only exhaust the mother further.

Summertime is a great time for mothers who suspect they have ADHD to come in and get relief with medication. And if a child is suspected of having ADHD, it is a good time to bring in the child for evaluation when they're not in school. If they have ADHD and are treated effectively, a mother's summer may improve dramatically.

Co-occurring conditions are common with adult ADHD. Two recent studies now have shown significant improvement in bulimia and fibromyalgia when ADHD is present as well and the ADHD is effectively treated. The abstracts of the two articles can be viewed below.

Women are getting help for adult ADHD at a faster pace than men now. The third abstract below describes this trend. Join the ranks of your colleagues and call for help today.


Darvin Hege M.D. ; June 10, 2007



J Womens Health (Larchmt). 2005 May;14(4):345-50
Bulimia nervosa and attention deficit hyperactivity disorder: a possible role for stimulant medication.
Dukarm CP.
Department of Pediatrics, Sisters of Charity Hospital, Buffalo, New York 14214-2692, USA. dukharm@buffnet.net
BACKGROUND: Bulimia nervosa and attention deficit hyperactivity disorder (ADHD) share several key features, including impulsivity and low self-esteem. Stimulant medications have been highly effective in the treatment of ADHD. However, medication management of bulimia with antidepressants has demonstrated only partial resolution of bulimic symptoms. To date, there are no published reports of controlled trials evaluating the efficacy of stimulants for bulimia. The purpose of this paper is to report 6 patients with comorbid bulimia and ADHD who were treated with the stimulant medication, dextroamphetamine. RESULTS: All 6 patients described reported complete abstinence from binge eating and purging after treatment with psychostimulants, and none of the patients discontinued taking the medication because of side effects. The side effect of decreased appetite proved beneficial in decreasing the desire to binge eat. However, all 6 patients remained within a healthy weight range. CONCLUSIONS: Data from these case reports suggest a possible benefit of screening for ADHD as part of the overall evaluation of bulimia. In addition, these cases suggest the potential role of psychostimulants in the management of bulimia because of the high rate of abstinence from bulimic symptoms and the low rate of adverse side effects. Clinical trials are needed to fully evaluate the efficacy and tolerability of psychostimulants in the treatment of bulimia nervosa.
PMID: 15916509 [PubMed - indexed for MEDLINE]


Fibromylagia, chronic fatigue, and adult attention deficit hyperactivity disorder in the adult: a case study.
Psychopharmacol Bull. 2007;40(1):118-26


Young JL, Redmond JC.
Rochester Center for Behavioral Medicine, Rochester Hills, MI. judithcredmond@aol.com
Adult attention deficit hyperactivity disorder (ADHD) may share common features with fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS). In an outpatient psychiatric clinic, a number of adult patients who presented primarily with symptoms of ADHD, predominately inattentive type, also reported unexplained fatigue, widespread musculoskeletal pain or a pre-existing diagnosis of CFS or FMS. As expected, ADHD pharmacotherapy usually attenuated the core ADHD symptoms of inattention, distractibility, hyperactivity, and impulsivity. Less expected was the observation that some patients also reported amelioration of pain and fatigue symptoms. The utility of ADHD medications in FMS and CFS states may be their innate arousal and enhanced filtering properties. This model supposes that FMS and CFS are central processing problems rather than peripheral disorders of muscles and joints.
PMID: 17285103 [PubMed - indexed for MEDLINE]

J Atten Disord. 2007 May;10(4):335-42
Trends in medication treatment for ADHD.
Castle L, Aubert RE, Verbrugge RR, Khalid M, Epstein RS.
Medco Health Solutions. lon_castle@medco.com.
Objective: This study examines demographic trends in the use of medications to treat ADHD in adult and pediatric populations. Method: Using pharmacy claims data for a large population of commercially insured Americans, the study measures ADHD treatment prevalence and drug use from 2000 to 2005. Results: In 2005, 4.4% of children (ages 0 to 19) and 0.8% of adults (ages 20 and older) used ADHD medications. Treatment rates were higher in boys (6.1%) than in girls (2.6%), but the rates for men and women were approximately equal (0.8%). During the period of the study, treatment prevalence increased rapidly (11.8% per year) for the population as a whole. Treatment rates grew more rapidly for adults than for children, more rapidly for women than for men, and more rapidly for girls than for boys. Conclusion: Improved identification of ADHD in adult and female patients has contributed to rapid growth in ADHD medication use. (J. of Att. Dis. 2007; 10(4) 335-342).
PMID: 17449832 [PubMed - in process]