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No teorijas l ī dz praksei:  Uzman ī bas defic ī ta un hiperaktivit ā tes sindroma (UDHS) diagnoze un  ā rst ē šana Guntis Rozent ā ls  Latvijas B ē rnu Neirologu Asoci ā cijas prezidents Uzman ī bas defic ī ts un hiperaktivit ā tes sindroms.  Diagnostika un jaun ā k ā s  ā rst ē šanas metodes. R ī ga, 2009. gada 3. apr ī lis
Dienas k ā rt ī ba ,[object Object],[object Object],[object Object],[object Object],[object Object]
Uzman ī bas defic ī ta un hiperaktivit ā tes sindroma (UDHS) simptomi; bie ž ums;  ietekme uz sabiedr ī bu
UDHS simptomi Neuzman ī ba Hiperaktivit ā te Impulsivit ā te
Simptomu grupas ,[object Object],[object Object],Neuzman ī ba Hiperaktivit ā te Impulsivit ā te ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
UDHS simptomu dinamika saist ī b ā   ar pacienta vecumu Pirmskola > 7g  S ā kumskola 7-12 g  Pusaudzis 13- 16 g  Vidusskola 16-19g  Pieaugušais ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
UDHS: izplat ī ba un demogr ā fija Goldman, et al.  JAMA .1998;279:1100-1107. 0 5 % 10 % 15 % 20 % New Zealand (Anderson et al 1997) Ontario (Szatmari et al 1989) US inner city (Newcorn et al 1989) Pittsburgh, Pa (Costello et al 1988) Iowa (Lindgren et al 1990) Germany (Baumgaertel et al 1995) London,  England (Esser et al 1990) Mannheim, Germany (Esser et al 1990) Tennessee (Wolraich et al 1996) United States (Shaffer et al 1996) UDHS  izplat ī ba  (%)  skolas vecuma b ē rniem P ē t ī jumi UDHS bie ž uma noteikšanai
Ne ā rst ē ts/neatbilstoši  ā rst ē ts UDHS ietekm ē  da žā dus dz ī ves aspektus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
UDHS pacienta uzved ī ba sal ī dzin ā jum ā  ar veseliem b ē rniem B ē rniem ar UDHS uzved ī bas normas iev ē rojami atš ķ iras no normas grupas  1   Respondenti ar UDHS  n=910,  Normas grupa  n=995 Respondents (%) % Coghill D, Soutullo C, d’Aubuisson C, Preuss U, Lindback T, Silverberg M, Buitelaar J. Impact of attention-deficit/hyperactivity disorder on thepatient and family:  Results from a European survey. Child and Adolescent Psychiatry and Mental Health 2008, 2:31, doi:10.1186/1753-2000-2-31.
Laiks, kur ā  visvair ā k tiek nov ē rota hiperaktivit ā te Respondents (%) % Respondenti ar UDHS  n=910,  Normas grupa  n=995 Coghill D, Soutullo C, d’Aubuisson C, Preuss U, Lindback T, Silverberg M, Buitelaar J. Impact of attention-deficit/hyperactivity disorder on the   patient and family:  Results from a European survey. Child and Adolescent Psychiatry and Mental Health 2008, 2:31, doi:10.1186/1753-2000-2-31.
UDHS pacienta uzved ī bas ietekme uz attiec ī b ā m Respondents (%) % Respondenti ar UDHS  n=910,  Normas grupa  n=995 C oghill D, Soutullo C, d’Aubuisson C, Preuss U, Lindback T, Silverberg M, Buitelaar J. Impact of attention-deficit/hyperactivity disorder on the   patient and family:  Results from a European survey. Child and Adolescent Psychiatry and Mental Health 2008, 2:31, doi:10.1186/1753-2000-2-31.
Uzman ī bas defic ī ta un hiperaktivit ā tes sindroma (UDHS) diagnostika
UDHS Diagnostiskie krit ē riji ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ī ss p ā rskats par diagnostikas/nov ē rt ē juma  skal ā m
Starptautisk ā  slim ī bu klasifikatora (SSK -10 ) un DSM- IV diagnostikas krit ē riji/skala  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1.SSK -10  mentālie un uzvedības klasifikācijas traucējumi .  Pētījuma diagnostikas kritēriji.  WHO.  ww.who.int/classifications.icd/en/GRNBOOK.pdf 2. Buitelaar JK, et al. Eur Neuropsychopharmacol 2003; 13: 297-304. 3. ICD-10  mentālie un uzvedības klasifikācijas traucējumi .  Klīniskais raksturojums un diagnostikas pamatnostādnes . WHO.   www.who.int/classifications.icd/en/bluebook.pd f 4.  Diagnostic criteria for ADHD (DSM-IV).  www.turnertoys.com/ADHD/APA_diagCriteria.htm
UDHS nov ē rt ē šanas skalas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
UDHS nov ē rt ē šanas skalas  Konnera skala ,[object Object],[object Object],[object Object],Adapted from Loney J, Milich R. In: Wolraich M, Routh DK, eds.  Advances in   developmental and behavioral pediatrics. 3rd ed. 1982. pp 113–147.
UDHS nov ē rt ē šanas skalas  Konnera skala LV 1. Adapted from Loney J, Milich R. In: Wolraich M, Routh DK, eds.  Advances in   developmental and behavioral pediatrics. 3rd ed. 1982. pp 113–147. 2. ADHD in education.  www.durham.gov.uk  Neuzman ī ba / p ā r ā k liela aktivit ā te  (I/O  -  inattention/overactivity ) apakšskala Opozicion ā rs / Nepak ļ aušan ā s  (O/D  -  oppositional/defiance ) apakšskala ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Dundee s ,[object Object],[object Object],[object Object],UDHS nov ē rt ē šanas skalas  Dundee   skala Coghill D; Development and practices in ADHD, Congress of European Society of  Child and Adolescent Psychiatry, Florence 2007
UDHS nov ē rt ē šanas skalas  SKAMP  skala ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
UDHS nov ē rt ē šanas skalas  SKAMP  skala Katrs punkts tiek skait ī ts atseviš ķ i .  Uz uzman ī bu attiecas sekojoši punkti : 1, 2, 3, 4, 5, B1  un  B2.  P ā r ē jie punkti attiecas uz iztur ē šanos  ( tie ir -   6, 7, 8, 9,  un  10).  Vid ē js uzman ī bas un iztur ē šan ā s punktu skaits ir noteikts no individu ā l ā  punktu skaita attiec ī gajam punktam ,[object Object],Uzman ī ba Iztur ē šan ā s ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ā rst ē šanas strat ēģ ijas
Galvenie kompleks ā s terapijas principi M ā c ī bu darba pl ā nošana skol ā  un m ā jas darbu veikšan ā Psihologa konsult ā cijas Uzved ī bas mode ļ a/trauc ē jumu  korekcija un modifik ā cija
Taktika m ā c ī bu darba pl ā nošanai  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Taylor E et al. Eur Child Adolesc Psychiatry  1998 ; 13 ( 4 ): 1 84 - 200 M ē r ķ is  kontrol ē t, regul ē t un vad ī t m ā c ī šanos /uzved ī bu skol ā , palielin ā t koncentr ā cijas sp ē jas .
Taktika uzved ī bas trauc ē jumu korekcijai m ā j ā s/ b ē rns- vec ā ki attiec ī bas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Br ī v ā  laika nodarb ī bas ,[object Object],[object Object],[object Object],[object Object]
Uzman ī bas defic ī ta un hiperaktivit ā tes sindroma (UDHS) Medikamentoza terapija
MTA  grupas neatkar ī gs p ē t ī jums UDHS pacientiem ( Multimodal treatment study af children with ADHD ) The MTA Cooperative Group. Arch Gen Psychiatry 1999; 56: 1073-86. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Individualiz ē ta medikamentoza terapija  Individualiz ē ta uzved ī bas terapija (biheivorisma terapija) Medikamentoza terapija+ Individualiz ē ta uzved ī bas terapija Nespecifiska terapija
MTA  grupas neatkar ī gs p ē t ī jums UDHS pacientiem (Multimodal treatment study af children with ADHD) ,[object Object],[object Object],[object Object],The MTA Cooperative Group. Arch Gen Psychiatry 1999; 56: 1073-86. Ieg ū tie rezult ā ti
Secin ā jumi ,[object Object],[object Object],[object Object],[object Object]
Paldies par uzman ī bu

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UDHS

  • 1. No teorijas l ī dz praksei: Uzman ī bas defic ī ta un hiperaktivit ā tes sindroma (UDHS) diagnoze un ā rst ē šana Guntis Rozent ā ls Latvijas B ē rnu Neirologu Asoci ā cijas prezidents Uzman ī bas defic ī ts un hiperaktivit ā tes sindroms. Diagnostika un jaun ā k ā s ā rst ē šanas metodes. R ī ga, 2009. gada 3. apr ī lis
  • 2.
  • 3. Uzman ī bas defic ī ta un hiperaktivit ā tes sindroma (UDHS) simptomi; bie ž ums; ietekme uz sabiedr ī bu
  • 4. UDHS simptomi Neuzman ī ba Hiperaktivit ā te Impulsivit ā te
  • 5.
  • 6.
  • 7. UDHS: izplat ī ba un demogr ā fija Goldman, et al. JAMA .1998;279:1100-1107. 0 5 % 10 % 15 % 20 % New Zealand (Anderson et al 1997) Ontario (Szatmari et al 1989) US inner city (Newcorn et al 1989) Pittsburgh, Pa (Costello et al 1988) Iowa (Lindgren et al 1990) Germany (Baumgaertel et al 1995) London, England (Esser et al 1990) Mannheim, Germany (Esser et al 1990) Tennessee (Wolraich et al 1996) United States (Shaffer et al 1996) UDHS izplat ī ba (%) skolas vecuma b ē rniem P ē t ī jumi UDHS bie ž uma noteikšanai
  • 8.
  • 9. UDHS pacienta uzved ī ba sal ī dzin ā jum ā ar veseliem b ē rniem B ē rniem ar UDHS uzved ī bas normas iev ē rojami atš ķ iras no normas grupas 1 Respondenti ar UDHS n=910, Normas grupa n=995 Respondents (%) % Coghill D, Soutullo C, d’Aubuisson C, Preuss U, Lindback T, Silverberg M, Buitelaar J. Impact of attention-deficit/hyperactivity disorder on thepatient and family: Results from a European survey. Child and Adolescent Psychiatry and Mental Health 2008, 2:31, doi:10.1186/1753-2000-2-31.
  • 10. Laiks, kur ā visvair ā k tiek nov ē rota hiperaktivit ā te Respondents (%) % Respondenti ar UDHS n=910, Normas grupa n=995 Coghill D, Soutullo C, d’Aubuisson C, Preuss U, Lindback T, Silverberg M, Buitelaar J. Impact of attention-deficit/hyperactivity disorder on the patient and family: Results from a European survey. Child and Adolescent Psychiatry and Mental Health 2008, 2:31, doi:10.1186/1753-2000-2-31.
  • 11. UDHS pacienta uzved ī bas ietekme uz attiec ī b ā m Respondents (%) % Respondenti ar UDHS n=910, Normas grupa n=995 C oghill D, Soutullo C, d’Aubuisson C, Preuss U, Lindback T, Silverberg M, Buitelaar J. Impact of attention-deficit/hyperactivity disorder on the patient and family: Results from a European survey. Child and Adolescent Psychiatry and Mental Health 2008, 2:31, doi:10.1186/1753-2000-2-31.
  • 12. Uzman ī bas defic ī ta un hiperaktivit ā tes sindroma (UDHS) diagnostika
  • 13.
  • 14. Ī ss p ā rskats par diagnostikas/nov ē rt ē juma skal ā m
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22. Ā rst ē šanas strat ēģ ijas
  • 23. Galvenie kompleks ā s terapijas principi M ā c ī bu darba pl ā nošana skol ā un m ā jas darbu veikšan ā Psihologa konsult ā cijas Uzved ī bas mode ļ a/trauc ē jumu korekcija un modifik ā cija
  • 24.
  • 25.
  • 26.
  • 27. Uzman ī bas defic ī ta un hiperaktivit ā tes sindroma (UDHS) Medikamentoza terapija
  • 28.
  • 29.
  • 30.