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ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
ADHD 101: Everything You Need To Know About Diagnosis and Treatment
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ADHD 101: Everything You Need To Know About Diagnosis and Treatment

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An Overview of Attention Deficit/Hyperactivity Disorder, including information on diagnosis and treatment options. Presented by Dr. MIchael Lara, MD

An Overview of Attention Deficit/Hyperactivity Disorder, including information on diagnosis and treatment options. Presented by Dr. MIchael Lara, MD

Published in: Health & Medicine
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  • hi could someone please mail me copy on jorhden.djembs@hotmail.fr , thanks
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  • This is a clear and comprehensive presentation on Adult ADHD by Michael Lara, MD, an extremely skilled psychiatrist based in Silicon Valley.

    I've been fortunate to be in attendance at several of Dr. Lara's presentations, and they are top-notch.

    His knowledge is unusually broad-based and yet highly specialized and up-to-date, incorporating lifestyle issues (diet and exercise, for example) as well as nutritional supplements and medication. He appreciates ADHD for the complex condition that it is.

    Gina Pera, author
    Is It You, Me, or Adult A.D.D.?
    http://www.ADHDRollerCoaster.org
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  • This section highlights key demograhic data among U.S. hispanics and identifies current disparities in the diagnosis and treatment of major depression and anxiety.
  • This section highlights key demograhic data among U.S. hispanics and identifies current disparities in the diagnosis and treatment of major depression and anxiety.
  • Transcript

    • 1. ADHD 101: The Basics ofADHD 101: The Basics of Evaluation and TreatmentEvaluation and Treatment Michael Lara, MD Diplomate, American Board of Psychiatry and Neurology Private Practice Psychiatry Belmont, CA www.MichaelLaraMD.com
    • 2. The only factor becoming scarce in a world of abundance is human attention -Kevin Kelly Always seek the advice of a trained health professional before seeking any new treatment regarding your medical diagnosis or condition. Any information received from this course is not intended to diagnose, treat, or cure. This presentation is for information purposes only.
    • 3. ADHD DefinedADHD Defined
    • 4. What is ADHD?What is ADHD? • Neurobehavioral disorder beginning in childhood that results in: • Inattention • Impulsivity • Hyperactivity • Causes dysfunction in at least two different areas: • Peer or family relationships • Work or school • Home • Symptoms are not accounted for by another medical or psychiatric condition
    • 5. ADHD PrevalenceADHD Prevalence ADHD has been found to exist in every country and culture studied Prevalence among children: 5%-8% Prevalence among adults: 4-8% Gender prevalence: Males: 10% Females: 4%
    • 6. Genetics of ADHDGenetics of ADHD If you have a…. Your risk for having ADHD is… Parent with ADHD More than 50% Brother or sister with ADHD 41% Child with ADHD 25% Identical twin with ADHD 80%
    • 7. ADHD in AdolescenceADHD in Adolescence 3x more likely to fail a grade 3x more likely to be suspended 2x likely to drop out of school Adolescents with ADHD also have: 4x as many serious injuries 3x as many motor vehicle accidents
    • 8. ADHD in AdulthoodADHD in Adulthood • ADHD symptoms persist for up to 65% of patients, even though they might not meet full criteria • Survey data suggest that 4.4% of adults have ADHD, yet only 10.9% of adults with ADHD received treatment in the prior year • 50% to 75% of adults with ADHD also suffer other mental health disorders ( anxiety, mood disorders, substance abuse) • Adults with ADHD earn $10K less than those without ADHD
    • 9. Consequences of Untreated ADHDConsequences of Untreated ADHD Problems at home Twice as likely to have been divorced 30% less likely to say they are “completely satisfied” with family life Problems at work Lower earning potential 40% less likely to be employed full time Almost 60% more job changes within past 10 years Problems in life 47% more likely to have received more than one speeding ticket within a 12-month period More than twice as likely to have been arrested
    • 10. What Causes ADD?What Causes ADD? No single cause has been identified; most likely the result of environmental factors and genetic predisposition Decreased cerebellar volume Hereditary dopamine deficiency DAT1, DRD4, dopamine beta hydroxylase Nutritional deficiency Zinc deficiency, iron deficiency, omega-3 fatty acid deficiency Toxicity Lead, heavy metals Environmental or lifestyle factors can exacerbate symptoms
    • 11. Differences in the ADHD BrainDifferences in the ADHD Brain Pre-frontal Cortex Responsible for executive function that regulates time management, judgment, impulse control, planning, organization, and critical thinking Limbic System Regulates emotion. Affects moodiness, irritability, negatively, and the ability to identify and make sense of emotions Reticular Activating System Responsible for arousal and attention; affects attention and impulse control
    • 12. Role of Cerebellum in ADDRole of Cerebellum in ADD Cerebellum responsible for organizing movement, coordination, and timing Studies in children with ADD reveal a diminished size in cerebellar vermis Some hypothesize that training cerebellum through motor/visual coordination exercises may enhance learning and diminish ADD
    • 13. Diagnosis of ADHDDiagnosis of ADHD
    • 14. Diagnosis of ADHDDiagnosis of ADHD History and mental status exam by a trained clinician are the cornerstones of a reliable diagnosis Questionnaires or clinician-administered scales are helpful for eliciting symptoms but are insufficient in themselves for making the diagnosis Limited role for neuroimaging MRI, fMRI, PET, or SPECT scans are of limited use in clinical setting but have a role in the research setting
    • 15. Differential Diagnosis of Adult ADHDDifferential Diagnosis of Adult ADHD Anxiety or Mood disorders Major depressive disorder, bipolar disorder Substance Abuse disorder Stimulant or caffeine abuse Neurologic disorders Seizure disorder, traumatic brain injury Nutritional/Metabolic disorders Hypoglycemia, B12 deficiency, hyponatremia Thyroid dysfunction Sleep disorders Apnea, narcolepsy, shift-work sleep disorder
    • 16. Neuropsychiatric Disorders that haveNeuropsychiatric Disorders that have Inattention as a Core FeatureInattention as a Core Feature • Mood Disorders • Major Depression, Bipolar disorder • Anxiety Disorders • Generalized anxiety disorder, PTSD, OCD • Psychotic Disorders • Premorbid schizophrenia • Traumatic brain injury • Developmental Disorders • Autism, learning disorders, conduct disorder, oppositional defiant disorders • Personality Disorders
    • 17. Attention Deficit TraitAttention Deficit Trait • ADT, a term coined by Dr. Edward Hallowell, is defined as a neurological phenomenon of cortical overload characterized by: •Distractability •Inner frenzy •Impatience • ADT may be regarded as a less-severe form of ADD that is triggered by environmental or lifestyle factors
    • 18. Diagnostic Criteria for ADD:Diagnostic Criteria for ADD: InattentionInattention • Six or more of the following symptoms of inattention: • Often fails to give close attention to details • Often has difficulty sustaining attention in tasks or play • Often does not seem to listen when spoken to directly • Often does not follow through on instructions • Often has difficulty organizing tasks and activities • Often avoids tasks that require sustained mental effort • Often loses things necessary for tasks or activities • Is often easily distracted by external stimuli • Is often forgetful in daily activities
    • 19. Diagnostic Criteria for ADD:Diagnostic Criteria for ADD: Hyperactivity-ImpulsivityHyperactivity-Impulsivity • Six or more of the following symptoms of inattention: • Often fidgets with hands or feet or squirms in seat • Often leaves seat in situations where remaining seated • Subjective restlessness or inapproriate motoric activity • Often has difficulty in engaging in leisure activities • Is often “on the go” or often acts as if driven by a motor • Often talks excessively • Often blurts out answers before question complete • Often has difficulty awaiting turn • Often interrupts or intrudes on others
    • 20. Adult Self-Report Scale (ASRS)Adult Self-Report Scale (ASRS) How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done? How often do you have difficulty getting things in order when you have to do a task that requires organization? How often do you have problems remembering appointments or obligations?
    • 21. Adult Self-Report Scale (ASRS)Adult Self-Report Scale (ASRS) When you have a task that requires a lot of thought, how often do you avoid or delay getting started How often do you fidget or squirm with your hands and feet when you have to sit down for a long time? How often do you feel overly active and compelled to do things, as if you were driven by a motor?
    • 22. Treatment Options for ADHDTreatment Options for ADHD
    • 23. How is ADD Treated?How is ADD Treated? Behavioral Modification/Coaching Cognitive behavioral therapy Dietary/Nutritional Modifications B-complex vitamins, Omega-3 fatty acids Exercise Rhythmic aerobic activity at 60-70% maximum heart rate High-Intensity Interval Training at >80% maximum heart rate Lifestyle Modification Limit email, cell phone, internet Medication • Stimulant and nonstimulant
    • 24. Pharmacologic OptionsPharmacologic Options
    • 25. Monoamines and AttentionMonoamines and Attention Serotonin NorepinephrineDopamine Anxiety Irritability Appetite Attention Concentration Motivation Drive Mood
    • 26. Serotonin PathwaySerotonin Pathway Tryptophan 5-HTP Serotonin Melatonin Tryptophan Hydroxylase (rate-limiting enzyme)
    • 27. Dopamine and Norepinephrine PathwayDopamine and Norepinephrine Pathway Tyrosine L-Dopa Dopamine Norepinephrine Tyrosine Hydroxylase (rate-limiting enzyme) Dopamine ß hydroxylase Phenylalanine
    • 28. Pharmacologic Options for ADHDPharmacologic Options for ADHD Stimulants Methylphenidate (Ritalin) Dexmethylphenidate (Focalin) Transdermal Methylphenidate (Daytrana) Mixed Amphetamine Salts (Adderall) Lisdexamfetamine (Vyvanse) Dextroamphetamine (Dexedrine) Nonstimulant medications Atomoxetine (Strattera) Modafinil (Provigil) Antidepressants Tricyclic Antidepressants Bupropion
    • 29. StimulantsStimulants • D-Amphetamine (Dexedrine) • Dexedrine tablets 2-4 hr • Vyvanse (Dexedrine prodrug) 8-12 hr • Mixed Amphetamine Salts (MAS) • AdderallXR 6-8 hr • Adderall tablets 3-6 hr • D,L-Methylphenidate (MPH) • Ritalin 2-4 hr • Ritalin-SR 8 hr • Ritalin-LA 8 hr • Concerta 10-12 hr • Dexmethylphenidate XR 8 hr • Transdermal MPH 9 hr
    • 30. Non-StimulantsNon-Stimulants • Modafinil (Provigil) • Prohistaminergic mechanism of action • “Non-stimulant” stimulant • Approved for excessive daytime sleepiness associated with shift- work sleep disorder, obstructive sleep apnea • Atomoxetine (Strattera) • Norepinephrine reuptake inhibitor in frontal cortex • Dosing in evening or morning • Delayed time to onset of therapeutic action • Antidepressants • Tricyclic Antidepressants • BupropionXL (WellbutrinXL)
    • 31. Nutritional PracticesNutritional Practices An Overview
    • 32. Nature’s PharmacopoeiaNature’s Pharmacopoeia Tryptophan Tyrosine Serotonin Dopamine Norepinephrine
    • 33. B-Vitamins and ADHDB-Vitamins and ADHD • B-vitamins are co-factors in the synthesis of monoamines • Most evidence for B-6 (pyridoxine) deficiency, but B-9 (folate) and B-12 deficiencies have been documented • High-stress states deplete body’s stores of B-vitamins • Antidepressants and stimulant medications are known to deplete B-vitamins • Key ingredient in many OTC formulations for ADHD treatment • Focus Factor, Synaptol • Recommend High-Potency, Hypoallergenic B-Complex with meals every morning
    • 34. Omega-3 Fatty AcidsOmega-3 Fatty Acids Form of polyunsaturated fats Omega-3 and Omega-6s are essential fatty acids (EFAs) Different types of Omega-3s • EPA and DHA: tuna, salmon, mackeral • ALA: dark, leafy green vegetables and flaxseed Recommend 2-5 g of pharmaceutical-grade Omega 3-Fatty Acids www.zonelabsinc.com www.omegabrite.com
    • 35. L-TyrosineL-Tyrosine Essential amino acid; precursor for dopamine • Reported to also increase PEA, a mild stimulant found in high concentrations in chocolate Benefits include relief of fatigue, ADHD, mental concentration, athletic performance enhancement Side effects include mild weight loss and GI upset
    • 36. Michael Lara, MD Diplomate, American Board of Psychiatry & Neurology www.MichaelLaraMD.com Always seek the advice of a trained health professional before seeking any new treatment regarding your medical diagnosis or condition. Any information received from this course is not intended to diagnose, treat, or cure. This presentation is for information purposes only.

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