The document summarizes key changes made to the diagnostic criteria for ADHD in the DSM-5. Some of the major changes include: expanding the age of onset for symptoms from 7 to 12 years old; reducing the number of required symptoms for adults from 6 to 5; changing the subtypes to presentations; removing the requirement for impairment in multiple settings; and allowing an ADHD diagnosis to be made comorbid with autism spectrum disorder. The changes are aimed at better capturing the presentation of ADHD across the lifespan but may increase prevalence rates, especially in adolescents and adults. There is still a lack of biological validity for psychiatric diagnoses.
Evidence-based counseling therapies for attention-deficit/hyperactivity disor...Jeffrey Ahonen
This presentation addresses psychotherapuetic treatment of attention-deficit/hyperactivity disorder in adults. A brief overview is presented of the current conceptualization of this disorder in the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A brief discussion is set forth regarding mental health counseling therapies that have demonstrated effectiveness in helping adults to cope and improve social and occupational functionality.
This presentation might be useful as an introduction to psychotherapeutic treatment of ADHD in adults, particularly within an undergraduate or lower-level graduate course in psychology or mental health counseling.
Evidence-based counseling therapies for attention-deficit/hyperactivity disor...Jeffrey Ahonen
This presentation addresses psychotherapuetic treatment of attention-deficit/hyperactivity disorder in adults. A brief overview is presented of the current conceptualization of this disorder in the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A brief discussion is set forth regarding mental health counseling therapies that have demonstrated effectiveness in helping adults to cope and improve social and occupational functionality.
This presentation might be useful as an introduction to psychotherapeutic treatment of ADHD in adults, particularly within an undergraduate or lower-level graduate course in psychology or mental health counseling.
Section 5 - Classification, Diagnosis and AssessmentSimon Bignell
Section 5 - Classification, Diagnosis and Assessment
'Autism, Asperger's and ADHD' module by Simon Bignell - Lecturer in Psychology at University of Derby.
Delirium is a syndrome not a disease and it has many causes. it is an acute organic mental disorder characterised by impairment of consciousness, disorientation and disturbances in perception and restlessness.
ADHD and Addiction: Diagnosis and ManagementJacob Kagan
Presentation by Jacob Kagan MD on the diagnosis and management of ADHD and Substance Abuse Disorders, including epidemiology and comorbid conditions,
causality and functional impact, potential explanations for the ADHD/SUD association,stimulant treatment and the risk for SUDs, diversion and misuse of stimulant medications, and treatment recommendations. http://jacobkaganmd.com
Abnormal Psychology: Neurodevelopmental DisodersElla Mae Ayen
Group of conditions with onset in the developmental period.
Disorders typically manifest early in development.
often before the child enter grade school
characterized by developmental deficits that produce impairments of personal, social, academic or occupational functioning.
Section 5 - Classification, Diagnosis and AssessmentSimon Bignell
Section 5 - Classification, Diagnosis and Assessment
'Autism, Asperger's and ADHD' module by Simon Bignell - Lecturer in Psychology at University of Derby.
Delirium is a syndrome not a disease and it has many causes. it is an acute organic mental disorder characterised by impairment of consciousness, disorientation and disturbances in perception and restlessness.
ADHD and Addiction: Diagnosis and ManagementJacob Kagan
Presentation by Jacob Kagan MD on the diagnosis and management of ADHD and Substance Abuse Disorders, including epidemiology and comorbid conditions,
causality and functional impact, potential explanations for the ADHD/SUD association,stimulant treatment and the risk for SUDs, diversion and misuse of stimulant medications, and treatment recommendations. http://jacobkaganmd.com
Abnormal Psychology: Neurodevelopmental DisodersElla Mae Ayen
Group of conditions with onset in the developmental period.
Disorders typically manifest early in development.
often before the child enter grade school
characterized by developmental deficits that produce impairments of personal, social, academic or occupational functioning.
This microteahing is very amazing because it shows parts of the journey of some doctors who treat ill people particularly children not only with medicine but also with humor. According to this reading is possible to lear some vocabulary and answer some questions.
New Headway Intermediate - Unit 2 Get Happy ! .. ..
New Headway Intermediate Unit 2 Get Happy !
New Headway Intermediate Unit 2 happiness.
TEMAS: Present Tenses, Simple or continuos? , Passive, Sport, Numbers and dates.
Topic 5 - Classification, Assessment and Diagnosis 2010Simon Bignell
Autism, Asperger's and ADHD
Topic 5 - Classification, Assessment and Diagnosis.
The views expressed in this presentation are those of the individual Simon Bignell and not University of Derby.
What is Attention-Deficit/Hyperactivity Disorder?
Inattentive, hyperactive & impulsive to excessive degree compared with their peers.
For more info, download the presentation.
Babatunde Idowu Ogundipe M.D. M.P.H.
Comprehensive Clinical Services P.C.
October 7 2011
ADD and ADHD are medical abbreviations, used in diagnosis and treatment of behavioral disorders in children and adults. ADHD and ADD are well-known abbreviations in the USA, UK, Ireland, Sweden, Iceland, Denmark, Netherlands, Norway, Finland, Canada, Malta and Australia.
A presentation by pediatric neuropsychologists Eavan Miles-Mason, PhD, and Renee Folsom, PhD, of Concord Comprehensive Neuropsychology Services (CCNS) on ADHD at the Lexington SEPAC.
Similar to שינויים באבחנת Adhdדר ליטנר מעודכן (20)
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Evaluation of antidepressant activity of clitoris ternatea in animals
שינויים באבחנת Adhdדר ליטנר מעודכן
1. THE DSM 5
UPDATE ON ADHD DIAGNOSTIC CRITERIA
Dr. Yael Leitner
CHILD DEVELOPMENT CENTER & ADHD CLINIC
Dana -Dwek Children’s Hospital
Sourasky Medical Center, Tel Aviv
2. The Revision
(by the ADHD and Disruptive Behavior Disorders Workgroup ,APA, May 2012)
Changing to a “life span” disorder:
Diagnostic category
Age of onset.
Number of symptoms required for diagnosis in people< 17 years.
Changing the description of the examples for each symptom
Changing the from subtypes into presentations
More lenient requirements for clinical impairment of
symptoms and for situational pervasiveness
Removing ASD from the exclusion criteria
Other changes
3. New overall Diagnostic Category
DSM IV:
Disorders usually first diagnosed in infancy,
childhood, or adolescence
DSM V:
Neurodevelopmental Disorders
4. Changing the age of onset
DSM IV:
B. Some hyperactive-impulsive or inattentive
symptoms that caused impairment were present
before age 7 years.
DSM V:
B. Several inattentive or hyperactive-impulsive
symptoms were present before age 12 years*.
5. *…thus, symptoms can now appear up to 5
years later. And, there is no longer the
requirement that the symptoms create
impairment by age 12, just that they are
present.
Changing the age of onset*
6. The rational for changing the age of onset
96 percent of lifetime cases of ADHD are captured
with an onset by age 12 to 14, suggesting that an
age 12 cutoff is superior to most alternatives
Research published since DSM-IV did not identify
meaningful differences in individuals whose
symptoms were present at younger vs. older ages
in functioning ,response to treatment, or outcomes
7. Number of symptoms required
and duration of symptoms
Individuals younger than 17
at least 6 of 9 inattentive and/or hyperactive impulsive
symptoms. (=DSM IV)
For individuals 17 and above
only 5 or more symptoms are needed*.
As in DSM-IV, the symptoms must be present for at least 6
months to a degree that is judged to be inconsistent with an
individual’s developmental level.
*This change from DSM-IV was made because of the reduction in symptoms that tends to occur
with increasing age.
The explanation for this change provided on the DSM-V web site is that a slightly lower
symptom threshold is sufficient to make a reliable diagnosis in adults.
8. Inattentive symptoms & examples
Often fails to give close attention to details or makes careless mistakes in
schoolwork, work, or during other activities
(e.g. overlooks or misses details, work is inaccurate).
Often has difficulty sustaining attention in tasks or play activities
(e.g., has difficulty remaining focused during lectures, conversations, or
lengthy reading).
Often does not seem to listen when spoken to directly
(e.g., mind seems elsewhere, even in the absence of any obvious distraction).
Often does not follow through on instructions and fails to finish school work,
chores, or duties in the work place
(e.g., starts tasks but quickly loses focus and is easily sidetracked).
Often has difficulty organizing tasks and activities. (e.g., difficulty managing
sequential tasks; difficulty keeping materials and belongings in order; messy,
disorganized work; has poor time management; fails to meet deadlines)
9. Inattentive symptoms & examples
Often avoids or is reluctant to engage in tasks that require sustained
mental effort
(e.g.; schoolwork or homework;
for older adolescents and adults: preparing reports, completing
forms, reviewing lengthy papers).
Often loses things necessary for tasks or activities
(e.g.; school materials, pencils, books, tools, wallets, keys, paper-
work, eyeglasses, mobile telephones).
Is often easily distracted by extraneous stimuli
(e.g.; for older adolescents and adults may include unrelated
thoughts).
Is often forgetful in daily activities
(e.g., doing chores, running errands;
for older adolescents and adults: returning calls, paying bills, keeping
appointments)
10. Hyperactive-Impulsive symptoms
& Examples
often fidgets with or taps hands or squirms in seat.
often leaves seat in situations when remaining seated is expected
(e.g., leaves his or her place in the classroom, in the office or other workplace, or in
other situations that require remaining in place).
often runs about or climbs in situations where it is inappropriate
(e.g., in adolescents or adults, may be limited to feeling restless).
often unable to play or engage in leisure activities quietly;
is often “on the go” acting as if “driven by a motor”
(e.g., is unable to be or uncomfortable being still for extended time, as in restaurants,
meetings; may be experienced by others as being restless or difficult to keep up with).
often talks excessively.
often blurts out answers before questions have been completed
(e.g., completes people’s sentences; cannot wait for turn in conversation).
often has difficulty awaiting turn (e.g., while waiting in line).
often interrupts or intrudes on others
(e.g. butts into conversations, games, or activities. may start using other people’s
things without asking or receiving permission; for adolescents and adults, may intrude
into or take over what others are doing).
11. Change from subtypes into presentations
Combined presentation: (314.01)
6 inattentive and 6 hyperactive/impulsive- unchanged from DSM IV
Predominantly inattentive presentation: (314.00)
6 inattentive+ 3-5 hyperactive/impulsive symptoms
Predominantly hyperactive/impulsive presentation
(314.01) :
6 hyperactive/impulsive symptoms- unchanged from DSM IV
Specify if: In partial remission:
When full criteria were previously met, fewer than the full criteria have been
met for the past 6 months, and the symptoms still result in impairment
12. New categories for individuals not
meeting full criteria
DSM IV
ADHD Not Otherwise Specified (NOS)
for individuals who displayed prominent symptoms but who did not
meet required criteria.
DSM V
When full criteria are not met, but symptoms that are present
create clinically significant distress or impairment in functioning
1. Other Specified ADHD (314.01)
(For example “Other specified ADHD with insufficient inattention symptoms”)
2. Unspecified ADHD.(314.01)
13. Multiple settings requirement
DSM IV
symptoms were required to cause some impairment in at
least two settings.(e.g. school& home)
DSM V
“several inattentive or hyperactive-impulsive
symptoms are present in two or more settings*.”
*symptoms must only be evident in more than one context but don’t have to
impair an individual’s functioning in multiple contexts
14. Need for clinically significant impairment
DSM IV
“Need for clinically significant impairment”
DSM V
“…clear evidence that the symptoms interfere with,
or reduce the quality of, social, academic,
or occupational functioning.”
15. Rule out alternative
explanations for symptoms
DSM IV
“The symptoms do not occur exclusively during the course of
a pervasive developmental disorders, schizophrenia, or
other psychotic disorder and are not better accounted for by
another mental disorder.”
DSM V
“The symptoms do not occur exclusively during the course of
a schizophrenia or other psychotic disorder and are not
better accounted for by another mental disorder.”
16. DSM V: ASD & ADHD
ADHD can now be diagnosed in conjunction
with Autism Spectrum Disorder.
In the past, ADHD would have been ruled out
based on the assumption that ADHD symptoms
were always better explained by the child’s
autism.
17. New requirement to specify severity
Mild* = there are few, if any, symptoms beyond those required to
make the diagnosis and no more than minor impairment in functioning.
Moderate* = symptoms or functional impairment between ‘mild’ and
‘severe’. People in this category may not necessarily show clinically
significant impairment.
Severe = reserved for cases with many symptoms in excess of those
required for the diagnosis, or several symptoms that are especially
severe, or marked impairment resulting from symptoms.
** In DSM-IV, where clinically significant impairment was required,
these individuals would not be diagnosed.
18. Possible impact of the proposed changes
Although the main concept is unchanged,
the suggested changes might increase the
prevalence of ADHD, especially in adolescents and
adults.
The added examples might also result in necessary
revisions and new validations of rating scales and
diagnostic interviews.
Refocus research on ADHD/ASD “comorbidity”.
19. NIH Director -Tom Insel , M.D.
On the new DSM 5
“….The goal of this new manual, as with all previous editions, is to provide a common
language for describing psychopathology. While DSM has been described as a
“Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining
each. The strength of each of the editions of DSM has been “reliability” – each
edition has ensured that clinicians use the same terms in the same ways. The
weakness is its lack of validity. Unlike our definitions of ischemic heart disease,
lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of
clinical symptoms, not any objective laboratory measure. In the rest of medicine,
this would be equivalent to creating diagnostic systems based on the nature of
chest pain or the quality of fever…..”
“…Patients with mental disorders deserve better. NIMH has launched the
Research Domain Criteria (RDoC) project to transform diagnosis by
incorporating genetics, imaging, cognitive science, and other levels of information
to lay the foundation for a new classification system. Through a series of
workshops over the past 18 months, we have tried to define several major
categories for a new nosology” ….
April 2013