This document describes a study that aims to determine the prevalence and characteristics of attention deficit hyperactivity disorder (ADHD) in adults attending mental health outpatient clinics in Sligo/Leitrim, Ireland. The study will screen adult patients using self-report questionnaires, and those who screen positive will undergo further clinical testing. Data on demographics, comorbid conditions, and childhood and adult ADHD symptoms will be collected. The study aims to identify undiagnosed ADHD cases and understand the types of comorbid illnesses that are present.
This presentation about mental health, Factor Affecting the Health, Mental illness, Psychological and physiological symptoms of mental disorders,Common mental disorders (depression, anxiety disorders, schizophrenia, eating disorders, addictive behaviors and Alzheimer’s disease), prevention and promotion program, Types of behavioral therapy, Factors contribute to the achievement of mental health.
This presentation about mental health, Factor Affecting the Health, Mental illness, Psychological and physiological symptoms of mental disorders,Common mental disorders (depression, anxiety disorders, schizophrenia, eating disorders, addictive behaviors and Alzheimer’s disease), prevention and promotion program, Types of behavioral therapy, Factors contribute to the achievement of mental health.
State of well-being in which the individual:
Realizes his own abilities,
Cope with normal stresses of life,
Can work productively
Able to make a contribution to community.
The term “psychosomatic disorder” is mainly used to mean “a physical disease that is thought to be caused, or made worse, by mental factors.” ... For example, chest pain may be caused by stress and no physical disease can be found.
“Mental health is as important as physical health to the overall well-being of individuals, societies and countries. Yet only a small minority of the 450 million people suffering from a mental or behavioural disorders are receiving treatment” (The World Health Report 2001, Chapter 1).
This ppt presentation discusses about the various models of mental illness. I found it useful to download as it gives a fair idea about various models which are generally not found in books.
Milen xx philippines mental health promotion and practice strategiesMilen Ramos
PROMOTION OF MENTAL HEALTH AMONG WOMEN IN PHILIPPINES
CELEBRATION OF INTERNATIONAL WOMEN S DAY
STAGING MENTAL HEALTH PROMOTION AND SERVICES
INDIVIDUAL, COMMUNITY AND NATIONAL INTERVENTION
School Social Work and Learning Disability Newsletter - Bridge the Gapalen kalayil
Bridge the Gap - Official Newsletter of School Social Work and Research Department of Helikx Open School for Children with Learning Disability. Newsletter includes articles on Visible thinking, Yoga, Functional Skills, School Sanitation and Responsible Chart.
State of well-being in which the individual:
Realizes his own abilities,
Cope with normal stresses of life,
Can work productively
Able to make a contribution to community.
The term “psychosomatic disorder” is mainly used to mean “a physical disease that is thought to be caused, or made worse, by mental factors.” ... For example, chest pain may be caused by stress and no physical disease can be found.
“Mental health is as important as physical health to the overall well-being of individuals, societies and countries. Yet only a small minority of the 450 million people suffering from a mental or behavioural disorders are receiving treatment” (The World Health Report 2001, Chapter 1).
This ppt presentation discusses about the various models of mental illness. I found it useful to download as it gives a fair idea about various models which are generally not found in books.
Milen xx philippines mental health promotion and practice strategiesMilen Ramos
PROMOTION OF MENTAL HEALTH AMONG WOMEN IN PHILIPPINES
CELEBRATION OF INTERNATIONAL WOMEN S DAY
STAGING MENTAL HEALTH PROMOTION AND SERVICES
INDIVIDUAL, COMMUNITY AND NATIONAL INTERVENTION
School Social Work and Learning Disability Newsletter - Bridge the Gapalen kalayil
Bridge the Gap - Official Newsletter of School Social Work and Research Department of Helikx Open School for Children with Learning Disability. Newsletter includes articles on Visible thinking, Yoga, Functional Skills, School Sanitation and Responsible Chart.
Presentation by professor Bob Grove on the occasion of the EESC SOC public hearing on European year of mental health - Better work, better quality of life in Brussels on 30 October 2012.
J Hanson et al LD and RTI presentationKevin McGrew
This is a presentation on LD and RTI developed by J. Hanson (Portland Public Schools) and colleagues that he has made available to others for viewing via IQ's Corner (www.intelligencetesting.blogspot.com)
This program is part of a comprehensive School Mental Health and High School Curriculum Guide.
Find out more about the guide by visiting:
teenmentalhealth.org
The school environment is an ideal place to begin the work of addressing mental health needs. Not only does the school offer a simple and cost-effective way of reaching youth, but it is also a convenient place where mental health can be linked with other aspects of health, such as physical health and nutrition, and with learning.
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
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.
Assignment InstructionsAnswer with minimum 2 paragraphs each th.docxrobert345678
Assignment Instructions:
Answer with minimum 2 paragraphs each the following questions based in the bellow clinical case:
1. What is the behavioral approach if you have a child (patient) that present with autism or ASD? Explain
1. What type of special diets you can recommend, or there is any research supporting a special type of diet?
1. What type of resources you can offer to the parents in term of programs at school or what kind papers you can offer to them, so they can have a better experience?
** At least 2 references per question**
Subjective:
CC (chief complaint): The child has problems with communication in social gatherings and at home and does not enjoy the company of others.
HPI: Patient 11 is a 9-year-old male Caucasian American child brought into the hospital on the seventh day of December 2022 for psychiatric assessment from 8:00 AM. The mother has been worrying over her child’s inability to communicate at home and in other social spaces. Further, she states that she has noticed her child's unusually easily irritable state in the past months but has not been worrying as much about it, stating that it is what children are like sometimes. She adds that her son does not enjoy the company of others, even at school, and she thinks that it may be why he is not doing well in class.
Substance Current Use: The client denies using illicit hard drugs like marijuana. No alcohol or tobacco abuse.
Medical History:
·
Current Medications: Daily multivitamin supplements once daily orally.
·
Allergies:
no known food, drug, or environmental allergies noted.
·
Reproductive Hx: No history of sexually transmitted diseases. He has not fathered a child.
ROS:
· GENERAL: denies weight changes and chronic pains. Sometimes feels fatigued
· HEENT: No eye pain or conjunctivitis; swallowing is okay. Denies sore throat. Denies any alterations in head physiology. No changes in the sense of taste.
· SKIN: Denies skin redness. Denies alopecia.
· CARDIOVASCULAR: Denies murmurs, arrhythmias, and lower limb edema.
· RESPIRATORY: Denies chest pressure, congestion, cough, hemoptysis, and wheezing.
· GASTROINTESTINAL: Denies bloating and constipation or GERD. Denies nausea, vomiting, or abdominal pain.
· GENITOURINARY: Denies dribbling of the bladder and itching.
· NEUROLOGICAL: Denies visual changes, muscle loss, changes in reflexes, and no balance problems.
· MUSCULOSKELETAL: Denies numbness or tingling and muscle or joint strength loss.
· HEMATOLOGIC: Denies easy bruising.
· LYMPHATICS: Denies neck, axillary or inguinal swelling or lymphadenopathy
· ENDOCRINOLOGIC: Denies known endocrine disorders.
Objective:
Physical exam:
Vital Signs: B.P.: 118/78, Pulse:94, RR: 20, non-labored, Temp: 36.0, BMI: 19.1
General: Alert and oriented, pleasant and cooperative. Not in any acute distress.
HEENT: No head or neck anatomical disruptions. No redness o.
15 Disruptive, Impulse-Control, and Conduct DisordersThis chapte.docxaulasnilda
15 Disruptive, Impulse-Control, and Conduct Disorders
This chapter contains an amalgam of disruptive, impulse-control and conduct disorders (CDs) characterized by externalizing behaviors previously spread throughout many chapters of earlier DSM editions. However, these disorders are no longer categorized by age (e.g., disorders of infancy, childhood, and adolescence), and all share the loss of restraint (i.e., poor control) in terms of an individual's emotional or behavioral responses that are demarcated by an infringement on the rights of others or breach of social norms. Attention should be paid to the symptom overlap that these diverse disorders share with Attention Deficit/Hyperactivity Disorder (ADHD) (which can be found in Chapter 2 on Neurodevelopmental Disorders); Disruptive Mood Dysregulation Disorder (DMDD) (which can be found in Chapter 5 on Depressive Disorders); Substance Use Disorders (SUDs) (the adjoining Chapter 16), as well as Antisocial Personality Disorder (which has a dual recording in both this chapter and in Chapter 18 on Personality Disorders) (APA, 2013).
First on the hierarchical spectrum of externalizing disorders in this chapter is Oppositional Defiant Disorder (ODD). An individual with must display at least four out of eight symptoms/behaviors with an individual who is not a sibling for at least 6 months from the following three categories: (1) angry/irritable mood; (2) argumentative/defiant behavior; and (3) vindictiveness. For example, argumentative/defiant behavior symptoms include: being argumentative; demonstrating a lack of compliance with authority figures' requests; annoying others deliberately; and blaming others for his or her mistakes. The anger/irritability category symptoms include loss of temper; getting easily upset and/or annoyed, and anger/resentment. The final category has only one symptom vindictiveness or spitefulness demonstrated at least two times within the previous 6 months (APA, 2013).
Many symptoms of this diagnosis are commonly displayed during normal childhood/adolescent developmental stages. Therefore, in an effort to help differentiate the symptoms that are characteristic of this diagnosis, practitioners are cautioned to consider the persistence and frequency of behaviors. For example, in young children under the age of 5, the symptoms must occur for the majority of days for at least 6 months. For older individuals, the symptoms must occur at least once weekly within a 6-month period. However, for vindictiveness regardless of age, the criterion is the same, twice within the previous 6-month period. Along with frequency, other factors must be taken into consideration, such as symptom intensity, and whether symptoms are normal given the individual's age, developmental stage, gender, and culture. In addition, the symptoms must cause significant suffering in the individual or in his/her immediate relationships (e.g., family, friends, peers) as well as impairment in psychosocial funct ...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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!
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
Epidemiology of Attention Deficit Hyperactive symptoms in the mental health outpatient clinics attendants of Sligo/Leitrim HSE
1. Epidemiology of Attention Deficit
Hyperactive symptoms in the mental health
outpatient clinics attendants of
Sligo/Leitrim HSE
12/11/2013
2. Background
ADHD is a mental disorder characterized by either significant difficulties of
inattention or hyperactivity and impulsiveness or a combination of the two.
According to the DSM IV TR, symptoms emerge before 7 years of age,
affecting about 3 to 5% of children globally (Nair at al, 2006).
It is often a chronic disorder (Van Cleave et al, 2008) with 30 to 50 percent of
those individuals diagnosed in childhood continuing to have symptoms
into adulthood (Bàlint at al, 2008).
3. Background
It is estimated that between 2 and 5 percent of adults in general population
live with ADHD (Kooij et al, 2010).
A number of studies (eg Valdizan et al, 2009; Biederman et al, 2000; Langberg
et al, 2008) have found that symptoms of hyperactivity and impulsivity decline
with age, although they persist in some cases and sometimes are the presenting
concerns in adult ADHD, whereas deficits in attention persist and become
more varied in adult cases.
4. Background
Manifestations that characteristically appear in adults are difficulty in
concentrating, poorer memory and short-term memory, disorganization,
difficulties with self-discipline, impulsiveness, low self-esteem, mental
restlessness, frustration and limited social skills.
A number of studies have found that many children with ADHD go
unrecognized and may present in adulthood for the first time (Asherson et al
2007, Kooij et al 2010).
5. Background
The more common symptoms seen during the childhood, such as hyperactivity and
impulsivity, can disappear during the adulthood and they could be replaced by
restlessness, inattention, disorganization, or impaired executive functioning ((Kooij et
al 2010).
Several research found that ADHD is significantly comorbid with a wide range of
other DSM-IV disorders (Jensen at al 1997, 2004 National Comorbidity Survey US,
Kessler at al 2006): like Mood Disorders, Anxiety Disorders, Substance Use Disorders,
Impulse Control Disorders: Intermittent Explosive Disorder, (Biederman et al, 1991;
Pliszka, 1998), Personality disorders, (Kernberg and Yeomans, 2013) and eating
disorders (Fernández-Aranda et al, 2013; Cortese et al, 2013).
6. Background
Undiagnosed or misdiagnosed ADHD can result in ineffective pharmacological
and non-pharmacological treatments which may not improve ADHD-related
symptoms.
In addition there is often a substantial psychosocial and functional decline
associated with undiagnosed and untreated ADHD (Able et al, 2007).
7. Background
o DSM V criteria for ADHD:
People with ADHD show a persistent pattern of inattention and/or
hyperactivity-impulsivity that interferes with functioning or development.
Inattention: Six or more symptoms of inattention for children up to age 16, or
five or more for adolescents 17 and older and adults; symptoms of inattention
have been present for at least 6 months, and they are inappropriate for
developmental level.
8. Background
Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses
focus, side-tracked).
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork
or homework).
Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork,
eyeglasses, mobile telephones).
Is often easily distracted
Is often forgetful in daily activities.
9. Background
Hyperactivity and Impulsivity: Six or more symptoms of hyperactivityimpulsivity for children up to age 16, or five or more for adolescents 17 and
older and adults; symptoms of hyperactivity-impulsivity have been present for
at least 6 months to an extent that is disruptive and inappropriate for the
person’s developmental level.
10. Background
Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be
limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Is often "on the go" acting as if "driven by a motor".
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has trouble waiting his/her turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games)
11. Background
In addition, the following conditions must be met:
Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
Several symptoms are present in two or more setting, (e.g., at home, school or work; with
friends or relatives; in other activities).
There is clear evidence that the symptoms interfere with, or reduce the quality of, social,
school, or work functioning.
The symptoms do not happen only during the course of schizophrenia or another psychotic
disorder. The symptoms are not better explained by another mental disorder (e.g. Mood
Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder)
12. Background
Based on the types of symptoms, three kinds (presentations) of ADHD can
occur:
1. Combined Presentation: if enough symptoms of both criteria inattention and
hyperactivity-impulsivity were present for the past 6 months
2. Predominantly Inattentive Presentation: if enough symptoms of inattention,
but not hyperactivity-impulsivity, were present for the past six months
3. Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of
hyperactivity-impulsivity but not inattention were present for the past six months.
Because symptoms can change over time, the presentation may change over time as
well.
13. Background
Aims of the study:
o To find out the prevalence of ADHD in those adults who attend the mental
health services in Sligo/Leitrim County, Republic of Ireland.
o To understand how many cases of ADHD are undiagnosed in the specific
adult population.
o To investigate what kind of comorbid illnesses with ADHD are present in
this population.
14. Methods
Inclusion of participants:
All patients using Out-Patient Mental Health Services in Sligo/Leitrim County, aged 18-65,
having a minimum of 5 years of education, able to speak, read and write in English language.
Exclusion of participants:
Patients under 18 years of age; patients over 65 years of age; patients admitted in in-patient
units; illiterate patients and/or not able to speak, read and write in English language.
Patients with severe learning disabilities and patients with severe brain injuries and with
amnesic disorders have been excluded.
15. Design
The proposed study will have two phases:
In the first phase all the people who attend the outpatient clinics and day hospital of
the adult mental health services of Sligo/Leitrim County and are eligible for inclusion
have been approached by the researchers for screening tests.
In a second phase those who will be positive in the screening tests will be invited for
more specific tests in a clinic which will be created for this purpose in agreement with
their consultant.
16. Design
First Phase:
Psychiatric patients attending Mental Health Services at Sligo County
(estimated around 2000 attendants) are being contacted in their outpatient
appointment and the purpose of the study is being explained to them by the
researcher.
Those ones who are accepting to take part in the survey are completing the
following two self report questionnaires:
17. Design
First Phase:
o Adult ADHD Self-Report Scale (ASRS): DSM-IV based, 18 questions
regarding symptoms of adult ADHD.
Sensitivity 96.7%
Negative predictive value 96.5%
Specificity 91.1%
Kappa 0.88
Positive predictive value 91.6%
(Kessler et al, 2007; Ramos-Quiroga et al, 2009; Zohar et al, 2010; Ji-Hae Kim et al, 2013)
18. Design
First Phase:
o Wender Utah Rating Scale (WURS): 61 questions answered by the adult
patients recalling their childhood.
Test-retest r = .96
Inter-rater reliability r = .75
Cronbach's alpha = 0.78
(Rossini et al, 1995; Fossati et al, 2001; Wierzbicki, 2005; Marchant et al, 2013)
19. Design
First Phase:
o Demographics: chart number, name, age, gender, marital status, years of
education, highest level of qualification achieved, living circumstances,
housing status, current employment, main occupation.
20. Design
Second Phase:
After this first screening process, any participant who have scored positive in
both of the two scales will be contacted by letter to attend a special clinic
where further testing will happen.
The scales/measurements that will be used at this second stage are:
21. Design
Second Phase:
o Conners’ Adult ADHD Diagnostic Interview for DSM-IV (CAADID): appropriate for
18 and older, divided in 2 parts (Part I – screening interview - and Part II – the only one
administered).
Sensitivity 98.86%
Negative predictive value 94.87%
Specificity 67.68%
Diagnostic precision 91.46%
Positive predictive value 90.77%
Kappa coefficient concordance between the clinical diagnosis and the CAADID is 0.88
(Sparrow et al, 2011; Ramos-Quiroga et al, 2012)
22. Design
Second Phase:
o Mini International Neuropsychiatric Interview (MINI): short
structured diagnostic interview for psychiatric disorders.
Good kappa coefficient, sensitivity, specificity for all diagnoses, inter-rater
and test-retest reliability.
(Lecrubier et al, 1997; Sheehan at al, 1998)
23. Design
Second Phase:
o Millon Clinical Multiaxial Inventory - III (MCMI-III): measure of 24
personality disorders and clinical syndromes for adults undergoing
psychological or psychiatric assessment or treatment, 175 true-false
questions; after the test is scored, it produces 29 scales (24 personality and
clinical scales and 5 scales used to verify how the person approached and
took the test).
Reliability r = .78
(Hsu, 2002; Blais et al, 2003)
24. Design
Second Phase:
o Global Assessment of Functioning (GAF) Scale: present in DSM IV,
single rating scale for evaluating a person’s psychological, social and
occupational functioning on a hypothetical continuum of mental healthillness and ranges from 1, representing the hypothetically sickest individual,
to 100, representing the hypothetically healthiest; divided into 10 equal parts.
Reliability r = .78
(Jones et al, 1995; Startup et al, 2002; Aas, 2010)
26. Consent
First Phase: written information, verbal consent.
Second Phase: written information, written consent.
For those who were screening positive and the symptoms of ADHD have been
confirmed with detailed testing their consultant will be informed if the
participant agrees to that.
No results of the tests/questionnaires or additional diagnosis will be given
directly to the participants.
27. Analysis of the data
The collected data are being anonymized and are being entered in a spreadsheet
software for analysis.
The first research question (point prevalence) will be answered as a ratio or
percentage (number of cases divided by total screened population) multiplied by a
hundred.
The second research question (undiagnosed cases of ADHD) will be answered as
percentage and in absolute numbers. This will be happen by reviewing the participants’
files for any reference in previously diagnosed ADHD.
The third research question (comorbidity) will be investigated with DSM-IV
diagnoses Axis I (psychiatric diagnoses from MINI scale) and Axis II (personality
disorders from MCMI-III).
28. Analysis of the data
Secondary analyses of the data:
o Agreement between the scales WURS and ASRS calculated with the Cohen’s
kappa coefficient.
29. Analysis of the data
o 300 consecutive patients analysed:
242 included (80.7%)
58 excluded (19.3%)
o Reason for exclusion:
36 refused (12%)
17 over 65 (5.7%)
5 learning disability (1.6%)
30. Analysis of the data
Statistics regarding the included subjects (242)
o Age: calculated on 222 pts (20 missing)
minimum 18
maximum 65
mean 41.20
std. deviation 12.445
31. Analysis of the data
o Gender: calculated on 241 pts (1 missing)
males 120 (49.8%)
females 121 (50.2%)
32. Analysis of the data
o Highest level of education achieved: calculated on 235 pts (7 missing)
junior certificate 31 (13.2%)
postgraduate degree 17 (7.2%)
leaving certificate 68 (28.9%)
other 56 (23.8%)
university degree 26 (11.1%)
none 11 (4.7%)
vocational diploma 17 (7.2%)
IT degree 9 (3.8%)
33. Analysis of the data
o Living Circumstances: calculated on 241 pts (1 missing)
alone 69 (28.6%)
with your own family 90 (37.3%)
with parents 46 (19.1%)
with others 36 (14.9%)
34. Analysis of the data
o Housing status: calculated on 215 pts (27 missing)
owner 103 (47.9%)
rented 112 (52.1%)
35. Analysis of the data
o Current employment status: calculated on 238 pts (4 missing)
currently employed 91 (38.2%)
unemployed 111 (46.6%)
retired 20 (8.4%)
student 16 (6.7%)
36. Analysis of the data
o Marital status: calculated on 240 pts (2 missing)
single 132 (54.6%)
married 64 (26.5%)
divorced 9 (3.8%)
co-habiting 21 (8.8%)
separated 11 (4.6%)
widowed 3 (1.3%)
37. Analysis of the data
o Diagnosis with both scales: calculated on 237 pts (5 missing)
negative 194 (81.9%)
positive 43 (18.1%)
38. Analysis of the data
o Agreement between the scales:
Total n = 242
Valid n = 237 (97.9%)
ASRS- WURS- 113 (47.7%)
ASRS+ WURS- 45 (19%)
ASRS- WURS+ 36 (15.2%)
ASRS+ WURS+ 43 (18.1%)
P = 0.001
Kappa = .252
Missing n = 5 (2.1%)
39. Analysis of the data
o Age and WURS’ score do not have normal distribution
Spearman’s rho = - .205
41. Analysis of the data
o Correlation between Education and ADHD:
Chi squared = 2.9
df = 7
P = .9
o Correlation between Employment and ADHD:
Chi squared = 2.22
df = 3
P = .53
42. Analysis of the data
o Correlation between Education and ADHD:
N = 230
Chi squared = 2.9
df = 7
P = .9
o Correlation between Employment and ADHD:
N = 233
Chi squared = 2.22
df = 3
P = .53
43. Provisional Conclusions and Critics
18.1% of the psychiatric population analysed is positive for both ASRS and
WURS.
o Scales seem to be valid
o More cases in psychiatric population than general adult population as previous
studies have already shown (10 – 20%, Fones et al, 2000; Kesler et al, 2010)
o Undiagnosed cases in child population?
44. Provisional Conclusions and Critics
Labile agreement between ASRS and WURS.
o Because the different age span considered?
o To consider a different scoring system for the scales?
o Need to reconsider and analyse the scales’ validity?
45. Provisional Conclusions and Critics
Social functioning, in terms of level of education achieved and
employment status, does not significantly differ from the considered
psychiatric population.
…any other observation?