Month: May 2013

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Attention Deficit Hyperactivity Disorder (ADHD) is a condition that can cause disruption in the daily lives of those who are affected by it.  ADHD can impact school performance, interpersonal relationships, and employment, as it affects concentration, activity levels, and impulse control.

An estimated 3 – 5 % of individuals in the U.S. are thought to have ADHD. While it develops in childhood, ADHD can continue throughout life. At least 30% of affected children continue to experience symptoms as adults.

The Nature of ADHD

Attention Deficit Hyperactivity Disorder is characterized by three hallmark symptoms:  inattention, hyperactivity, and/or impulsivity.  While all children demonstrate some degree of these traits due to their immature development, these behaviors are more frequent and severe with ADHD.  To receive a diagnosis, an individual must exhibit symptoms to a greater degree than their peers for at least six months.

Three ADHD subtypes have been identified:

  • Predominantly hyperactive-impulsive — difficulty controlling behavior and over-activity, with few attention problems;
  • Predominantly inattentive – difficulty with inattention, with few problems with hyperactivity or impulse control;
  • Combined hyperactive–impulsive and inattentive – presence of strong symptoms of hyperactivity, impulsivity, and inattention.  Most children are found to have the combined type of ADHD.

While adult symptoms of ADHD may be similar, they may be expressed differently– for example, restlessness rather than hyperactivity.

Causes of ADHD

As with many other disorders, ADHD is the likely result of a combination of factors.  Researchers have found that levels of certain chemicals or neurotransmitters in the brain tend to be lower in individuals with ADHD.  Known or suspected contributing factors include:

  • Genetics. ADHD often runs in families, and scientists are attempting to isolate genes that may contribute to the development of the disorder.
  • Pre–natal problems.  Low birth weight and difficulty pregnancies have been linked to ADHD.
  • Environment.  Studies have found potential links between ADHD and alcohol use or smoking during pregnancy and exposure to high levels of lead and such environmental toxins as PCBs or pesticides.
  • Brain injury.  Head injuries, particularly to the frontal lobe, seem to increase the risk for ADHD.
  • Nutrition.  Much speculation has focused on the possible effects of refined sugar and food additives, but research is inconclusive.

Treatment of ADHD

While there is no known cure, ADHD is a manageable disorder that responds to proper treatment.  Treatments focus on symptom reduction and management.

Medication is the primary treatment mode. Stimulant drugs are often used with children because, unlike with adults, they actually have a calming effect.  A few non-stimulant medications have demonstrated benefits. While parents are understandably cautious about medication, the proper regimen can help a child learn to focus and behave more appropriately.

In addition, treatment may include psychotherapy, education, or specialized training.  For example, behavioral therapy can assist a child in controlling his or her symptoms.  Structured routines can be developed that will assist parents and teachers in managing behaviors.  Social skills training can provide children with tools to interact more appropriately with others.

The good news for many:  most individuals “outgrow” ADHD as they mature into adulthood.  But strides in treatment give hope to all, regardless of age.

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Today, approximately 5.7 million U.S. adults in the U.S. have bipolar disorder, a serious mental illness.  Also known as manic-depressive disorder, the illness is characterized by extreme mood swings.

Bipolar disorder typically develops during an individual’s late teen or early adult years, with half of all cases emerging before age 25.

Symptoms

Bipolar disorder is characterized as one of several types, depending upon the cluster of symptoms:

  • Bipolar I— requires at least one full manic episode, with or without depressive episodes.
  • Bipolar II – features cycles of depression and elevated moods (often referred to as hypomanic episodes) that do not reach the level of a full mania.
  • Bipolar Disorder Not Otherwise Specified (BP-NOS) — does not fully meet criteria for Bipolar I or II or follow a fixed pattern.
  • Cyclothymia – exhibits much milder symptoms of the disorder.

An estimated 10-20% of affected individuals also experience rapid cycling, characterized by at least four episodes in one year.

Manic symptoms include excessive excitement, restlessness, increased energy, racing thoughts, irritability, sleeplessness, and a tendency to engage in reckless and impulsive actions.

Depressive symptoms include sadness, crying episodes, weight loss or gain, feelings of hopelessness or helplessness, decreased energy, loss of interest in daily activities, and thoughts of death or suicide.

Sometimes psychotic symptoms may also be present, such as hallucinations or delusions; e.g., “I am the wealthiest person in the world.”

Causes

While the causes of bipolar disorder are not completely understood, several risk factors may influence its development.

An individual whose parent or sibling has the disorder is up to six times more likely to develop the illness.  Researchers are seeking specific genes that play a causative role.  MRIs have shown structural changes in the brains of affected individuals. Imbalances in neurotransmitters, important brain chemicals, may be another culprit, as well as hormone imbalances.

Trauma or extreme stress may influence the development of the disorder or trigger episodes.

Treatment

Without treatment, bipolar disorder often worsens over time. Treatment is usually a combination of medication and psychotherapy.

Common medications used include:

  • Mood stabilizers, including Lithium and various anticonvulsants.
  • Atypical antipsychotics, such as Zyprexa or Abilify.
  • Antidepressants, usually in combination with a mood stabilizer.
  • Symbyax, FDA-approved specifically for bipolar disorder.
  • Benzodiazepines, such as Klonopin or Ativan for anxiety and sleep disturbance.

Medication may be a lifetime commitment for a person with bipolar disorder.

Psychotherapy can help individuals learn to cope with the effects of the illness and avoid situations which might trigger episodes.  Cognitive behavioral therapy (CBT) teaches individuals to change negative patterns of behavior and thought, while interpersonal and social rhythm therapy focuses on improvement of relationships and more stable daily routines.  Psychoeducational approaches provide information to increase understanding and assist in recognition of warning signs.

Therapists also work with entire families or with groups of individuals with bipolar disorder.  Family-focused therapy helps families with communication, symptom recognition, and more effective coping skills.  Group therapy allows individuals to learn from others with the disorder, while practicing better interpersonal skills.

For individuals who have been resistant to other treatment methods, electroconvulsive therapy (ECT) has offered some benefit.

While there is no permanent cure for bipolar disorder, effective treatment can lead to better illness management and allow individuals to live normal lives.