What is ADHD? Symptoms, Causes & Treatment

 What is ADHD? Symptoms, Causes & Treatment

One of the most prevalent childhood neurodevelopmental illnesses is ADHD. It is usually diagnosed in childhood and might extend into adulthood. Children with ADHD may have difficulty paying attention, control impulsive behaviours (doing without considering the outcome), or being extremely active.

Signs and Symptoms

It is natural for children to have difficulty focusing and behaving at times. Children with ADHD, on the other hand, do not just grow out of these behaviours. The persistent, sometimes severe symptoms can be problematic at school, at home, or with friends.

A child who has ADHD might be:

·         a lot of daydreaming

·         frequently forget or misplace stuff.

·         fidget or squirm

·         excessive talking

·         make wrong decision or take unwarranted risks

·         have a difficult time rejecting temptation

·         having difficulty taking turns

·         have trouble getting along with people

Types

There are three ways that ADHD might present itself, depending on which symptoms are most noticeable in the individual:

•         Presentation that is Predominantly Inattentive: It is difficult for the person to plan or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or fails to notice little details in regular tasks.

 

•         Predominantly Hyperactive-Impulsive Presentation: The presenter fidgets and speaks a lot. It's hard to sit still for a long time (e.g., for a meal or while doing homework). Younger kids might constantly run, jump, or climb. The person is agitated and struggles with impulse control. Impulsive persons may interrupt others frequently, speak abruptly, or take things from them. Waiting his turn and following instructions are challenging for him. For certain people, impulsivity increases their risk of accidents and injury.

 

•         Composite symptoms: Equal amounts of both types of symptoms are present.

Like the symptoms themselves, appearance might alter over time.

 

Causes of ADHD

Researchers are studying the causes and risk factors of ADHD to improve management and reduce the likelihood that someone will develop ADHD. Current research indicates that genetics plays an important role in ADHD, but its causes and risk factors are unknown. Recent studies have linked genetic causes to ADHD. In addition to genetics, 1,

Scientists are studying other possible causes and risk factors such as: Example:

·         Brain injury

·         Exposure to environmental hazards such as lead during pregnancy or adolescence

·         Smoking and drinking during pregnancy

·         Premature birth

·         Low birth weight

Research does not support the widely held belief that social and environmental factors such as parenthood, excessive television viewing, excessive sugar consumption, family disorders and poverty cause ADHD. . Of course, many factors, including these, can exacerbate symptoms, especially in some individuals. However, there is not enough data to conclude that they are the main cause of ADHD.

Diagnosis

Determining if a child has ADHD is a multistep process. Symptoms of many other conditions, such as anxiety, depression, sleep disorders, and certain types of learning disabilities, may resemble those of her ADHD, which cannot be diagnosed with a single test. A physical exam, which includes a hearing and vision test, is one step in her procedure to rule out other conditions with symptoms similar to ADHD. A checklist to assess ADHD symptoms and obtain medical history from the child's parents, teachers, and sometimes the child himself is commonly used to diagnose ADHD.

Treatments

Doctor Talks to Family

Usually the most effective way to treat ADHD is a combination of medication and behavioral therapy. Behavioral therapy, especially parent training, is recommended as the first line of treatment for preschool children (ages 4-5) with ADHD before considering drug therapy. The ideal solution will vary for each child and family. Close monitoring, follow-up, and making changes along the way are all part of an effective treatment strategy.

Adults with ADHD

Adulthood is not affected by ADHD. Adults with ADHD may not receive treatment. Symptoms can cause problems in relationships, at work, or at home. Symptoms may appear differently in older people. For example, hyperactivity can manifest itself as severe restlessness. Symptoms may worsen as the demands of maturity increase. For more information about lifelong diagnosis and treatment, visit the National Resource Center for ADHD and the National Institute of Mental Health website.

 

Beck Depression Inventory

 

Beck Depression Inventory

 (BDI)

 

Definition

A set of 21 self-reported questions known as the Beck Depression Inventory (BDI) was created to assess the depth, intensity, and frequency of depressive symptoms in individuals between the ages of 13 and 80. A simpler form with only seven questions is intended for use by primary care physicians.

Purpose

Aaron T. Beck, a pioneer in cognitive therapy, created the BDI at first. Its goal is to identify, evaluate, and track changes in depressed symptoms in patients receiving mental health therapy.

Precautions

The BDI is intended for usage by qualified experts only. It should be given by a qualified mental health professional with experience using and interpreting it.

Description

The 1961 BDI was modified in 1969, and copyright protection was added in 1979. In order to incorporate changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), a manual used by mental health professionals to diagnose mental disorders, the second version of the inventory (BDI-II) was created and released in 1996.

The BDI long form consists of 21 questions or items, each of which has four alternative answers. Each response is given a number between zero and three that represents the intensity of the symptom the patient has been dealing with for the past two weeks. Seven self-reported items make up a version (BDI-PC) intended for use by primary care professionals.

The BDI contains specific questions that measure mood, pessimism, sense of failure, guilt, punishment, self-dislike, self-accusation, suicidal thoughts, crying, irritability, social withdrawal, body image, work difficulties, insomnia, fatigue, appetite, weight loss, bodily preoccupation, and loss of libido. The first 13 items evaluate psychological symptoms, and items 14 through 21 evaluate more physical problems.

In a primary care context, the BDI is also used to identify depression symptoms. As part of a psychiatric or medical assessment, the BDI typically takes five to ten minutes to complete.

Results

The degree of depression is determined by the total of all BDI item scores. Both the general population and people with a clinical diagnosis of depression have different test scores. A score of 21 or more is considered to be depressive for the general population. For those who have received a clinical diagnosis, scores ranging from 0 to 9 represent the least amount of depressive symptoms, 10 to 16 represent mild depression, 17 to 29 represent moderate depression, and 30 to 63 represent severe depression. Major depression and dysthymia are two examples of distinct subtypes of depressive illnesses that the BDI may distinguish between (a less severe form of depression).

For content validity, concurrent validity, and construct validity, the BDI has undergone rigorous testing. The BDI has content validity, which is the degree to which test items accurately reflect the phenomenon being assessed, as a result of physicians' shared understanding of the depressive symptoms that psychiatric patients commonly exhibit. At least 35 studies have demonstrated concurrent validity between the BDI and depressive measures like the Hamilton Depression Rating Scale and the Minnesota Multiphasic Personality Inventory-D. Concurrent validity is a measure of how closely a test accords with currently accepted standards.

 

KEY WORDS

Reliability: The capacity of a test to produce reliable, repeated results.

Validity: A test's capacity to measure what it purports to measure with accuracy.

The BDI has been linked to medical symptoms, anxiety, stress, loneliness, sleep patterns, drunkenness, suicidal thoughts and behaviours, and adjustment among young people, according to studies that measure an internal construct or variable.

The validity of the BDI has also been confirmed by factor analysis, a statistical technique used to identify underlying correlations between variables. The BDI can be seen as a syndrome (depression) made up of three elements: unfavourable self-perceptions, diminished performance, and somatic (physical) disruption.

Few studies have found an adverse relationship between higher BDI scores and educational attainment; the BDI, however, does not always correlate with sex, ethnicity, or age.

Cognitive-behavioral treatment is also mentioned.

 

 Beck Anxiety Inventory

 (BAI)

Purpose: Designed to discriminate anxiety from depression in individuals.

Population: Adults.

Score: Yields a total score

Time: (5-10) minutes.

Author: Aaron T. Beck.

Publisher: The Psychological Corporation.

Description: The Beck Anxiety Inventory (BAI) was created in response to the need for a test that could validly and consistently distinguish between anxiety and depression. For clinical and scientific reasons, such a tool would be preferable to currently used self-report measures, which have not been proved to adequately distinguish between anxiety and depression.

Scoring: There are 21 items on the scale, each of which describes a typical anxiety symptom. On a scale of 0 to 3, the respondent is asked to rate how much each symptom has troubled them over the last week. A total score is calculated from the items and can range from 0 to 63.

Reliability: High internal consistency and item-total correlations ranging from.30 to.71 (median=.60) were obtained for the scale's reliability. One week later, a subset of patients (n=83) completed the BAI, and the correlation between the BAI scores at intake and the 1-week BAI scores was.75.

Validity: There were substantial associations between the BAI and a number of self-report and clinician-rated scales. The BAI and the HARS-R and HRSD-R had correlations of.51 and.25, respectively. The BAI and BDI have a correlation of.48. Three investigations were used to determine the convergent and discriminant validity to distinguish between homogeneous and heterogeneous diagnostic groupings. The outcomes support the existence of these validity.

Norms: The three psychiatric outpatient normative samples were taken from sequential routine evaluations at the Center for Cognitive Therapy in Philadelphia, Pennsylvania. The sample size was 1,086 in total. There were 630 females and 456 males.

Recommended for use in clinical and research settings to measure anxiety.

 

Body Dysmorphic Disorder

Diagnostic Criteria                                                                            300.7 (F45.22)

Criteria A

Preoccupation with one or more perceived physical flaws or imperfections that are not visible to others or seem minor to them

Criteria B

In reaction to the anxieties over appearance, the individual engaged in repetitive actions (such as mirror checking, obsessive grooming, skin picking, and reassurance seeking) or mental activities (such as comparing one's looks to others).

Criteria C

Clinically substantial suffering or impairment in social, occupational, or other areas is brought on by the preoccupation. or other crucial functional areas

Criteria D

In a person whose symptoms fit diagnostic criteria for an eating disorder, worries about body fat or weight do not provide a better explanation for the obsession with beauty.

Preoccupation with one or more physical faults or imperfections that are not visible to others or seem minor to you.

Specify if:

When a person has muscle dysmorphia, they are fixated with the thought that their body type is inadequately muscular or too tiny. Even when the person is focused with other body parts, which is frequently the case, this specifier is employed.

Indicate if

• Describe your level of understanding of your body dysmorphic disorder beliefs, such as "I look horrible" or "I seem distorted,"
• With good or average awareness, the person is aware that the ideas related to body dysmorphic disorder are either untrue or may not be true.
• Poor insight: The person believes that the thoughts associated with body dysmorphic disorder are probably real.
• The person is totally convinced that the body dysmorphic disorder ideas are true due to lack of understanding or delusional views.
• 
  

Associated Features Supporting Diagnosis

Many persons who suffer from body dysmorphic disorder have notions or delusions that others are particularly interested in them or mock (imitate) them because of how they look.

High levels of anxiety are linked to body dysmorphic disorder.

Social phobia

Social withdrawal

Feeling down

narcissism, and

Low extroversion and perfectionism

a low sense of self

Many people are reluctant to discuss their worries with others because they are ashamed of how they look and spend too much time worrying about their looks.

On rare occasions, someone might operate on themselves.

Such treatments seem to have a poor response rate for body dysmorphic disorder, and

ü  

Prevalence

2.4% of adults in the US (2.5% of women and 2.2% of men) are obese.

The prevalence in Germany is currently between 1.7% and 1.8%, with a gender distribution comparable to that in the US.

The prevalence is currently 9%-15% among dermatological patients, 7%-8% among Americans undergoing cosmetic surgery, 3%-16% worldwide (according to most research), 8% among adults undergoing orthodontic treatment, and 10% among those undergoing oral or maxillofacial surgery.

Development and Course

ü  

The average age of onset of a condition is 16 to 17 years.

Age upon onset is 15 years on average.

12 to 13 years old is the average age of onset.

In two-thirds of cases, the illness manifests before the age of 18.

In general, signs of subclinical body dysmorphic disorder start around age 12 or 13.

Although some individuals have an abrupt beginning of body dysmorphic disorder, subclinical issues typically develop gradually to the full disease.

Risk and Prognostic Factors

Environmental

ü  Body dysmorphic disorder has been associated with high rates of childhood neglect and abuse

 

Genetic and physiological

ü  The prevalence of body dysmorphic disorder is elevated in first-degree relatives of individuals with obsessive-compulsive disorder (OCD).

Differential Diagnosis

 

 Normal concerns about looks and glaring physical flaws

 Body dysmorphic disorder is distinguished from normal appearance problems by repetitive behaviors that are obsessed with appearance, time consuming, usually difficult to resist and control, and cause clinically significant distress and disability.

Serious (that is, non-minor) physical defects are not diagnosed as body dysmorphic disorder.

Skin picking, a sign of body dysmorphic disorder, can, nevertheless, result in visible skin lesions and scarring. Body dysmorphic disorder should be identified in these circumstances.

v

Eating disorders

In For people with eating disorders, concerns about being fat are considered a symptom of an eating disorder rather than body dysmorphic disorder.

v Body dysmorphic disorder can cause weight problems. Eating disorders and body dysmorphic disorder can coexist, in which case both should be diagnosed.

 

Other obsessive-compulsive and related disorders

Body dysmorphic disorder's preoccupations and repetitive behaviors are distinct from OCD's obsessions and compulsions in that the former focus solely on appearance. These disorders also differ in other ways, such as body dysmorphic disorder's lack of insight.Body dysmorphic disorder, not excoriation (skin-picking) disorder, is diagnosed when skin picking is intended to improve the appearance of perceived skin defects.

Instead of trichotillomania (Hairpulling disorder), body dysmorphic disorder is diagnosed when hair removal (plucking, pulling, or other types of removal) is intended to improve perceived defects in the appearance of facial or body hair.

Other distinctions exist amongst disorders, such as body dysmorphic disorder's weaer insight. Excoriation (skin-picking) disorder, not excoriation (skin-picking) disorder, is diagnosed when skin picking is done to mask perceived skin flaws.

 

Illness anxiety disorder

v  Individuals with body dysmorphic disorder are not preoccupied with having or acquiring a serious illness and do not have particularly elevated levels of somatization.

 

Major depressive disorder

v  The prominent preoccupation with appearance and excessive repetitive behaviors in body dysmorphic disorder differentiate it from major depressive disorder

 

v  However, major depressive disorder and depressive symptoms are common in individuals with body dysmorphic disorder, often appearing to be secondary to the distress and impairment that body dysmorphic disorder causes

 

v  Body dysmorphic disorder should be diagnosed in depressed individuals if diagnostic criteria for body dysmorphic disorder are met

 

Anxiety disorders

v  Social anxiety and avoidance are common in body dysmorphic disorder.

 

v  Preoccupation may be delusional, and repetitive behaviors, and the social anxiety and avoidance are due to concerns about perceived appearance defects

 

v  They belief or fear that other people will consider these individuals ugly, ridicule them, or reject them because of their physical features

 

v  Anxiety and worry in body dysmorphic disorder focus on perceived appearance flaws in contrast to generalized anxiety disorder.

Psychotic disorders

v  Individuals with body dysmorphic disorder have delusional appearance beliefs (i.e., complete conviction that their view of their perceived defects is accurate), & is diagnosed as body dysmorphic disorder, with absent insight/delusional beliefs, not as delusional disorder.

      In contrast to schizophrenia and schizoaffective disorder, body dysmorphic disorder involves prominent appearance preoccupations and related repetitive behaviors. However, disorganized behavior and other psychotic symptoms are absent (with the exception of appearance beliefs, which may be delusional). Delusions of reference are common in body dysmorphic disorder.

Other disorders and symptoms

v  Body dysmorphic disorder should not be diagnosed if preoccupation is limited to discomfort with or a desire to be rid of one's primary and/or secondary sex characteristics in an individual with Gender Dysphoria

 

v  If the preoccupation focuses on the belief that one emits a foul or offensive body odor as in Olfactory Reference Syndrome (which is not a DSM-5 disorder).

 

 Body identity integrity disorder

A desire to have a limb amputated to correct an experience of a mismatch between a person's sense of body identity and their actual anatomy is known as apotemnophilia, which is not a DSM-5 disorder.However, unlike body dysmorphic disorder, the concern does not center on the limb's appearance.

Koro, which is not a DSM-5 disorder, is the desire to have a limb amputated to correct an experience of a mismatch between a person's sense of body identity and their actual anatomy.However, in contrast to body dysmorphic disorder, the focus of the concern is not on how the limb looks.

Dysmorphic concern (which is not a DSM-5 disorder) is a much broader constructs than, and is not equivalent to, body dysmorphic disorder. It involves symptoms reflecting an over concern with slight or imagined flaws in appearance.

Clinical Interview and Psychiatric History

 

Clinical Interview

Psychiatric History and  Mental Status

Clinical interview: psychiatric history and mental status 

• general introduction
• meeting the patient and selecting a location
• Using interviewing methods
• taking a medical history

General introduction 

• The goal of a diagnostic interview is to acquire data to aid the examiner in making a diagnosis, which then informs treatment.
• Descriptive phenomenology, which includes signs, symptoms, and clinical course, forms the basis of psychiatric diagnosis.
• A mental status assessment and a psychiatric history make up the two components of the psychiatric examination.

Choosing a place and meeting the patient 

• A diagnostic interview's objective is to gather information to help the examiner make a diagnosis, which subsequently guides treatment.
• Psychiatric diagnosis is based on descriptive phenomenology, which includes signs, symptoms, and clinical course.
• The two parts of the psychiatric examination are a mental status evaluation and a psychiatric history.

Applying interviewing techniques 

• Allow the interview to run naturally, let the patient narrate his life's experiences in any sequence he chooses, and provide structure by encouraging him to comment on his thoughts and feelings. who struggle with thought organisation - particular questions
• Ask the patient a question that will encourage them to speak (open vs. closed questions)
• the use of leading questions
• assist the patient in elaborating ("Please continue by telling me more").

Applying interviewing techniques 

• Reflect back to your patient how you are experiencing (express your patient's sentiments in the right words).
• You mean, you didn't feel better?, the patient wondered.
• summarise the patient's remarks Additional advice: Avoid using jargon, speaking in the patient's words, asking why, separating thinking from feelings, and giving assurance too soon.

Taking a psychiatric history 

1.Finding information (name, age, ethnic, sex, occupation, number o children, place of residence)

2. Source of referrals

3. The main issue ('What brought you to meet me?')

4. Background of the current issue:

• onset of the issue
• duration and direction
• psychological signs
• severity of the issue
• potential precipitators

Taking a psychiatric history 

5. Past psychiatric history:

• all prior incidents and signs
• hospitalizations, prior therapies, and how they responded

The best indicator of future medical care

1. Reaction is a result of prior treatment!
2. Taking a mental health history

6. Personal history:

Infancy:

• birth history, developmental milestones

Childhood:

• early education, education, and academic performance

Adolescence:

• beginning of puberty, first sexual encounter
• peer interaction

Adulthood

• education, experience in the military, and employment
• social interactions, sexual history, union, and offspring

Taking a psychiatric history 

7. Family history of mental illness

8. Medical history:

• current medical state and being treated
• significant ailments and cures from the past
• medical inpatient stays
• surgical background

9. Drug and alcohol history

Mental status examination 

1. Appearance and behavior (dress, facial expression, eye contact, motor activity)

2. Speech (rate, clarity)

3. Emotions

• patient's description is subjective
• Objective: Expression of emotion is conveyed by facial expression, posture, and vocal tonality.

(Mood: a persistent emotion; Affect: how a patient expresses their emotions; Variability, Intensity, Liability, Appropriateness)

Mental status examination

4. Thought

a) thought form:

• the connections between ideas (logical, goal-directed, loose associations)

b) thought content:

• delusions (false beliefs) (false beliefs)
• both the insertion and disengagement of thoughts
• decrease in both personal and real aspects (sense of unreality or strangeness)
• preoccupations, obsessions - undesirable thoughts that are resistant to logic
• Phobia: an excessive, irrational fear

Mental status examination 

Examples of questions (concerning thought

disorder):

• Do you believe someone is out to get you?
• Do you believe that others are able to read your mind or hear your thoughts?

Additional advice

• Always seek explanation when something doesn't seem to make sense!
• The most crucial issue is identifying whether psychosis is present.

Mental status examination

5. Perception:

Hallucination ("Do you ever hear voices or see things other than what you can see or hear? "), illusion, and misinterpretation of sensory information

Do individuals not see or hear?

to what degree the patient is motivated to

predicated on hallucinatory behaviour

Mental status examination 

6. Sensorial and intellectual functions:

• alertness (degree of awake) (degree of wakefulness)
• orientation to the circumstance, person, place, and time
• concentration (to focus and a sustain attention) (to focus and a sustain attention)
• instantaneous recall of current and distant memories (repeat 5 number forwards and backwards)
• calculation (basic arithmetic) (simple arithmetic)
• wealth of information
• abstraction (proverbs, comparisons), 
• discernment, and understanding