| DISEASE | ETIOLOGY | SIGNS & SYMPTOMS | DIFFERENTIAL DIAGNOSIS | DIAGNOSIS | TREATMENTS |
|---|---|---|---|---|---|
| ADHD | Genetic, neurological, tempermental and environmental factors Brain region malfunction Defective genes | Inattention Impulsivity Motor hyperactivity Low self esteem | Depression Anxiety | Complete neurological exam Physical exam normal | Mental health counseling Structured environment Regular and frequent exercise, well balanced diet, good sleep and hygiene Adderall 5mg PO BID Ritalin 2.5mg PO TID Concerta 18 mg PO QD may increase by 18 Q 7 days max 54 mg day Follow up weekly for a month, then monthly thereafter |
| Delirium | Underlying medical causes | Acute decreased LOC Inattention Distractibility Fluctuating course | Dementia Depression | Detailed HPI Mini Mental status Exam Geriatric Depression Scale CBC B12 and folate | Treat underlying cause Minimize stimuli Maintain orientation Treat agitation with Haldol, lorazepam or risperidone |
| Dementia | Progressive deterioration in mental status occurring gradually. Unknown cause | Difficulty with problem solving, organization and abstract thinking | Delirium Depression B12 and folate deficiency Hypothyroidism Tumor CVA Infection Hearing loss Parkinsons Aids MI | Detailed HPI Rule out reversible causes CBC Thyroid function B12 Folate level | Discontinue all sedatives and hypnotics if possible Aricept 5mg PO HS Paxil 20 mg PO daily |
| Depression | chemical neurotransmitters Psychosocial disorders Alcohol/ substance abuse Prolonged stress Chronic medical conditions Medications | Mood disturbances Sadness Loss of interest in doing things Poor hygiene Poor grooming | Hypothyroidism Cancer Infection Autoimmune disease B12 folate deficiency | Ask about thoughts of suicide Provide depression screening CBC, TSH ESR CMP Medication levels EKG prior to prescribing TCA’s | SSRI’s : Paxil, Lexapro, Celexa. Zoloft Therapy |
The DSM-IV describes the core features of ADHD as “a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically found in individuals at a comparable level of development.” Patients with ADHD have symptoms related to an inability to regulate their attention and monitor their impulses. The disorder is usually first diagnosed in childhood but can persist into adulthood.
Since ADHD is known to be neurobiological in origin, it is critical that evaluation include a family history. There are numerous rating scales for use in the evaluation of children with suspected ADHD. An example of a gender specific tool can be found at http://www.addvance.com/resources/Articles/Checklist.htm
Rather than doing a “classic” presentation on ADHD and learning disabilities, I want to guide your thinking with some questions. Visit the website http://www.nimh.nih.gov/publicat/adhd.cfm
Those of you who have seen ADHD children or adults in your practice, come prepared to tell us about the patient. I think sharing real life cases in which you were involved are very good learning experiences.