Psychiatry MMC

Psychiatry 2006 - ISSN: 1550-5952 - Volume 3 - Issue 8 - August 2006
Feature Article:
Adult ADHD: Diagnosis, Differential Diagnosis, and Medication Management
by Julie P. Gentile, MD; Rafay Atiq, MD; and Paulette M. Gillig, MD, PhD

Attention deficit hyperactivity disorder (ADHD) persists into adulthood in approximately 10 to 60 percent of individuals diagnosed in childhood. Expression of symptoms changes in the adult assessed for the disorder. The symptoms of adult ADHD resemble the symptoms of childhood ADHD, but symptom intensity, especially hyperactivity, may decrease over time. A childhood history of ADHD is requisite for a diagnosis of adult ADHD, although full DSM-IV criteria for the childhood disorder need not be met as long as there exists impairment in multiple settings (i.e., academic, relationship, and occupational). There is a high probability of co-morbid disorders, as well as the likelihood that the adult with ADHD has developed coping mechanisms to compensate for his or her impairment. Pharmacologic treatments and multiple types of psychotherapy are available for adults with ADHD.

Key Words: ADHD, adults, pharmacotherapy
Pharmacotherapy of ADHD in Young Children
by Brigette S. Vaughan, MSN, APRN; and Christopher J. Kratochvil, MD

Abstract Attention-deficit hyperactivity disorder (ADHD) is a disorder common throughout childhood, with recognizable symptoms as early as preschool in many cases. ADHD is often treated in young children by simply implementing strategies proven efficacious and safe in older children and adolescents, as limited data is available in children younger than age six. Research has been extended into this age group by the Preschool ADHD Treatment Study (PATS) and other recent trials, providing clinically relevant data on differences in tolerability and efficacy of ADHD pharmacotherapies, primarily methylphenidate. No published data is yet available on the use of atomoxetine in children under age six. Growth is an area of particular interest and concern in the pediatric population, with data demonstrating variability in the long-term rates of growth in height as well as weight. While pharmacotherapy holds the potential for significant benefit in young children with ADHD, concerns with variatio
Psychological Symptoms in Paid Caregivers of Dementia Patients: A Pilot Study
by Ronald Brenner, MD; Subramoniam Madhusoodanan, MD; Ella Brodsky, MD; Wilfredo Soberano, MD; Maxine Shack, MA; Arlene Nelson-Sasson, CSW; and Paul Czobor, PhD

abstract Objectives: Determine symptoms, correlates, or predictors of depression and anxiety in paid caregivers of elderly persons with dementia. Participants: The 28 participants were paid caregivers of patients attending an adult day-care program for patients with Alzheimer disease. Each participant had a total score of 16+ or a score of 3+ on at least one item of the Problems and Complaints Inventory. Measurements: Participants completed the Hamilton Depression (HAM-D) and Anxiety (HAM-A) scales and the Zarit Burden Interview. The total daily and weekly time that caregivers worked with their patients was recorded. Results: Severity of depression (HAM-D scores) was significantly related to Zarit Burden Interview scores (p<0.001). In addition, HAM-D scores tended to be related to the number of hours per week provided by a caregiver (p=0.09). Severity of anxiety (HAM-A scores) tended to be related to Zarit Burden Interview scores (p=0.08). Conclusion: These findings indicate t
The Physician Advisor�s Role in Contemporary Psychiatry and Quality of Care
by Geetha Jayaram, MD, MBA

abstract The medical profession has always sought to govern itself through standards for teaching, patient care, and avoidance of adverse outcomes for patients. In the last decade, the burdens of self governance have greatly increased to include performance initiatives, revenue generation, and reduction of financial risks to training medical institutions. The physician advisor (PA) as a clinical leader facilitates care and cost initiatives with administrative leadership. The goal of this article is to describe the varied and complex responsibilities of such a role and ways to impact care delivery in psychiatry. Methods used to impact on patient care are described. Anticipated results through the use of systematic administrative leadership are outlined.

Key Words: Patient care, quality assurance, physician advisor

Forensic Files:
Case Study: Competency Evaluations
by Seth Feuerstein, MD, JD

Psychotherapy Rounds:
Psychotherapy for the Patient with Adult ADHD
by Julie P. Gentile, MD; Rafay Atiq, MD; and Paulette M. Gillig, MD, PhD