OUTLINE
• INTRO
• EPIDEMIOLOGY
• ETIOLOGY
• CLINICAL PRESENTATION/ DSM V
• CO- MORBIDITY
• MANAGEMENT
INTRODUCTION
ADHD Attention Deficit/ Hyperactivity Disorder
• Neurodevelopmental disorder of child-hood and may persist into adulthood
• T
Characterised by:
• Diminished attention- impaired attention, distractibility, loses things
• Increased hyperactivity and or impulsivity-cannot sit still, fidgety, on the go,
cannot wait for his or her turn
EPIDEMIOLOGY
• Affect more males than girls, with prevalence of 10%.
• Affects 5% to 8% of school-going kids
• 60% persist into adulthood
• First degree relatives have a higher chance of developing ADHD
ETIOLOGY
• Multifactorial, the cause is linked to altered catecholamine metabolism (DA, Serotonin,
or glutamate receptors)
• Genetic predisposition
• Environmental: Prematurity, in utero alcohol exposure, complications at birth
• CNS insults
• Injury to the frontal cortex
DSM
V
▪ g. Often loses things necessary for tasks or activities (e.g., school
materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses,
mobile telephones).
▪ h. Is often easily distracted by extraneous stimuli (for older
adolescents and adults, may include unrelated thoughts). i. Is often
forgetful in daily activities (e.g., doing chores, running errands; for
older adolescents and adults, returning calls, paying bills, keeping
appointments).
CO-MORBIDITY
• PSYCHIATRIC
• Learning disorder
• Communication disorder
• Anxiety disorders
• Mood disorders- depressive disorders, bipolar disorders
• Conduct disorders
• Medical
• Epilepsy
TREATMENT
• Bio-psychosocial
• Biological
• Stimulants Non-Stimulants -Ritalin
• -Concerta -Bupropion
• -Vyvanse -Guanafacine
• Adderal Atomoxetine
APPROACH
• Initial treatment: 4-5 years- behavioural interventions only
• >/=6 and older: Pharmacotherapy with adjunctive behavioural interventions
• First line is pharmacotherapy
STIMULANTS
• Methylphenidate prep: Ritalin (0.3 to 1 mg/kg tid up to 60)
• Concerta up to 54 mg/q AM
NONSTIMULANTS
• Bupropion prep: Wellbutrin 3-6 mg/kg
• a-Adrenergic agonists: Clonidine 0.1 mg tid; Intuniv up to 4 mg/day once
PSYCHOTHERAPIES
• Behavioural interventions:
Patient training in behavioural management in order to reinforce preferred behaviours
• Cognitive behavioural therapy (CBT): adjunct in adults
• Psychologist
• BT- TOKEN economy
• Occupational therapy
• Social skills training
• Classroom
DISRUPTIVE, IMPULSE
CONTROL AND CONDUCT
DISORDERS
CLASSIFICATION (DSM-5)
• Oppositional Defiant Disorder
• Conduct Disorder
• Intermittent Explosive Disorder
• Pyromania
• Kleptomania
• Other Specified Disruptive, Impulse-control, and Conduct Disorders
• Unspecified Disruptive, Impulse-control, and Conduct Disorders
ETIOLOGY
Associated with genetic, environmental, psychological, and social factors
• e.g abuse
• exposure to toxins
• positive family history
• neglect
• family instability
DIFFERENTIAL DIAGNOSIS
• Conduct d/o
• Intermittent explosive d/o
• ADHD
• Intellectual disability
MANAGEMENT
Psychotherapy
• Individual and family therapy
• Parent management training
• Social skills programs
CONDUCT DISORDER
• Persistent patterns of behavior in a child or adolescent
that develop over time are often marked by aggression
and the infringement of others' rights.
• These behaviors can include physical aggression
towards others, damaging property, theft, deceit, and
frequent breaches of age-appropriate rules.
• It’s important to note that isolated incidents of
aggressive behavior do not warrant a diagnosis of
Conduct Disorder, there must be a consistent pattern of
such behaviors.
• Similar etiology as ODD
DIFFERENTIALS
• ODD
• IED
• ADHD
• Adjustment disorders
MANAGEMENT
Psychosocial Intervention
• Cognitive behavioral Therapy
• Parent Management Planning
• Peer group therapy
Psychopharmacologic intervention
• Second Generation Antipsychotics for aggressive and assaultive behavior,
Risperidone has deemed as the superior antipsychotic in this context. Other
atypical antipsychotics can be efficacious but side effects need to be monitored.
• SSRIs are used to clinically target symptoms of impulsivity, irritability and mood
lability often seen in conduct disorder. Fluoxetine and sertraline, paroxetine and
citalopram can be used
• Mood stabilizers for agitation, dysphoria and distress, sodium valproate can be
used
INTERMITTENT EXPLOSIVE
DISORDER
DSM 5
ETIOLOGY
DIFFERENTIALS
ETIOLOGY
DIFFERENTIALS
MANAGEMENT
PYROMANIA
