Current Issues in Psychopharmacology

ADHD is a psychiatric disorder that usually develops in childhood and is characterized by over activity, inattentiveness, impulsiveness, instinctive ness, etc. In children with ADHD, about one out of every two would continue to develop several symptoms in the adult stage. Children receive greater amount of care and treatment for ADHD. However, very few adults are diagnosed and treated for ADHD.

Adults with ADHD develop several problems including memory problems, poor concentration, difficulty in organizing work and performing tasks, difficulty in meeting with the targets, poor management, and several other difficulties at home, work, school or in social settings. Personal relationships with others are often distorted. The person often develops several other emotional, behavioral, and academic problems. The other problems faced by individuals suffering from ADHD include:-

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People suffering from ADHD have a very poor image of oneself. In the management of ADHD, psychotherapy along with short-term administration of medications is required. Many of the healthcare organizations do not have the competency to identify, diagnose and treat ADHD in adults. In children, ADHD occurs in 2 % to 18 % depending on the community. In adults, the prevalence rate of ADHD varies from 1 % to 36 %, differing hugely from one study to another. Many studies have considered different diagnostic criteria and methodology for ADHD.

Different studies may consider different DSM criteria including DSM-IV-TR and DSM-III-R, and hence the prevalence in adults seems to vary depending on the type of diagnostic criteria selected. According to the DSM-IV-TR criteria certain symptoms need to exist including:- • inattention • over activity • Significant impairment of normal functioning (Moss et al 2005 & Cleveland Clinic, 2008) The DSM-IV-TR utilized for children may not be appropriate for adults, as their setting of functioning is different from that of children.

The adult may not be aware at the exact date of onset of the symptoms of ADHD. Usually children experience the symptoms of ADHD only after the age of 7 years. Understanding the problems with the DSM criteria, the Utah guidelines have been brought out to identify, diagnose and treat ADHD in adults. Some of the criteria to be recognized as ADHD in adults include:- • Motor hyperactivity • Attention deficits • Labile effects • Temper outbursts • Emotional liability • Disorganization • Impulsiveness • Other features of ADHD (Moss et al 2005 & Cleveland Clinic, 2008)

The Utah criterion tries to exclude the features of inattentiveness, and gave greater amount of importance to impulsiveness and hyperactivity. One of the major symptoms of ADHD is the strained relationship the individual develops with family members, spouses, friends, colleagues, etc. The near and dear ones of the patient may not recognize the disorder and the individual themselves may get frustrated with the symptoms, often causing a lot of problems with other people. The individual may find it very difficult to function at the home, school, and workplace or in social settings.

The individual cannot manage time, and may instead go on to protecting self-esteem. There may be a lot of workplace conflicts and the individual may indulge in socially unacceptable behavior such as drug abuse, frustration, rude comments, etc. The social skills of an adult suffering from ADHD are very poor. Relationships with spouses are also lost in patients suffering from ADHD. The problem-solving and decision-making ability is also lost (Moss et al 2005 & Cleveland Clinic, 2008). ADHD is caused due to both environmental and genetic factors.

In one identical twin suffering from ADHD in childhood, the other twin is at a 55 to 90 % risk of developing the disorder. ADHD is usually considered to be a serious form of behavior and blood tests or imaging scans cannot demonstrate the pathology. Several parts of the brain including right prefrontal cortex, caudate nucleus, cerebellum, sub cortical structures and globus pallidus adn affected and be smaller than normal in size. These structures help to control impulsiveness, attentiveness, stimuli response and processing, etc (Moss et al 2005 & Cleveland Clinic, 2008).

Several neurotransmitters including dopamine, norepinephrine, etc play a major role in the development and progression of ADHD. Several emotional responses including impulsiveness, risk-taking, reward-seeking and mood are affected by dopamine, whereas norepinephrine controls mood changes, arousal and attentiveness. One of the receptors in the brain known as the dopamine receptor D4 is altered in ADHD due to a faulty genetic expression. Dopamine transporter-1 (DT1) is also over-expressed resulting in abnormalities in behavior and emotions.

Individuals control attentiveness and response to the environment due to the DRD4 function (it regulates the levels of dopamine and norepinephrine). At the synapses junction, DT1 and dopamine transporting proteins are taken up before the synapses, so that adequate response can be enabled on the postsynaptic receptor. In ADHD, the receptors may also function abnormally. When the drugs are utilized in the treatment of ADHD, they influence the dopaminergic and the noradrenergic systems and in this way help to identify any abnormality that lies in the biology of the brain (Moss et al 2005, Gardner, 2004 & Cleveland Clinic, 2008).

In more than 70% of all cases, ADHD is an inherited disorder. The genetic patterns influence the manner of development of ADHD. In parents who have developed ADHD, the child has a 7 times higher than normal risk of developing the condition. It is not clear whether a single gene is responsible for the development of ADHD. However, certain points located on the chromosomes may increase the susceptibility of developing ADHD. In another study conducted on adopted children of ADHD patients, the risk was lower than those who had natural children.

In one study, delayed motor development and low birth weight was found to have a significant risk factor in the development of ADHD. Studies conducted in identical twins confirmed the presence of abnormalities in the prefrontal lobes, than in non-identical twins (Moss et al 2005, Gardner, 2004 & Cleveland Clinic, 2008). Several environmental may increase the risk of ADHD. These include physical, chemical and emotional stress factors. One of the significant risk factors in the development of ADHD is the use of nicotine during the pregnancy which can potentially harm the fetus and cause the development of ADHD later in life.

A few studies have even demonstrated that several other maternal factors such as maternal stress, smoking by the mother, excessive caffeine consumption, may increase the risk of ADHD, but even newer studies were not able to demonstrate this. Other environmental factors which may increase the risk of ADHD include lead exposure, low birth weight, lower socioeconomic status, etc (Moss et al 2005, Gardner, 2004 & Cleveland Clinic, 2008). References: Cleveland Clinic (2008). ADHD, Retrieved on August 31, 2008, from Cleveland Clinic Web site: http://my. clevelandclinic.

org/disorders/Attention_Deficit_Hyperactivity_Disorder/hic_Attention_Deficit_Hyperactivity_Disorder_ADHD_in_Adults. aspx Gardner, A. (2004). “Brain Differences found in ADHD kids. ” Retrieved on August 31, 2008, from Health Day Reporter Web site: http://www. gordonresearch. com/articles_adhd/Brain_Differences_Found_in_ADHD_Kids. pdf Moss, S. B. Et al (2005). “Attention Deficit/Hyperactivity Disorder in Adults. ” Primary Care: Clinics in Office Practice, 34(3). September. http://www. mdconsult. com/das/article/body/103481354-4/jorg=journal&source=MI&sp=19972185&sid=740569428/N/608463/1. html? issn=0095-4543#h0700039502