Attention Deficit Hyperactivity Disorder (ADHD)


The patient with attention deficit hyperactivity disorder has difficulty focusing his attention, engaging in quiet passive activities, or both. Some patients have an attention deficit without hyperactivity; they’re less likely to be diagnosed and receive treatment.

Attention-deficit hyperactivity disorder (ADHD) is one of the most common reasons children are referred for mental health services.  It affects as many as one in every 20 children. This disorder occurs in roughly 3% to 5% of school­age children. Males are three times more likely to be affected than females. The presence of other psychiatric disorders also needs to be determined.


Attention deficit hyperactivity disorder is thought to be a physiologic brain disorder with a familial tendency. Some studies indicate that it may result from altered neurotransmitter levels in the brain.

Signs and symptoms

The kinds of symptoms professionals look for in diagnosing ADHD include

  • difficulty following instructions or completing tasks
  • difficulty ‘sticking to’ an activity
  • easily distracted and forgetful
  • Having trouble waiting his or her turn
  • Interrupting or intruding on others
  • difficulty playing quietly
  • always seeming to be “on the go”
  • blurts out answers without waiting for the question to finish
  • difficulty in waiting or taking turns

In order to be diagnosed with ADHD some of these problems would have been apparent before the age of six or seven years.

These behaviours must normally occur in more than one setting (for example at home as well as at school) for ADHD to be diagnosed.


Education is the first step in effective treatment of attention deficit hyperactivity disorder. The entire treatment team (which ideally includes parents, teachers, and therapists as well as the patient and the doctor) must fully understand the nature of this disorder as well as the disorder’s effect on the individual’s ability to function.

Specific treatments vary, depending on the severity of signs and symptoms and their effects on the patient’s ability to function adequately. Behavior modification, coaching, external structure, use of planning and organizing systems, and supportive psychotherapy can all help the patient more effectively cope with the disorder.

Some patients benefit from medication to relieve symptoms. Ideally, the treatment team identifies the symptoms to be managed, selects appropriate medication, and then tracks the patient’s symptoms carefully to determine the effectiveness of the medication. Stimulants, such as methylphenidate and dextroamphetamine, are the most commonly used agents. However, other drugs, including tricyclic antidepressants (such as desipramine and nortriptyline), mood stabilizers, and beta blockers, sometimes help control symptoms. Tomoxetine, currently in clinical trials, has been found in preliminary studies to be effective; further research will involve extending the duration of treatment to determine the effects of the medication.

Special parenting skills are often required because children with AD/HD may not respond as well to typical parenting practices. Also, because ADHD tends to run in families, parents often have some problems with organization and consistency themselves and need active coaching to help learn these skills.


Preventive measures to reduce the incidence of ADHD in adolescents are not known at this time. However, early detection and intervention can reduce the severity of symptoms, decrease the interference of behavioral symptoms on school functioning, enhance the adolescent’s normal growth and development, and improve the quality of life experienced by children or adolescents with ADHD.



Alcoholism Fact – Signs & Symptoms, Treatment


Alcoholism is a chronic disorder most often described as the uncontrolled intake of alcoholic beverages that interferes with physical and mental health, social and familial relationships, and occupational responsibilities. Alcoholism cuts across all social and economic groups, involves both sexes, and occurs at all stages of the life cycle. beginning as early as elementary school age.

Most adults in the United States are light drinkers; a minority – about 10% of the population – account for 50% of all alcohol consumption. About 13% of all adults over age 18 have suffered from alcohol abuse or dependence at some time in their lives. The prevalence of drinking is highest between the ages of 21 and 34, but current statistics show that up to 19% of 12- to 17-year-olds have a serious drinking problem. Males are, two to five times more likely to abuse alcohol than are females. According to some statistics, alcohol abuse is a factor in 60% of all automobile accidents. Alcoholism has no known cure.


Numerous biological, psychological, and sociocultural factors may cause alcohol addiction, but no clear evidence confirms the influence of any of these factors. Family background may playa significant part: An offspring of one alcoholic parent is seven to eight times more likely to become an alcoholic than is a peer without such a parent. Biological factors may include genetic or biochemical abnormalities, nutritional deficiencies, endocrine imbalances, and allergic responses.

Psychological factors may include the urge to drink alcohol to reduce anxiety or symptoms of mental illness; the desire to avoid responsibility in familial, social, and work relationships; and the need to bolster self-esteem.

Sociocultural factors include the availability of alcoholic beverages, group or peer pressure, an excessively stressful lifestyle, and social attitudes that approve frequent imbibing. Advertising supports society’s message that alcohol consumption is part of a healthy lifestyle. Paradoxically, many alcoholics come from families in which alcohol is forbidden.

Signs and symptoms

Most alcoholics deny that they have a drinking problem. Other indications of alcoholism and alcohol abuse include:

  • Keeping alcohol in unlikely places at home, at work or in the car
  • Gulping drinks, ordering doubles, becoming intoxicated intentionally to feel good or drinking to feel “normal”
  • Nausea and vomiting
  • Having legal problems or problems with relationships, employment or finances
  • Rapid heart rate and sweating
  • Restlessness or agitation


Total abstinence is the only effective treatment. Supportive programs that offer detoxification, rehabilitation, and aftercare, including continued involvement in Alcoholics Anonymous (AA), may produce long-term results.

Acute intoxication is treated symptomatically by supporting respiration, preventing aspiration of vomitus, replacing fluids, administering I.V. glucose to prevent hypoglycemia, correcting hypothermia or acidosis, and initiating emergency treatment for trauma, infection, or GI bleeding.

Treatment of chronic alcoholism relies on medications to deter alcohol use and treat effects of withdrawal; psychotherapy, using behavior modification techniques, group therapy, and family therapy; and appropriate measures to relieve associated physical problems.

Aversion, or deterrent, therapy uses a daily oral dose of disulfiram to prevent compulsive drinking. This drug interferes with alcohol metabolism and allows toxic levels of acetaldehyde to accumulate in the patient’s blood, producing immediate and potentially fatal distress if the patient consumes alcohol up to 2 weeks after taking it.

Disulfiram is contraindicated during pregnancy and in patients with diabetes, heart disease, severe hepatic disease, or any disorder in which such a reaction could be especially dangerous. Another form of aversion therapy attempts to induce aversion by administering alcohol with an emetic.

For long-term success with aversion, or deterrent, therapy, the sober alcoholic must learn to fill the place alcohol once occupied in his life with something constructive. For patients with abnormal dependence or for those who also abuse other drugs, aversion therapy with disulfiram may only substitute one drug dependence for another; so it should be used prudently.

Tranquilizers, particularly benzodiazepines, occasionally are used to relieve overwhelming anxiety during rehabilitation. However, these drugs have addictive potential (substituting one substance abuse problem for another), and they can precipitate coma or even death when combined with alcohol. Naltrexone may be useful as an adjunct to psychotherapy, especially when there are high levels of cravings. Antipsychotics are prescribed to control hyperactivity and psychosis. Anticonvulsants, anti emetics, and antidiarrheals also are used to treat symptoms of alcohol withdrawal.

Supportive counseling or individual. group, or family psychotherapy may improve the alcoholic’s ability to cope with stress, anxiety, and frustration and help him gain insight into the personal problems and conflicts that may have led him to alcohol abuse. Ongoing support groups also can help him overcome his dependence on alcohol. In AA, a self-help group with more than a million members worldwide, the alcoholic finds emotional support from others with similar problems. About 40% of AA members stay sober as long as 5 years, and 30% stay sober longer than 5 years.


Educational programs and medical advice about alcohol abuse have been successful in decreasing alcohol abuse and its associated problems. Alcohol dependency requires more intensive management.

The National Institute on Alcohol Abuse and Alcoholism recommends that women have no more than 1 drink per day and men no more than 2 drinks per day. One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor.



Clinical Depression (Major Depression)

Clinical Depression

Clinical depression is also know as major depression, it is the most severe category of depression. It is normal for people to feel depressed when something bad happens, such as the death of a loved one. This type of depression normally goes away after a couple of weeks; but sometimes it persists. It can last for periods of six months or more, and then it is classified as clinical depression. Without treatment, symptoms of clinical depression can last for weeks, months, or years. Appropriate treatment for clinical depression, however, can help most people who suffer from clinical depression.

Signs and Symptoms of Clinical depression

In a clinical depression, more of the symptoms of depression are present, and they are usually more intense or severe. However, each individual may experience symptoms differently. Symptoms may include:

  • Inability to experience pleasure
  • Hopeless about the future, excessive pessimistic feelings
  • Insomnia or excessive sleeping
  • Fatigue or loss of energy nearly every day
  • Drug or alcohol abuse
  • Thoughts of suicide
  • Feelings of guilt, worthlessness, helplessness
  • Significant weight loss or gain

What are the Causes of Clinical Depression?

Current theory suggests those clinical depression results from complex interactions between brain chemicals and hormones that influence a person’s energy level, feelings, sleeping and eating habits. These chemical interactions are linked to many complex causes–a person’s family history of illness, biochemical and psychological make-up, prolonged stress, and traumatic life crisis such as death of a loved one, job loss, or divorce. Sometimes no identifiable cause triggers an episode of clinical depression; usually one or more stresses are involved. Medical research has found that people who suffer from clinical depression have changes in important brain chemicals, such as serotonin and norepinephrine. New medications are available that restore these brain chemicals to their proper balance and relieve symptoms of clinical depression.


Major depression can profoundly alter social, family, and occupational functioning. However, suicide is the most serious complication of major depression, resulting when the patient’s feelings of worthlessness, guilt, and hopelessness are so overwhelming that he no longer considers life worth living.

Note: If specific plans for suicide are uncovered or if significant risk factors exist (previous history, profound hopelessness, concurrent medical illness. substance abuse, social isolation), refer the patient to a mental health specialist for immediate care. Nearly 15% of patients with untreated depression commit suicide, and most of these patients sought help from a doctor within 1 month of their deaths.

Diagnostic criteria

A patient is diagnosed with a major depressive episode when he fulfills the criteria documented in the DSM-IV.

  • At least five of the following symptoms must have been present during the same 2-week period and represent a change from previous functioning; one of these symptoms must be either depressed mood or loss of interest in previously pleasurable activities (Don’t include symptoms that are due to a general medical condition, delusions, or hallucinations):

– depressed mood (irritable mood in children and adolescents) most of the day. nearly every day, as indicated by either subjective account or observation by others

– a markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

-significant weight loss or weight gain (greater than 5% of the patient’s body weight in a month) when not dieting or a change in appetite nearly every day

– insomnia or hypersomnia nearly every day

– psychomotor agitation or retardation nearly every day

– fatigue or loss of energy nearly every day

– feelings of worthlessness and excessive or inappro­priate guilt nearly every day

– diminished ability to think or concentrate or indecisiveness, nearly every day

– recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or suicide attempt or a specific plan for committing suicide.

  • The symptoms aren’t due to a mixed episode.
  • The symptoms aren’t due to a medical condition (such as hypothyroidism) or the effects of a medication or other substance (drug abuse, for example).
  • The symptoms aren’t better accounted for by bereavement (for example, symptoms persist for more than 2 months after a loved one’s death or are characterized by marked functional impairment, morbid thoughts of worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation).

Psychological tests such as the Beck Depression Inventory can be used to determine the onset, severity, duration, and progression of depressive symptoms. The dexamethasone suppression test may show a failure to suppress cortisol secretion; however, this test has a high false-negative rate. Toxicology screening may suggest a drug-induced depression.

Treatments for Clinical Depression

The first step to getting appropriate treatments for clinical depression is a physical examination by a physician. If a physical cause for the clinical depression is ruled out, a psychological evaluation should be done by referral to a psychologist or psychiatrist. Physical treatments have several options including antidepressant medication therapy, psychotherapy or electroconvulsive therapy or ECT.

  1. Antidepressant medication therapy, it takes about 5 or 6 weeks to find out if that antidepressant medication is appropriate – that is it is working and does not have untoward side effects – and then it takes 6 months or more of continuation treatment to ensure that the medication remains effective.
  2. Psychotherapy – most often cognitive-behavioral and/or interpersonal therapy) for the individual. Cognitive-behavioral focused on the negative thinking and behavioral patterns associated with depression, and teaches the individual to recognize and target the self-defeating behavioral patterns that contribute to their depression.
  3. Electroconvulsive therapy (or ECT). This usually involves 8 to 10 treatments over a 3 to 4 week period. One can consider ongoing treatment once every 2 weeks to once every 4 weeks over a several month period if this treatment has been successful. (ECT)

The effectiveness of treatment often depends on factors such as the amount of optimism and hope the sufferer is able to maintain, the control he or she has over stressors, the severity of symptoms, the amount of time the sufferer has been depressed, the results of previous treatments, and the degree of support of family, friends, and significant others.

While treatment is generally effective, there are some cases where the condition fails to respond. Treatment-resistant depression requires a full assessment which may lead to the addition of psychotherapy, higher medication doses, changes of medication or combination therapy, a trial of ECT /electroshock, or even a change in the diagnosis with subsequent treatment changes. Although this process helps many, some people’s symptoms continue unabated.



Bulimia Nervosa

bulimia nervosa

Bulimia (buh-LEE -me-ah) nervosa, typically called bulimia, is a type of eating disorder. The essential features of bulimia nervosa include eating binges followed by feelings of guilt, humiliation, and self-deprecation. These feelings precipitate the patient’s engaging in self-induced vomiting. the use of laxatives or diuretics, or strict dieting or fasting to overcome the effects of the binges. Unless the patient devotes an excessive amount of time to binging and purging, bulimia nervosa seldom is incapacitating.

Most people with bulimia nervosa are females, ranging in age from the teens to early 20s, who are preoccupied with their weight and body image. Bulimia nervosa affects all races, but is most often diagnosed in Caucasian women.


The exact cause of bulimia is unknown, but various psychosocial factors are thought to contribute to its development. Such factors include family disturbance or conflict, sexual abuse, maladaptive learned behavior, struggle for control or self-identity, cultural overemphasis on physical appearance, and parental obesity. Bulimia nervosa is strongly associated with depression.

Signs and symptoms

  • self-induced vomiting (usually secretive)
  • depression
  • inappropriate use of diuretics or laxatives
  • overachieving behavior
  • persistent preoccupation with eating and an irresistible craving for food.
  • anxiety


Treatment of bulimia nervosa may continue for several years. Interrelated physical and psychological symptoms must be treated simultaneously. Merely promoting weight gain isn’t sufficient to guarantee long-term recovery. A patient whose physical status is severely compromised by inadequate or chaotic eating patterns is difficult to engage in the psychotherapeutic process.

Psychotherapy focuses on breaking the binge-purge cycle and helping the patient regain control over eating behavior. Treatment may occur in either an inpatient or outpatient setting. It includes behavior modification therapy, possibly in highly structured psychoeducational group meetings. Individual psychotherapy and family therapy, which address the eating disorder as a symptom of unresolved conflict, may help the patient understand the basis of her behavior and teach her self­control strategies. Antidepressant drugs such as imipramine may be used to supplement psychotherapy.

The patient also may benefit from participation in self-help groups such as Overeaters Anonymous or in a drug rehabilitation program if she has a concurrent substance abuse problem.


Preventive measures to reduce the incidence of bulimia are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the process of normal growth and development, and improve the quality of life experienced by adolescents with bulimia. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.