ATTENTION DEFICIT HYPERACTIVE DISORDER (ADHD)
ADHD is a commonly misunderstood psychiatric disorder. It affects 4.5% of the population (1800 full time residents in Okeechobee county) Over 90% is genetic. Being born premature can cause ADHD as can exposure to toxins in the uterus or afterwards.
It is a criteria driven illness. Untreated, 46% of those with ADHD will develop the borderline personality disorder at puberty with mood swings, anger, raging and self destructive behaviors. 50% of individuals with ADHD are substance abusers, that goes down by 90 % when the ADHD is successfully treated. People with ADHD are 500% more likely to get in a motor vehicle accident, that risk returns to normal when successfully treated.
Some of the major symptoms include everything being in unfinished piles, not being able to stay on task, being easily distractible and multiple motor vehicle accidents. Hot headed behaviors, substance abuse, road rage, trouble finishing tasks are associated with ADHD including “impulsive aggressiveness.” Multiple divorces and legal problems including incarceration complicate the lives for those with untreated ADHD.
There are 3 types of ADHD. The hyperactive type, which tends to go away with time. The inattentive type tends to persist throughout life and causes the most problems long term. There is also a mixed type. Stimulants such as Adderall and Ritalin (methylphenidate) are life changing for those with ADHD. Stimulants allow the patient to function normally and successfully in society. They are very safe, even in heart failure. Uncontrolled seizures, unstable angina or rapid heartbeat temporarily stops the stimulant until they are under control. There are two non stimulants, Strattera (atomoxetine) and Qelbree (viloxazine). They work for some patients, but most patients will need a stimulant. Many patients still have “executive dysfunction” despite the medications.
The brain area involved is the right prefrontal cortex. The dopamine D4 gene seems to be responsible for the inattention. Medications improve function of that brain area and allow the patient to function normally. Diets deficient in fruits and vegetables make ADHD worse. There is a national stimulant shortage, which has been a huge hassle for patients, their families, physicians and pharmacists. Unfortunately many local pharmacists believe there is no such thing as ADHD, and are 20 years behind the times in terms of dosing and the medical literature.
Dr. Joseph Biederman, Professor of Psychiatry at Harvard, advises higher doses of stimulants when needed for successful ADHD treatment in adolescents and adults. "It should be reiterated that stimulant medications are considered to be very safe, and that dosage titration should continue until an adequate dose is reached, if tolerated. ...there is a wide dosage range for their safe use ... under-dosing in older adolescents and adults is a significant problem...". Most patients need higher doses to fully control the ADHD.