Attention Deficit Disorder

Attention Deficit Disorder (ADD) is a common condition that typically starts in childhood. It has been estimated to affect 5-7% of school age children. It is sometimes is associated with a hyperactivity component (ADHD). This occurs more commonly in males than females. It is often the hyperactivity that gets noticed first by parents and teachers.

Children with ADD or ADHD are noted to have problems with maintaining focus and are unable to pay attention at school. This inattentive behavior at school is manifested as making careless mistakes in schoolwork or homework, not listening to instructions, forgetful about assignments or daily activities, appears disorganized, and is easily distracted by minor extraneous stimuli. The ADD/ADHD child is often impulsive and has difficulty waiting his or her turn, blurts out answers before the question is completed and interrupts others frequently. The hyperactivity component is demonstrated by leaving the seat in the middle of class, talking excessively, difficulty in engaging in quiet behaviors, and runs around inappropriately. These children may also have a mood disorder associated with the ADD. They often get isolated and made fun of by other children because of their problematic social interaction with non-ADD children.

In the past most physicians and psychologists felt that children outgrew ADD. Now we believe that a significant percent of these children, maybe as high as 50%, do not grow out of the condition. Many adults learn ways to cope with the problems associated with ADD. They also find that certain jobs and career fields are more suitable to their impairment. However, the basic problems of inattention, impulsivity, and hyperactivity continue to cause some personal, social, educational, and occupational problems in their lives. In adulthood the hyperactivity becomes more of a restlessness with impatience and fidgetiness as the primary symptoms. The impulsivity is now more verbal with saying the wrong thing, interrupting, or speaking out of turn. Sometimes things like impulsive buying maybe a symptom of ADD. The most problematic symptom is the inattention, which manifests as trouble staying on task and completing work assignments. It results in poor organization skills and trouble with making and maintaining a schedule. The inattention results in social problems because these adults commonly forget anniversaries, birthdays, and other important dates. ADD in adults often prevents advancement in their careers and limits more advanced educational opportunities.

Treatment for ADD mainly involves use of medications. Behavioral and psychotherapy do not have much of a role in treatment of ADD. The traditional medications are all psycho stimulants such as Ritalin, Adderall, and Concerta. Strattera is in a new class of medication that works on norepinephrine, a chemical in the brain. This medication is useful in the group of patients that are intolerant of the traditional stimulants.

If you believe that you may suffer with ADD you should consult your pediatrician or family physician. There are many good treatment options available.

– – – Mark Smith, MD – – –

Premenstrual Syndrome

Premenstrual Syndrome

PMS (Premenstrual Syndrome) and PMDD (Premenstrual Dysphoric Disorder) usually present with both physical and mood symptoms. PMS and PMDD affect approximately 20-30% of menstruating women. The average age at which women seek treatment is in the early 30’s. There is not a set criteria for diagnosis of PMS. However, the more severe version of PMS referred to as PMDD does have a set criteria for diagnosis. Recent population-based studies have found no association between PMS and any demographic or personal habits such as education, income, employment status, or marital status. There is a higher rate of PMS/PMDD in Hispanic women and a lower rate among Asian women compared to Caucasian females.
Emotional symptoms are the most common reason that women seek treatment, with irritability being by far the most common symptom. Other emotional symptoms include depression, anxiety, sadness, crying spells, anger, and mood lability. The most common physical symptoms are breast tenderness, fatigue, insomnia, abdominal bloating, weight gain, appetite increase, hot flashes, headache, and muscle/joint aches.
PMS is diagnosed when women report at least one of the symptoms listed above during the five days before menses in each of the three prior menstrual cycles. The symptoms are relieved within 3-4 days of the onset of menses without recurrence until the middle of the next cycle. The symptoms cause dysfunction in some aspect of the patient’s life — personal, work, social, etc.
PMDD is diagnosed when most menstrual cycles during the past year have 5 or more of the following symptoms:
1. Markedly depressed moods or feeling of hopelessness
2. Marked anxiety or tension
3. Marked mood swings
4. Persistent anger or irritability
5. Loss of interest in past enjoyable activities
6. Difficulty concentrating
7. Lethargy and fatigue
8. Marked change in appetite
9. Change in sleep, insomnia, or hypersomnia
10. Sense of being overwhelmed or out of control
11. Other physical symptoms: breast tenderness, abdominal bloating, headache, swelling of extremities, muscle/joint aches
Symptoms start 4 days prior to menses and end 4-5 days after start of menses. The disturbance interferes with some aspects of the patient’s life. The problem is not related to other underlying problems such as depression or anxiety.
Treatment for PMS/PMDD has improved significantly in the last few years. The serotonergic antidepressants (SSRIs) such as Prozac, Zoloft, and Paxil have been proven to be extremely effective in treating the majority of symptoms. The SSRIs improve both mood and physical symptoms as well as the patient’s overall functioning, including work productivity and social relationships. They work rapidly with significant improvement seen within the first cycle of treatment. They can be used on a continuous basis or intermittently during the premenstrual period. Intermittent dosing offers advantages with lower costs and possible reduction in some side effects such as weight gain and decreased sex drive. The major disadvantage is with intermittent dosing is that women have to track their start and stop dates. Other treatments that have demonstrated some usefulness with PMS/PMDD are exercise on a regular basis and calcium 600mg twice daily. Chaste berry (vitex agnus castus) is an herbal treatment that has shown some promise for treatment of PMS/PMDD. Further study of this herbal treatment is ongoing.

Mark Smith, M.D.