ITT I diagnose you with Adult ADHD and Prescribe Meds

Report: 1 in 5 of US adults on behavioral meds

These numbers are simply astounding. I attribute a lot of it to pharma company marketing. But also the way the psychology profession has changed. Most psychiatrists have been reduced to script writing. It's all they have time for/have an interest in doing. Therapy has been delegated to clinical psychologists and social workers.

There's also the cultural fascination with pharmacological solutions to problems.

The regional differences in drug use was also interesting.

If I were a conspiracy theorist, which I am so obviously not, I would wonder if there weren't some kind of national effort underway to placate the masses with Xanax in combination with liberal doses of religion and cable television.

What could possibly be a better solution to income equality in the United States than to throw Abilify at the problem?

"In the "diabetes belt" states of Tennessee, Kentucky, Mississippi and Alabama, about 23 percent of people are on at least one psychiatric or behavioral disorder drug"

The diabetes belt is also the poverty belt. Being poor is a behavioral disorder.

 

Yep. Gotta dumb down the people. Make them flat line zombies.

Opiate for the masses(organized religion and new age pablum) combined with bread and circuses(Modern sports and reality TV).

 

Eh, it's being overprescribed. Eventually it'll get back down to equilibrium as people start to realize they're not ADHD, they're just lazy and inattentive.

That warning is on there because, and I'm simplifying the matter tremendously, there are basically two chemical reasons for depression, and thus two treatments, and if they prescribe you the wrong one it can actually exacerbate the problem. BUT the only way to treat you is to try one of the two treatments. So yes, if you have problem A and the drug treats problem B, you're going to get more depressed.

 

Among people 35-54 years old, prescription drugs are the leading cause of accidental death. It beats out automotive accidents. They kill more people than heroin and cocaine. But I suppose that for America, freedom to self medicate or freedom to prescribe whatever the patient thinks that he or she wants is a necessary freedom, guaranteed by pharmaceutical companies.

 

I love the medicalization of humanity. A local MP here in Australia was recently charged with having sex with an underage prostitute. The explanation for this conduct was "hypersexuality" caused by medication the patient was receiving for early Parkinsons. The accused is actually a victim, you see.

As a lawyer I am constantly bemused by medical 'experts' who are able to 'medicalize' any behaviour whatsoever - violence, gambling, buggering little boys? No problem, there is a medical condition out there to excuse it and a prescription to treat it.

 

Really? That was an actual defense? It does seem that any sort of behavior can be analyzed and determined to be caused by some psychological issue. This is coming from someone who loves psychology, but I think that the practice is being abused and used to manipulate people and defend behaviors that are really indefensible. Rape a child? It was probably because you were raped as a child. Kill someone after eating a Twinkie? It's the Twinkie defense for you. So yeah, while I'm sure there are actual disorders out there that need help--the way we're handling it as a culture is reprehensible. And I think it's a symptom of our society trying to split everything up into a label and if you're not labeled something then you don't belong or you're a defective or something. It's that constant need to feel a part of something in a society that's increasingly becoming separated.

 

I submitted an article for review on ethical issues in the diagnosis and treatment of ADHD a week ago today. My co-author and I argue that the data support ADHD as a valid diagnosis, but note that a trend in the population does not translate into the presence of the disorder in a particular patient, and that whether someone is using DSM-IV-TR criteria (or ICD-10) criteria, clinicians are doing their patients a disservice if they ignore the spectrum of disorders that can account for the behavioral issues in question.

 

A friend of mine was diagnosed with adult ADHD, was never diagnosed as ADHD in childhood (he was a child long before it became a popular diagnosis). He has been on Strattera for I think at least a decade. He claims the med is critical in helping him concentrate and focus at work, yet he's also struggled with alcoholism, has had multiple DUIs and so on; certainly the diagnosis and medication hasn't "solved" any of his other problems. He also is in therapy and goes to AA meetings regularly, not that those have ended the substance abuse either. Some people indeed face a potluck buffet of issues. In this case, ADHD provided a label, and a medication to go with it. And it gave my friend a badge for self-identification.

 

What's the difference between having ADHD and being lazy and disorganized? The answer is nothing.

Therefore whoever defines these things needs to do a better job.

 

Either you aren't expressing yourself well or you really don't know what you're talking about.

 

ADD patients (the real ones) have slower acting neurotransmitters (IIRC). The treatment is to speed those up which would essentially make them more 'normal'. This is why caffeine can work with ADD. The problem is the over-prevalence of parents who diagnose their kids and then seek treatment for something that's not even a problem. The other crappy part is that there's no way to prove that someone has it other than by using the symptoms of it. I think they are trying to use MRI's to diagnose it and see if their brain patterns match up. However, to say they're 'lazy and disorganized' is just silly.

 

Kinda. There is a lot of on-going research into the specific etiology of the disorder and there aren't generally applicable biological markers for it. There are a number of neurological structures that are being examined (and several candidate genes involved), but things are still pretty tentative.

 

So have they studied different groups of kids that just use pills to focus, those who use parents that give a crap, and a combination of both to see what works the best.



Having Aspbergher's syndrome and going to group therapy I can tell you that most of problems can be fixed not with pills but with behaviour therapy that includes the parents and the family as a whole. its no different then a kid with a handicap. The whole family needs to work together to help the child and themselves. Same with a kid with ADHD or even Autism.

 

That only applies for some people. ADHD, like Autism, actually encompasses an entire spectrum of disorders, in varying strengths for different people.

In my case, after I was diagnosed with ADHD I was put on a fairly low-dosage of Ritalin. That served as a crutch for me while my parents worked with me to develop the skills that I would need to modify my behavior. As a result, I haven't had any medication for my ADHD in over a decade. (Admittedly, I have learned to self-medicate with a can of Pepsi in more extreme circumstances, but those are also rare.)

My younger sister, on the other hand, continues to take medication to this day, and likely will for most of the rest of her life. Why? Because her case is different than mine, and medication provides the most effective basis for treatment. That doesn't mean that she neglects behavior therapy, but that she is using a combination of multiple approaches.

As with all mental health issues, each case is different, and what works for one individual effectively may not be as effective for another individual.

Kimball Kinnison

 

As Kimball said, it is a spectrum disorder. However, broadly speaking, the research trend has been that most patients see the greatest improvement with a combination of pharmacological and behavioral therapies. Behavioral therapies alone are helpful, but not to the same degree as the others. Now, there is a caveat, as part of the concern with an ADHD diagnosis is the non-selective nature of methylphenidate effectiveness (it helped everyone to focus, regardless of whether there was a diagnosis of ADHD present), so simply responding positively to the medication is not an indicator that ADHD is actually present. Other medications have shown selectivity in efficacy, which provides stronger support for those individuals having a disorder (either due to a structural difference or chemical imbalance), but there isn't a clear genotype-phenotype relationship yet, which is a recurrent problem in psychiatry. Pharmacological treatments are difficult because of underlying genetic issues, which is a focus in current pharmacological research (and behavioral genetics).

The larger issue is that behavioral problems can be traced to multiaxial issues. Psychiatric diagnosis currently recognizing four diagnostic axes - Axis 1 is your mood/anxiety/chemical dependency/etc. issues which can potentially respond to pharmacological intervention, Axis 2 is pervasive stuff like personality disorders and mental retardation, Axis 3 is concurrent medical issues, and Axis 4 indicates psychosocial stressors. As my colleague and I point out in our article, ADHD-type behavioral issues can be traced to problems on any one of these, so the fact that there is a demonstrable trend in a patient population does not necessarily mean that this particular patient has ADHD. Consequently, we argue that responsible diagnosis and treatment will reflect a more holistic understanding of the patient and not simply latch on to pharmacological interventions (this approach has also produced greater outcome satisfaction in families and schools).

 

I didn't mean that people with ADHD are just lazy and disorganized (although one could say that, since a person with a gland problem is still fat).

I just meant that I had looked at the DSM IV criteria for an adhd diagnosis and the criteria is "are you lazy and disorganized?"

That's why I said there needed to be a better a definition for ADHD, so that it could be differentiated from just being lazy.

 

That's simply not true.

DSM-IV and DSM-IV-TR criteria:

I've highlighted the parts that are especially relevant.

 

Oh,my, my roommate has a lot of the symptoms listed in #1 and they have persisted for many months. Hmmm....what to do?

She leaves burners on the stove on and then goes into her room because her phone rang and she forgets about the burner. I've had to turn things off quite often. It's getting worrisome.

She is easily distracted, too.

 

Be careful about making diagnoses based on checklists - being scatterbrained isn't the same as ADHD.

 

Okay, but she is very scatterbrained. I am worried because a woman recently destroyed her own apartment, and that of 15 neighbors, by leaving french fries (french fries!!) cooking after having gotten distracted by going into another room to help her child with a crossword puzzle. The smoke alarm saved lives, but not the apartments. 8 were burned out and the other 8 suffered extensive water damage.

 

Oy, that's pretty bad. But I'm a firm advocate of not diagnosing over the internet.

 

Oh, I wasn't asking for a diagnosis, just advice on should I subtly recommend that she talk to her doctor about her forgetfulness. I think it is serious enough that she should mention it to him.

Maybe there's something he can give her that will help. Gingko biloba (I can't spell it!) is out because that raises a person's blood pressure and she's already on blood pressure medicine.

 

Interesting article in the NYT yesterday about the effort to revise the Diagnostic and Statistical Manual of Mental Disorders (DSM IV).

Should normal bereavement/grief over the loss of a loved one be diagnosed as depression?

A friend of mine was prescribed anti-depressants after her husband's death from cancer a few years ago. It seemed like a good idea for her. Some people need help to get over their grief. Sometimes grief sparks a deeper depression, I'm sure. Also, I know people who have sought therapy for binge eating and have been classified in that "eating disorder not otherwise specified" category. This kind of thing is very, very common.

A psychologist friend of mine who specializes in eating disorders describes dieting as "self-induced mental illness."

Plus there's a long tradition of mental health professionals offering therapy to people who aren't necessarily suffering from what anyone would characterize as a mental illness. I'm sure there are people out there who would argue that seeing a therapist when you don't actually have a problem is just inviting trouble.

It all depends on the situation of course. I'm getting older, and over the decades I've seen a lot of otherwise normal people do some crazy-ass ****, so I'm not ready to condemn the DSM revision process, nor am I qualified to assess it in any meaningful way. So, there you have it. No real reason for this post.