مقاله رایگان با موضوع بیش فعالی در بزرگسالان
عنوان مقاله:
اختلال کم توجهی/ بیش فعالی در بزرگسالان: یک مطالعه موردی
Attention deficit/hyperactivity disorder in adults: A case study
سال انتشار: 2022
رشته: پزشکی
گرایش: روانپزشکی، مغز و اعصاب
دانلود رایگان این مقاله:
دانلود مقاله بیش فعالی در بزرگسالان
مشاهده سایر مقالات جدید:
Treatment and management of adult ADHD
The overall goal of treatment of adults with ADHD is the relief of distressing symptoms and improvement in occupational and social performance. Treatment is usually individualized based on the client’s presentation and accompanying impairments. Pharmacological and nonpharmacological approaches have been shown to be effective in the treatment of adult ADHD. Pharmacological treatment for ADHD has been shown to improve daily activities positively, and adults receiving medication treatment reported great satisfaction with the outcomes (Sandhu et al., 2020). Treatment is guided by objective and subjective assessment findings and severity of symptom impairment. It may require multiple medications to relieve symptoms. Many times, ADHD occurs with other mental health disorders. In these situations, optimal treatment outcomes are accomplished by medication combinations targeting each disorder (Karlstad et al., 2016). If ADHD is comorbid with other mood disorders, it is recommended to initially treat the most impairing disorder (Bloch et al., 2016). For example, if the client with a mood disorder identifies the inability to focus or to complete a task as most impairing, ADHD should be considered, and symptoms should be treated before treating the mood disorder. Stimulant treatment Stimulant medications have been shown to be effective in the treatment of ADHD in both children and adults. The mechanism of action for drug therapy is believed to be linked to an increase in extracellular dopamine and norepinephrine levels in the frontal cortex by inhibiting the reuptake of these neurotransmitters (Contini et al., 2013). The overall outcome is improvement in impulsive behavior and cognitive processes (Hawk et al., 2018).
Methylphenidate (Ritalin) is a common stimulant medication prescribed for individuals diagnosed with ADHD and shown to decrease symptoms, such as frustration and anxiety, and to improve cognitive functioning in adults. Methylphenidate is available in immediate-release and extended-release. Extended-release methylphenidate has proven effective in relieving both ADHD and mood disorder symptoms if individuals can tolerate the therapy (Koyuncu, Çelebi, Ertekin, Kok, ¨ & Tükel, 2017). However, methylphenidate can cause decreased appetite impaired sleep, palpitations, hypertension, and tremors in some clients. If this occurs, the dose should be lowered, discontinued, or changed to another stimulant (Pozzi et al., 2018). Table 1 shows commonly prescribed stimulants for adults with ADHD. Other medications are constantly being developed with fewer side effects. The medication prescribed will be dependent on the provider, client preference, symptom alleviation, and tolerance (McCarthy, 2014). Non-stimulant therapy Although stimulant medications are usually the first-line treatment for adults with ADHD, there are times when alternate methods should be used. Non-stimulant medications can be an effective alternative. Individuals at risk for adverse reactions include clients with a history of cardiac disease, substance misuse (especially cocaine or methamphetamine), sleep disorders, or anyone who may have experienced an increase in anxiety or other emotional responses with stimulant use (Berro, Andersen, Spielman, Tufik, & Howell, 2017; Dogra, 2018; Fairman, Davis, Peckham, & Sclar, 2018). Individuals with comorbid mood disorder and ADHD show a decrease in inattentive depressive behaviors when treated with a non-stimulant (Shaker, Helmy, Adel, & Fahmy, 2020)
. These findings are important in consideration of the adverse effects of stimulant therapy. Atomoxetine (Strattera) is a non-stimulant medication that can be prescribed to reduce the symptoms of adult ADHD. It does not exacerbate the symptoms of other comorbid disorders and has demonstrated efficacy in comorbid anxiety (Clemow, Bushe, Mancini, Ossipov & Upadhyaya, 2017). Tricyclic antidepressants (TCAs) such as imipramine and desipramine at doses of 200 mg/day have effectively treated anxiety and decreased ADHD symptoms (Elliott et al., 2020).
چکیده
اختلال کم توجهی/ بیش فعالی (ADHD) اغلب در بزرگسالان به اشتباه تشخیص داده می شود یا بد درمان می شود، زیرا اغلب به عنوان یک مشکل دوران کودکی در نظر گرفته می شود. اگر کودکی با این اختلال تشخیص داده شود و تحت درمان قرار گیرد، اغلب این اختلال تا بزرگسالی ادامه می یابد. در ADHD بزرگسالان، علائم ممکن است اختلالات همراه یا شبیه سایر بیماری هایی باشند که تشخیص و درمان را دشوار می سازند. بزرگسالان مبتلا به ADHD برای تشخیص و درمان مناسب نیاز به ارزیابی عمیق دارند. تشخیص و درمان بزرگسالان مبتلا به ADHD می تواند پیچیده باشد و اغلب به مراقبت های بین رشته ای نیاز دارد. ارائه دهندگان بهداشت روان و غیر روان اغلب این اختلال را نادیده می گیرند یا از درمان بزرگسالان احساس ناراحتی می کنند. هدف این مقاله بحث در مورد تشخیص و مدیریت بزرگسالان مبتلا به ADHD است.