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Journal Article Course: J2 Adult ADHD and Comorbid Disorders (1 CE, $7)
The articles can be obtained for free here:
This is a course based on reading freely available, peer-reviewed journal articles
Read two journal articles and receive one CE credit for just $7. The full text of the journal articles can be obtained for free online via PubMed.com. The articles have been field tested and it should take approximately one hour total to read both articles. They are titled "Unrecognized Attention-Deficit/Hyperactivity Disorder in Adults Presenting with Other Psychiatric Disorders" by Russell A. Barkley, Ph.D. & Thomas E. Brown, Ph.D. and "Adult ADHD and comorbid depression: A consensus-derived diagnostic algorith for ADHD" by Diane McIntosh, Stan Kutcher, Carin Binder, Anthony Levitt, Angelo Fallu & Michael Rosenbluth.
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Todd Finnerty, Psy.D. acts as the instructor for the course. Contact Dr. Finnerty with any questions via firstname.lastname@example.org or (330)495-8809.
Course Objective #1: You will be able to describe ways of differentiating Adult ADHD from other disorders
Course Objective #2: You will be able to describe how ADHD comorbid with other disorders may impact treatment
Unrecognized Attention-Deficit/Hyperactivity Disorder in Adults Presenting with Other Psychiatric Disorders
Full text on the web
Full text PDF file
Authors: Russell A. Barkley, Ph.D. & Thomas E. Brown, Ph.D.
Abstract: "Many adults with a diagnosed psychiatric disorder also have attention-deficit/hyperactivity disorder (ADHD). In many cases, comorbid ADHD is unrecognized and/or undertreated. Differential diagnosis of adult ADHD can be challenging because ADHD symptoms may overlap with other psychiatric disorders and patients may lack insight into their ADHD-related symptoms. Current ADHD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision may prevent appropriate diagnosis of many patients with significant ADHD symptoms. Adults may not be able to provide a history of onset of symptoms during childhood, and it may be difficult to confirm that ADHD symptoms are not better accounted for by other comorbid psychiatric conditions. Comorbid ADHD is most prevalent among patients with mood, anxiety, substance use, and impulse-control disorders. ADHD can negatively affect outcomes of other comorbid psychiatric disorders, and ADHD symptoms may compromise compliance with treatment regimens. Furthermore, unrecognized ADHD symptoms may be mistaken for poor treatment response in these comorbid disorders. In these individuals, ADHD pharmacotherapy seems to be as effective in reducing core ADHD symptoms, as it is in patients who have no comorbidity. Limited evidence further suggests that ADHD therapy may help to improve symptoms of certain psychiatric comorbidities, such as depression. Therefore, management of ADHD may help to stabilize daily functioning and facilitate a fuller recovery."
CNS Spectrums 2008 Nov;13(11):977-84
Adult ADHD and comorbid depression: A consensus-derived diagnostic algorith for ADHD
Full text on the web
Full text PDF file
Authors: Diane McIntosh, Stan Kutcher, Carin Binder, Anthony Levitt, Angelo Fallu & Michael Rosenbluth
Abstract: "OBJECTIVE: Many patients present to their physician with depression as their primary symptom. However, depression may mask other comorbid disorders. This article presents diagnostic criteria and treatment recommendations (and monitoring) pertaining to the diagnosis of adult attention deficit hyperactivity disorder (ADHD), which may be missed in patients who present with depressive symptoms, or major depressive disorder (MDD). Other co-occurring conditions such as anxiety, substance use, and bipolar disorder are briefly discussed. METHODS: A panel of psychiatrist-clinicians with expertise in the area of child and adolescent ADHD and mood disorders, adult mood disorders, and adult ADHD was convened. A literature search for recommendations on the diagnosis and treatment of co-occurring conditions (MDD, anxiety symptoms, and substance use) with adult ADHD was performed. Based on this, and the panel's clinical expertise, the authors developed a diagnostic algorithm and recommendations for the treatment of adult ADHD with co-occurring MDD. RESULTS: Little information exists to assist clinicians in diagnosing ADHD co-occurring with other disorders such as MDD. A three-step process was developed by the panel to aid in the screening and diagnosis of adult ADHD. In addition, comorbid MDD, bipolar disorder, anxiety symptoms, substance use and cardiovascular concerns regarding stimulant use are discussed. CONCLUSION: This article provides clinicians with a clinically relevant overview of the literature on comorbid ADHD and depression and offers a clinically useful diagnostic algorithm and treatment suggestions."
Neuropsychiatric Disease and Treatment 2009;5:137-50. Epub 2009 Apr 8
CE Quiz Questions
The quiz questions that you will be asked are:
|Question #1||(True/False) The person taking this quiz is the one registered for the course and has reviewed the materials (you must answer "True").|
|Question #2||(True/False) The article notes that the four most prevalent psychiatric disorders linked to elevated rates of comorbid ADHD are drug dependence, agoraphobia, dysthymia and bipolar disorder.|
|Question #3||According to the authors, executive functioning (EF) includes|
a. behavioral inhibition and managing emotions
b. sustaining and shifting attention to tasks
c. using working memory
d. all of the above
|Question #4||(True/False) Per the article, adults with ADHD may show normal or excellent functioning while doing tasks in which they have strong personal interest or when they feel themselves under threat of immediate negative consequences.|
|Question #5||The authors suggest that the most sensitive approach to diagnosing ADHD in adults is|
a. traditional neuropsychological tests
b. a review of DSM-IV-TR criteria
c. assessing how the person performs complex, self-managed tasks of everyday life
d. a trial on methylphenidate
|Question #6||(True/False) Per the article, treating ADHD may have a positive impact on the treatment for any comorbid psychiatric disorders.|
|Question #7||(True/False) According to the McIntosh, et. al. article; Individuals with comorbid ADHD and depression are at greater risk than those with ADHD alone for negative social and vocational outcomes.|
|Question #8||(True/False) Screening tools presented in the article included the ASRS for Adult ADHD and the PHQ-9 for depression.|
|Question #9||(True/False) The panel recommended that if mild depressive symptoms associated with ADHD were present you should treat the depression first.|
|Question #10||(True/False) The panel suggested that significant depression should be addressed first and ADHD symptoms should then be re-evaluated after the depression improves.|
|Question #11||(True/False) The panel suggested that depending on the nature and acuity of any comorbid substance abuse, the diagnosis and treatment of ADHD should be deferred until the substance use problems have stabilized.|