Diagnosing and treating ADHD in children

Childhood ADHD or attention deficit hyperactive disorder is one of the commonest causes of childhood learning disability. Therefore, early diagnosis and treatment is essential for better outcome.

Parents need to identify some of the salient features, therefore they can refer the child to a proper channel.

How to diagnose ADHD?

To get a accurate diagnosis, the doctor need to have good experience in child psychiatry. However, some symptoms point towards ADHD. In addition, most of the children in the age of 4 –5 are quite active and therefore diagnosis can be missed.

1. Short attention span. Most children with ADHD cannot concentrate on one task for more than 5 –10 minutes. They will shift their attention from one topic to another in very quick succession.  e.g.  after 2 –3 minutes of drawing a picture, they may start to ride a bicycle, after 4 –5 minutes they may again play with clay. However, most children in ages of 4 – 5 normal attention span is around 15 - 20 mins.

2. Doing dangerous things to themselves can be a another diagnostic factor. Children around 3 – 5 years generally know what is dangerous and what is not. However, ADHD children in that age may try to harm themselves by recklessness. They may climb trees without thinking about their safety or try to jump here and there in road. 

How ADHD affects childs life?

How to treat it?

Children with confirmed diagnosis can be effectively treated with medications. In addition, they need special schools and specially trained teachers. Most children with ADHD can become normal after proper treatment.

What are the medications used in ADHD?

1. Different types of medication used in ADHD

Side effects of drugs used for ADHD
1. Side effects of Ritalin
2. Side effects of Concerta
3. Side effects of Vyvanse

How to change human behavior through Cognitive dissonance theory?

Cognitive dissonance theory is a prominent social influence theory that was developed by Leon Festinger. It is used in behavioral modification such as in preventing alcohol abuse.

According to this theory, there is a drive towards cognitive consistency in humans. These cognitives are attitudes, behavior, and facts. When there is a inconsistency between two cognitions, the person experiences an internal discomfort. This makes the individual to remove that discrepancy and bring the cognitions into harmony.

For an example, we can ask a person who is abusing alcohol to join an anti alcohol public campaign. We can motivate him to do this by saying that it is not such a big deal and you can make new friends. In addition, if he is not willing to stop alcohol then we can say that he can continue drinking in other times and the participation is just a another event.

However, active participation in an anti alcohol campaign creates a cognitive dissonance in a person who abuse alcohol and it causes discomfort.

Image via Wikipedia

Most people will remove that discomfort by changing their attitude against alcohol. which will ultimately result in stopping the alcohol taking behavior. It is because changing the line of action that is already undertaken create more discomfort and it introduces the idea that the initial judgment to participate in the event is wrong. It is usually against one’s generally favorable view of oneself.

Actually anti alcohol campaigns are not much of a help to general public. However, they are effective in controlling alcohol intake in the people who actively participating in such programs.

Interactions of alcohol with antidepressants (Elavil, Prozac)

Alcohol is a complex psycho pharmacological agent. It has many actions on the central nervous system. Main actions are GABA stimulation and Glutamate inhibition. GABA is a naturally occurring neurotransmitter. In addition, Alcohol acts on brains opiod  receptors and causes euphoria.Alcohol also has selective serotonin reuptake inhibition properties (action of prozac).

All these actions results in significant interactions between other psychopharmacological medications such as antidepressants.

Interactions with TCA (Elavil, Amitryptalline)

 Alcohol causes reduction in REM (Rapid eye movement) sleep. It is one reason for the hangover seen in the following day. In addition, it worsens sleep disorders. Antidepressants such as TCAs also causes disturbances in REM sleep. REM sleep is believed to be important for our mental health. Taking Elavil and alcohol will result in greater sleep disturbance and can increase the hangover.

In addition, both agents causes drowsiness. Therefore it can increase the day time drowsiness as well. Both agents cause impairment skilled tasks, therefore operating machinery or driving motor vehicles would be very dangerous if you take Alcohol in combination with Elavil.

If somebody who used to take alcohol would find that they will get problems of alcohol for a small amount, when they combine Elavil or any other TCA class antidepressant with alcohol.

Interactions with SSRIs
 Even though, Prozac cause no sedation, it can happen if you take alcohol and prozac together. Prozac will increase the sedative properties of alcohol.

Summary
You should be very cautious when taking both alcohol and antidepressants. It is better not to drive or operate machinery when you take alcohol (even amount of alcohol that can be previously taken safely) with an anti depressant.

Sources
British National formulary 


Further reading
http://www.mayoclinic.com/health/antidepressants-and-alcohol/AN01653

Pathological Alcohol intoxication (mania a potu)

This is a type of abnormal state associated with alcoholism. Pathological alcohol intoxication is an extraordinary severe response to alcohol, especially to small amounts marked by apparently senseless violent behavior, usually followed by exhaustion, sleep and amnesia for the episode.
















However it is a rare phenomenon. In addition it is important to note that it is used by criminals to form a legal defense against their criminal activities. e.g. I killed that person because I took quarter of glass beer and I am having pathological intoxication. But most experts can differentiate real pathological intoxication from a fake one.

But some doctors think that there is no entity called pathological intoxication and there is no evidence based data to back it up.

In addition, this condition is not associated with bipolar mania (as the name suggests). You can read my blog post on relationship between alcohol and bipolar mania here

How Pathological intoxication differs from usual intoxication?

In usual alcohol intoxication person usually takes significant amount of alcohol. In addition he/she has physical features of alcohol intoxication such as slow reaction time and impaired coordination. Here behavior can become violent, but sometimes not.

In pathological state, behavior is always violent. After the violent episode the person complain lack of memory of the behavior. Usually in pathological intoxication behavior is more organized than the common alcohol intoxication. In addition in pathological intoxication, the person is not addicted to the alcohol. He/she usually takes alcohol occasionally and gets a severe reaction to it, then stops taking alcohol for a while.

How to differentiate pathological intoxication from delirium tremens

It should be distinguished from delirium tremens which is associated with alcohol withdrawal. Delirium tremens is a state that follows after a reduction in amount of alcohol taken by an alcohol dependent person. Person who abuses alcohol for some time may take less than the usual amount of alcohol and then he/she may go into develop delirium tremens. 

Here person sees abnormal things and hears voices/sounds that are not real. In addition in delirium the person can becomes violent, but usually due to the wrong interpretation of surroundings and people. Organized criminal activity is extremely rare in delirium tremens and if not treated it can become life threatening. However pathological intoxication is never a life threatening condition.

Relationship to the Movie : Final analysis

The movie "Final Analysis" directed by Phil Joanou and acted by Richard gere, Kim bassinger and Uma Thurman depicts pathological alcohol intoxication. In fact, it is quite accurate in terms of scientific perspective. Here you can see a trailer of this 1992 movie. 

Summary

Pathological intoxication is a rare abnormally violent response to minute amounts of alcohol. Pathological intoxication per se is not life threatening. It can be differentiated from the common alcohol intoxication. In addition it can used in legal defense.   

Further reading on alcohol related issues

Why is alcohol so addictive ?

A case history of Pathological alcohol intoxication - PsycNET - American psychological association

Pathological intoxication, Is there such an entity (Pubmed abstract)

Librium for alcohol withdrawal

Uses and side effects of Nodict tablets : A medication prescribed for alcohol relapse prevention.

Sources

Symptoms of mind by Andrew Sims

What is Delusion of Love (Erotomania) ?

Love and being loved are common human emotions. Delusional variety of this emotion is called delusion of love, Erotomania or de Clérambault's syndrome. It is quite different from nymphomania or satyriasis, which are disorders of excessive sexual activity. Erotomania is much commoner in women.

What is delusion of love?
Here, typically a woman believes a man who is in higher social status and older, is in love with her. Although the person has done nothing to deserve her attention and he may even be unaware of her existence. Often reasons given by her for being in love is illogical. For an example a women who is saying that her school headmaster is in love with her may say that it is because he enters into the lecture hall in the direction she was seated at.



In addition, sometimes this delusion can have a persecutory tinge. For an example, the deluded person may say that the love letters send by her school headmaster were stolen by her friends.
Most of the time the man is a well known public figure, singer or patients employer. Sometimes patient may even believe that he (victim) is the father of her children.

Who gets it?
Usually it is seen in delusional disorders. Here the patient does not have any other delusions and her life is revolved around a delusion. But it is common in other psychiatric disorders like schizophrenia and Bipolar disorder.
In popular culture
It is said that, Michael Jackson’s popular song Billie Jean is based on an incident where delusion of love is involved. Lyrics of Billie jean.

Sources
1. Symptoms of mind by Andrew sims
2. Wikipedia Billie jean page

The side effects of Ridal

Ridal is an atypical antipsychotic drug prescribed for schizophrenia, other psychoses and bipolar mania. It is a commonly used brand of Risperidone in New zealand.

Ridal is brand of risperidone

Uses of Ridal 

This medication is primarily used for schizophrenia and bipolar disorder. In addition, it is used to manage behavioural problems associated with dementia. It is also used for severe behavioural problems associated with childhood mental health disorders.

How Ridal works?

Since this drug is an atypical antipsychotic, side effects are less than the typical antipsychotics such as largactil. It is because older typical antipsychotics usually block only the dopamine receptors and this causes more side effects. Ridal blocks both dopamine and serotonin receptors. It seems that the additional serotonin block counteracts the dopamine side effects.

What are the common side effects of Ridal?

Drowsiness is the commonest side effect. Gastrointestinal disturbances like nausea and vomiting are also common. In addition, some patients may get abnormal movements with this medication and akathesia (inability to keep the feet in one place) is another troublesome side effect that can occur with Ridal. Drug induced Parkinson’s disease is another side effect.

Headache is another common side effect. Some patients can get blurred vision. In addition, women may complain abnormal milk production from their breasts. Sometimes this medication can cause sexual dysfunction (impotence) in both men and women.

Ridal is similar to Sizodon a brand of risperidone manufactured in India. So you can find more information there. 

Why is alcohol addictive?

Alcohol is a rather unusual substance and people consume it since the beginning of the human civilization. However, scientists say if Alcohol was found today, it would be certainly a banned substance (FDA would have definitely banned it).

Properties of Alcohol

Alcohol is a simple molecule, but it shows some remarkable properties and actions on neuroreceptors that cause addiction.
1. Alcohol acts on GABA type A receptor via benzodiazepine site. Therefore, alcohol has the actions of Vallium or Xanax
2. Alcohol acts on opioid receptors in the brain: - This causes euphoria and effects of heroin. But in a less intense way.
3. Alcohol acts on the dopamine system of the brain: - This is similar to Cocaine.
4. Alcohol in larger doses acts as a general anesthetic

Image via Wikipedia

5. Alcohol has some properties of SSRI or selective serotonin reuptake inhibitors: Therefore it causes increased energy and alleviates depression but for a greater cost.

What is the brain reward system?

Knowledge about the brain’s reward system is necessary to understand why alcohol is so addictive.
In human brain there is a reward system in place to motivate us. It activates when you eat, have sex, and achieve something. It makes you feel good. In addition, human brain learns about these rewards and attaches memories surrounding these events. This helps us to pursuit our goals.

Problem with alcohol is that it activates the brains reward system artificially and it is much more intense than the natural rewards. Then the brain pathologically learns about alcohol and its surroundings (sight of a bar, friends who drinks and surrounding circumstances).

Since alcohol activates reward system, addicted person will ignore natural ways to get his pleasures resulting in loss of employment, loss of academic performance and relationship problems.

In addition, when he sees a bar or meets a friend who took alcohol with him causes activation of the memories of the reward system that make him seek alcohol. It is a strong desire and most people cannot control it, even they decided to get rid of alcohol.

What is Alcohol withdrawal?

Since alcohol has many pharmacological actions on the brain’s neuroreceptors, human brain adapts to long term alcohol intake by way of changing its own chemistry. Then there would be a new equilibrium between alcohol and anti-alcohol chemistry in the brain. Therefore, when alcohol is suddenly withdrawn these anti – alcohol forces become unopposed and causes severe withdrawal reaction. This withdrawal reaction makes the addicted person to take alcohol.

Sometimes the withdrawal reaction is so strong it can even kill the person, if withdrawal is tried without medical help.


Therefore, it is highly advisable to take medical help when long term alcohol user is stopping alcohol.