Search Results for "attention deficit"
Is ADHD Sabotaging Your Weight Management Efforts?
Are you an impulsive eater? Do you have a hard time meal planning or keeping a food journal? Do you find it hard to remember if you had breakfast or not (never mind what you actually ate)? Do you start every new diet or exercise program with super enthusiasm, only to lose interest a few days later? Does your day lack a routine (for no good reason)? These are just some of the ways in which Attention Deficit Hypertactivity or just Attention Deficit Disorder (ADHD/ADD) can sabotage your efforts to control your weight. Now, an article by Philip Asherson and colleagues from Kings College London, UK, published in The Lancet Psychiatry discuss important conceptual issues regarding the diagnosis and management of ADHD/ADD in adults. Although ADHD/ADD is largely thought to be a problem in kids and youth, it remains a considerable and often undiagnosed issue in adults. Thus, as the authors point out, “…treatment of adult ADHD in Europe and many other regions of the world is not yet common practice, and diagnostic services are often unavailable or restricted to a few specialist centres.” This is all the more surprising (and disappointing) given that adult patients respond similarly to current drug and psychosocial interventions, with the same benefits seen in children and adolescents. With regard to diagnosis it is important to note that, “Symptoms of ADHD cluster together into two key dimensions of inattention and hyperactivity-impulsivity, are reliably measured, and are strong predictors of functional impairments, but they reflect continuous traits rather than a categorical disorder.” “Of particular relevance to adult ADHD is the relative persistence of inattention and improvements in hyperactive-impulsive symptoms during development, so that many patients who had the combined type presentation of ADHD as children present with predominantly inattentive symptoms as adults.” “In clinical practice, the continuous nature of ADHD should not present diagnostic difficulties in moderate-to-severe cases, but might cause difficulties in mild cases with more subtle forms of impairment. Careful attention is needed to assess the effect of ADHD symptoms on impairment and quality of life, including an understanding of the broader range of problems linked to ADHD (eg, executive function [self-regulation] impairments, sleep problems, irritability, and internal restlessness), in addition to functional impairments such as traffic accidents and occupational underachievement. Therefore, some individuals, who seem to function well, might nevertheless suffer from a substantial mental health problem related to ADHD.” Key criteria according to… Read More »
All Obese Patients Should Be Screened For ADHD
Regular readers will recall previous posts on the association between attention deficit disorder (ADD) and obesity. As this condition significantly affects impulse control, ability to plan, perseverance, time management, and many other factors and skills essential for weight management, this relationship should be no surprise. In our own clinical experience (as suggested in several recent publications from others), managing ADD can often be the key step to managing weight gain. Once you start systematically screening patients for ADD in an obesity clinic, it seems to be present in a surprisingly large number – almost 20-30%. This number is consistent with the findings of another study, this time by Bruno Palazzo Nazar and colleagues from the Federal University of Rio de Janeiro, Brazil, published in the Journal of Attention Disorders. The study sample consisted of women seeking nonsurgical treatment of obesity at a public endocrinology hospital with an eating disorders and obesity clinic, in Rio de Janeiro. One hundred and fify-five consecutive patients presenting in the clinic were approached for this study. Exclusion criteria included less than 5 years of schooling/inability to read and fill out forms and questionnaires; current alcohol or drug abuse, history of bipolar or psychotic disorder; current treatment with psychoactive drugs; and presence of uncontrolled clinical, neurological, or endocrine disorders, especially if they interfere with weight, appetite, and attention; and patients older than 60 years. Based on a battery of validated questionnaires and semi-structured interviews, 28.3% of patients were diagnosed with ADD, which, in turn, was significantly correlated with more severe binge eating, bulimic behaviors, and depressive symptoms. As the authors note, this rate of almost 30% is far higher than the expected rate of less than 5% in the general population. In fact, given the rather rigorous exclusion criteria, the actual prevalence of ADHD in this patient set may actually be even higher. As a clinician, I’d certainly support the notion that we should be aware of the high prevalence of ADHD in patients presenting in obesity programs. Making this diagnosis and managing this issue, may make all the difference in long-term outcomes. AMS Cambridge, UK photo credit: Peter Vidrine via photo pin cc Nazar BP, Pinna CM, Suwwan R, Duchesne M, Freitas SR, Sergeant J, & Mattos P (2012). ADHD Rate in Obese Women With Binge Eating and Bulimic Behaviors From a Weight-Loss Clinic. Journal of attention disorders PMID: 22930790 .
The Limitations of Checklists in Assessing Mental Health
An assessment of mental health (the first ‘M’ of obesity) should be part of every assessment for obesity. Not only can virtually all mental health problems (from mild to severe) promote weight gain, but they can and, in virtually all severe cases, will, present significant barriers to weight management. Unfortunately, most practitioners, who are called upon to give weight management advice, have little to no formal training in diagnosing, let alone dealing with, mental health disorders. This is when they sooner or later fallback on checklists – often self-administered – to screen for the presence of mental illness. In a ‘perspective’ piece recently published in the New England Journal of Medicine, Johns Hopkins University’s Paul McHugh and Phillip Slavney, discuss the limitations of overly relying on checklists for mental health assessments. As they explain, the use of checklists to assess the presence of ‘symptoms’, proliferated in psychiatric practice following the introduction of the Diagnostic and Statistical Manual (SDM), which introduced a much needed ‘standardisation’ in the assessment of mental health disorders. As a downside however, simply counting or checking off symptoms on a list has resulted in a shift towards ‘phenomenology’ rather than to consideration of etiological differences in clinical symptoms that may appear similar both to the patient and to an observer. Thus, for example, simply counting off symptoms, may lead to the ‘diagnosis’ of depression in someone who is bereaved, has classic melancholia or is simply ‘demoralised’ by circumstances. (I would add untreated sleep apnea to the list of potential confounders) As the authors note: “The mixing of similar-appearing patients who have conditions that are distinct in nature probably explains why the use of this diagnostic category expanded over time and suggests why the effectiveness of antidepressant medications given to people with a diagnosis of major depression has, of late, been questioned.” “This tendency to blur natural distinctions may explain why other DSM diagnoses – such as post-traumatic stress disorder (PTSD) and attention deficit disorder – have been overused if not abused.” Indeed, as the authors explain, the introduction of the DSM with, “Its emphasis on manifestations persuaded psychiatrists to replace the thorough ‘bottom-up’ method of diagnosis, which was based on a detailed life history, painstaking examination of mental status, and corroboration from third-party informants, with the cursory ‘top-down’ method that relied on symptom checklists.” Thus, although “checklist diagnoses” cost less time and money, “they fail woefully to… Read More »
Mental Health and Obesity: Day 1
Yesterday, in my talk, at the sold-out standing-room-only Hot Topics Conference on Obesity and Mental Health here in Toronto, I pointed out that individuals presenting with obesity often also present with mental health problems ranging from mood to attention deficit or addiction disorders. In addition, they often have eating disorders, poor self-esteem and body image and other challenges that affect their eating and activity behaviours. Thus, routine assessment and management of mental health problems should be part of obesity management practice. I also presented a brief overview of the Canadian Obesity Network’s 5As of Obesity Management. Roger McIntyre (U of Toronto) presented data showing that individuals with bipolar disorder (BD) are differentially affected by overweight, obesity, and abdominal obesity. The hazards posed by excess weight in the Bd population on illness presentation, clinical course, and outcome have underscored the need to prioritize the prevention and treatment of overweight in this vulnerable population. Emerging evidence indicates that overweight/obesity may adversely affect neurocognitive performance in individuals with BD and may also be inversely associated with other addictive behaviours (e.g. substance use disorders). The contribution of distal adversity (e.g. childhood physical, sexual abuse) as a vulnerability factor for obesity has not been sufficiently reported or characterized. He also presented results from two recently completed studies documenting the effect of obesity on white matter integrity and as well the (positive) impact of bariatric surgery on the course of BD. Randy Sansone (Wright State University, Dayton, Ohio) spoke on the role of borderline personality disorder (an Axis II dysfunction that is characterized by inherent difficulties with self-regulation), which may coexist in syndromes that are characterized by self-regulation difficulties. Perhaps, not surprisingly, studies in various eating disorder samples clearly suggest that restrictive personality styles are associated with restrictive eating pathology whereas impulsive personality styles are associated with impulsive eating pathology. Present data indicate that slightly over one-quarter of obese individuals may suffer from varying degrees of borderline personality disorder. Obviously, this has a number of clinical implications, particularly in terms of assessment, treatment strategies, and outcome. Allan Kaplan (U of Toronto) focussed in his presentation on the fascinating phenomenology and etiology of the two commonest recognized eating disorders, bulimia nervosa and binge eating disorder, and their relationship to obesity. Needless to say, all health professionals dealing with obesity have to be well qualified to recognise and address these eating disorders in their patients and, if necessary,… Read More »
Register Now: Workshop on Obesity and Mental Health, Toronto, June 26-28
Regular readers will be well aware of the important relationship between obesity and mental health. Not only can excess weight affect self-esteem, body image, eating behaviours and even promote depression and anxiety, the opposite is also true – virtually all mental health problems ranging from depression and attention deficit disorder to PTSD and addictions can promote weight gain or pose important barriers to weight management. Health practitioners, researchers and policy makers wanting to learn more about Obesity and Mental Health can join the Canadian Obesity Network, the International Association for the Study of Obesity and the Centre for Addiction and Mental Health at the upcoming Hot Topic Conference: Obesity & Mental Health, June 26-28, 2012, in Toronto. More than 20 Canadian and internationally renowned experts from a variety of disciplines will provide participants with a sound understanding of the scientific and methodological issues in obesity and mental illness research and practice. LEARNING OBJECTIVES Build your knowledge and understanding in the areas of: · Clinical assessment and management of patients with obesity and mental illness. · Current evidence and best practices in psychological and behavioural interventions. · Emerging pharmacological treatments for obesity and mental illness. · The neuropsychobiology of ingestive behaviour and mental health disorders. · Interdisciplinary obesity research and practice. · Bias and stigma associated with obesity and mental illness. · Research priorities in the emerging field of obesity and mental illness. To view the preliminary program and to register click here. Space is Limited – Register Today! Look forward to seeing you in Toronto next month! AMS Edmonton, Alberta