An Interview with Dr Sanjeev Sharma : An Integrated Approach to Attention Deficit and Hyperactivity Disorder ( ADHD )
Part 1
This article appears with the kind permission of FxMed . It comprises part of an edited interview with Dr Sanjeev Sharma by FxMed ambassador Dr Adrian Lopresti . In this part of the interview Adrian and Sanjeev discuss the following issues of diagnosis and the part played by neurotransmitters in ADHD :
• The defining aspects of Adult ADHD diagnosis ;
• Is hyperactivity required for a ADHD diagnosis ?
• DSM-5 and other diagnostic criteria for ADHD ;
• The importance of formal ADHD diagnosis ;
• Restrictions surrounding medications ;
• Neurotransmitters implicated in ADHD and the mechanisms of actions of ADHD medications .
Sanjeev : ADHD has been in existence for a long time . It is a well-known condition . But historically it has contained a lot of taboos , particularly in the 1990s , when there was a movement against over-prescribing medications for the condition . But if you see into the breakdown , into the symptomatology of individual cases , it is a quality-of-life illness , not a life-threatening one . If an individual is not treated , will they die ? Of course not . But can their quality of life be better ? Yes . On a day-to-day basis , this has implications for how they organise their lives and for their professional pursuits .
Usually , ADHD is identified at a young age , especially if the individual is impulsive and hyperactive . But there ' s a third component of this illness , which is inattentiveness , which unfortunately can go misdiagnosed for several decades . And this is something I come across in my practice , where individuals have reached their 20s and 30s and in their professional setups they can see that they ' re struggling . And they may or may not have the other key symptoms which I referred to , impulsivity and hyperactivity . So , it is a disorder in which these three key symptoms are there , and depending on individual needs we plan their treatments after assessment is done .
Adrian : So do you have many patients whom you newly diagnose as adults who were obviously missed during childhood ? Is that quite common ?
Sanjeev : Yes . One of my subspecialty interests is addictions . Where I work we specialise in dual diagnosis , mental health and addictions . Now , a substantial chunk of the population -maybe more than 60 % - who have been using any addictive substances have associated undiagnosed ADHD . And these are the individuals who can start in childhood with delinquent behaviour , followed by rebellious behaviour , then develop conduct disorder , which can gradually develop into an antisocial personality . As well there may be substance abuse . But usually , if you look at the trajectory of these individuals , you will find many have had an early inattention problem . They cannot sit and they can be easily provoked or excited , and then come into conflict
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