ADHS in der Allgemeinpraxis. Henriette Walter MedUiWien

Transkript

1 ADHS in der Allgemeinpraxis Henriette Walter MedUiWien

2 ADHS in Kindheit

3 Attention deficit hyperactivity disorder: Was braucht man in der Praxis? In der Praxis ist eine klare Diagnose absolut notwenig (ICD-10, ICD-11, DSM5) Pat / = Kind oder Erwachsener Biologische Störung, Ko-Morbiditäten Möglichkeit / Gespräche mit Familie/ PartnerIn Kontakt mit Psychologischer Praxis für die entsprechenden Tests.

4 ADHS im Alltag heute

5 Komorbidität Epilepsie, petit mal Depressionen Angststörungen Bipolarität Aggresssive Verhaltensstörungen Frühkindliche Entwicklungsstörungen (z.b. Meningitis)

6 Genetic correlations across psychiatric phenotypes The color of each box indicates the magnitude of the correlation, and the size of the box indicates its significance (LDSC), with significant correlations filling each square completely. Asterisks indicate genetic correlations that are significantly different from zero after Bonferroni correction.

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8 Ursachen von ADHS Hirnverletzungen im Frontalbereich Komplikationen, Alkohol, Nikotin in Gravidität Anomalien in Hirnentwicklung (Tumoren) Genetische Anlagen

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10 Differentialdiagnosen Hyperthyreose Schizophrenie, Austismus-Spectrum Epilepsie, Organ Strg., Dysthymie Bipolare Störung oft als bipolar fehldiagnostiziert oft mit Lithium ohne Wirkung behandelt oft als Persönlichkeitsvariante gesehn oft mit Alkohol selbst behandelt oft sozial depraviert oft sogar eingesperrt

11 Was ist ADHS?

12 Aufmerksamkeitsstörung

13 Hyperaktivität

14 Impulsivität

15 Diagnostische Kriterien (ICD-10) - Aufmerksamkeitsstörung Mind. 6 Monate lang mind. 6 der folgenden 9 Symptome 1. unaufmerksam gegenüber Aufgabendetails oder Sorgfaltsfehler bei Aufgaben 2. häufig nicht in der Lage, Aufmerksamkeit beim Spiel oder bei Aufgaben aufrechtzuerhalten 3. hören häufig scheinbar nicht, was ihnen gesagt wird 4. können Aufgaben und Pflichten häufig nicht erfüllen (nicht aufgrund oppositionellen Verhaltens) 5. beeinträchtigt, Aufgaben und Pflichten zu organisieren 6. vermeiden ungeliebte Aufgaben, die Durchhaltevermögen erfordern 7. verlieren häufig Dinge, die zur Durchführung von Aufgaben wichtig sind (z.b. Stifte) 8. werden häufig von externen Stimuli abgelenkt 9. sind im Verlauf der alltäglichen Aktivitäten oft vergesslich

16 Diagnostische Kriterien (ICD-10) Überaktivität Mind. 6 Monate lang mind. 3 der folgenden 5 Symptome 1. fuchteln häufig mit Händen und Füßen oder winden sich auf Sitzen 2. verlassen ihren Platz im Klassenraum oder in anderen Situationen, in denen Sitzenbleiben erwartet wird 3. laufen häufig herum oder klettern exzessiv in Situationen, in denen dies unpassend ist 4. sind häufig unnötig laut beim Spielen oder haben Schwierigkeiten bei den leisen Freizeitbeschäftigungen 5. anhaltendes Muster exzessiver motorischer Aktivität, die durch den sozialen Kontakt oder Verbote nicht durchgreifend beeinflussbar sind

17 Diagnostische Kriterien (ICD-10) Impulsivität Mind. 6 Monate lang mind. eines der folgenden 4 Symptome 1. platzen mit der Antwort heraus, bevor die Frage beendet ist 2. können häufig nicht warten, bis sie an der Reihe sind 3. unterbrechen oder stören andere häufig (z.b. mischen sich ins Gespräch oder Spiel anderer ein) 4. reden häufig exzessiv, ohne angemessen auf soziale Beschränkungen zu reagieren

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19 ICD-11: 6A05 Attention deficit hyperactivity disorder (ADHD).is characterized by a persistent pattern (at least 6 months) of inattention and/or hyperactivity-impulsivity, with onset during the developmental period, typically early to midchildhood.

20 6A05 Attention deficit hyperactivity disorder Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level of stimulation or frequent rewards, distractibility and problems with organization. Hyperactivity refers to excessive motor activity and difficulties with remaining still, most evident in structured situations that require behavioural self-control. Impulsivity is a tendency to act in response to immediate stimuli, without deliberation or consideration of the risks and consequences. The relative balance and the specific manifestations of inattentive and hyperactive-impulsive characteristics varies across individuals, and may change over the course of development. In order for a diagnosis of disorder the behaviour pattern must be clearly observable in more than one setting. Inclusions: attention deficit disorder with hyperactivity attention deficit syndrome with hyperactivity Exclusions: Autism spectrum disorder (6A02) Disruptive behaviour or dissocial disorders (BlockL1-6C9)

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22 Symptome als Ressourcen?

23 Vielen Dank für Ihre Aufmerksamkeit Henriette Walter

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25 6A05 Attention deficit hyperactivity disorder ICD-11 Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level of stimulation or frequent rewards, distractibility and problems with organization.

26 6A05 Attention deficit hyperactivity disorder Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level of stimulation or frequent rewards, distractibility and problems with organization. Hyperactivity refers to excessive motor activity and difficulties with remaining still, most evident in structured situations that require behavioural self-control.

27 6A05 Attention deficit hyperactivity disorder Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level of stimulation or frequent rewards, distractibility and problems with organization. Hyperactivity refers to excessive motor activity and difficulties with remaining still, most evident in structured situations that require behavioural self-control. Impulsivity is a tendency to act in response to immediate stimuli, without deliberation or consideration of the risks and consequences.

28 DD: Autismus Spektrum

29 ICD-11 6A05.Y Attention deficit hyperactivity disorder, other specified presentation 6A05.Z Attention deficit hyperactivity disorder, presentation unspecified

30 6A05 Attention deficit hyperactivity disorder Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level of stimulation or frequent rewards, distractibility and problems with organization. Hyperactivity refers to excessive motor activity and difficulties with remaining still, most evident in structured situations that require behavioural self-control. Impulsivity is a tendency to act in response to immediate stimuli, without deliberation or consideration of the risks and consequences. The relative balance and the specific manifestations of inattentive and hyperactive-impulsive characteristics varies across individuals, and may change over the course of development. In order for a diagnosis of disorder the behaviour pattern must be clearly observable in more than one setting. Inclusions: attention deficit disorder with hyperactivity attention deficit syndrome with hyperactivity Exclusions: Autism spectrum disorder (6A02) Disruptive behaviour or dissocial disorders (BlockL1-6C9)

31 6A05 Attention deficit hyperactivity disorder Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level of stimulation or frequent rewards, distractibility and problems with organization. Hyperactivity refers to excessive motor activity and difficulties with remaining still, most evident in structured situations that require behavioural self-control. Impulsivity is a tendency to act in response to immediate stimuli, without deliberation or consideration of the risks and consequences. The relative balance and the specific manifestations of inattentive and hyperactive-impulsive characteristics varies across individuals, and may change over the course of development. In order for a diagnosis of disorder the behaviour pattern must be clearly observable in more than one setting. Inclusions: attention deficit disorder with hyperactivity attention deficit syndrome with hyperactivity Exclusions: Autism spectrum disorder (6A02) Disruptive behaviour or dissocial disorders (BlockL1-6C9)

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33 6A05.0 Attention deficit hyperactivity disorder, predominantly inattentive presentation All definitional requirements for attention deficit hyperactivity disorder are met and inattentive symptoms are predominant in the clinical presentation. Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level of stimulation or frequent rewards, distractibility and problems with organization. Some hyperactive-impulsive symptoms may also be present, but these are not clinically significant in relation to the inattentive symptoms.

34 6A05.1 Attention deficit hyperactivity disorder, predominantly hyperactive-impulsive presentation All definitional requirements for attention deficit hyperactivity disorder are met and hyperactive-impulsive symptoms are predominant in the clinical presentation. Hyperactivity refers to excessive motor activity and difficulties with remaining still, most evident in structured situations that require behavioural self-control. Impulsivity is a tendency to act in response to immediate stimuli, without deliberation or consideration of the risks and consequences. Some inattentive symptoms may also be present, but these are not clinically significant in relation to the hyperactiveimpulsive symptoms.

35 6A05.2 Attention deficit hyperactivity disorder, combined presentation All definitional requirements for attention deficit hyperactivity disorder are met. Both inattentive and hyperactive-impulsive symptoms are clinically significant, with neither predominating in the clinical presentation. Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level of stimulation or frequent rewards, distractibility and problems with organization. Hyperactivity refers to excessive motor activity and difficulties with remaining still, most evident in structured situations that require behavioural self-control. Impulsivity is a tendency to act in response to immediate stimuli, without deliberation or consideration of the risks and consequences.