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COMORBIDITY

COMORBIDITY

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COMORBIDITY

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  1. COMORBIDITY By Larry B. Silver, M.D.

  2. THERE IS A CONTINUUM OF NEUROLOGICALLY-BASED DISORDERS THAT ARE OFTEN FOUND TOGETHER • If any one of the disorders on this continuum is found, there is up to a 50 percent possibility that one or more of the disorders on this continuum will be found. • Thus, if any disorder on this continuum is found, it is important to explore for the other possible disorders.

  3. THE CONTINUUM • CORTEX-BASED DISORDERS • Learning, Motor, Language Disorders • Organization, Executive Function Disorders • ATTENTION-DEFICIT/HYPERACTIVITY DISORDER • EMOTIONAL “REGULATORY” DISORDERS • Anxiety Disorders • Depression • Anger-Control Disorders • Obsessive-Compulsive Disorder • TIC DISORDERS • ??? BIPOLAR DISORDER

  4. DIAGNOSTIC CLUES THAT BEHAVIORS ARE NEUROLOGICALLY-BASED THERE IS A CHRONIC AND A PERVASIVE HISTORY OF THE CLINICAL PROBLEMS. THERE OFTEN IS A FAMILY HISTORY OF THE CLINICAL PROBLEMS

  5. CORTICAL-BASED DISORDERS • LEARNING DISABILITIES • LANGUAGE DISABILITIES • MOTOR DISABILITIES

  6. ATTENTION DEFICIT HYPERACTIVTY DISORDER

  7. EMOTIONAL REGULATORY DISORDERS • ANXIETY DISORDERS • DEPRESSION • ANGER CONTROL DISORDERS • OBSESSIVE-COMPULSIVE DISORDER

  8. ANXIETY DISORDERS • GENERALIZED ANXIETY DISORDER • PANIC DISORDER • PHOBIAS • OBSESSIVE-COMPULSIVE DISORDER

  9. DEPRESSION • MAJOR DEPRESSIVE DISORDERS • Present two or more weeks • DYSTHYMIC DISORDER • Present for two or more years

  10. INTERMITTENT EXPLOSIVE DISORDER • Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property. • The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors. • The aggressive episodes are not better accounted for by another mental disorder.

  11. OBSESSIVE-COMPULSIVE DISORDER: OBSESSIONS • OBSESSIONS ARE UNWANTED THOUGHTS, IMAGES, OR IMPULSES THAT THE INDIVIDUAL REALIZES ARE SENSELESS OR UNNECESSARY, INTRUDE INTO ONE’S CONSCIOUSNESS INVOLUNTARILY, AND CAUSE FUNCTIONAL IMPAIRMENT AND DISTRESS

  12. OBSESSIVE-COMPULSIVE DISORDER: COMPULSIONS • COMPULSIONS ARE ACTIONS THAT ARE RESPONSES TO A PERCEIVED INTERNAL OBLIGATION TO FOLLOW CERTAIN RITUALS OR RULES. COMPULSIONS CAN BE MOTIVATED DIRECTLY BY OBSESSIONS OR EFFORTS TO WARD OFF CERTAIN THOUGHTS, IMPULSES, OR FEARS.

  13. COMMON BEHAVIORS WITH OBSESSIVE-COMPULSIVE DISORDER • Counting or repeating behavior • Checking or questioning behavior • Collecting or hoarding behavior • Arranging and organizing behavior • Cleaning and/or washing behavior • “Preening” behaviors (nail biting, cuticle picking, hair pulling, picking at sores)

  14. TREATMENT FOR REGULATORY DISORDERS • THE “SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) Trade NameGeneric Name Prozac fluoxetine Paxil paroxetine Zoloft sertraline Luvox fluvoxamine Celexa citalopram

  15. THE TIC DISORDERS

  16. THE TIC DISORDERS • TRANSIENT TIC DISORDERS • CHRONIC TIC DISORDERS • Chronic Motor Tic Disorder • Chronic Vocal Tic Disorder • TOURETTE’S DISORDER

  17. TREATMENT FOR TIC DISORDERS TRADE NAMEGENERIC NAME Catapres clonidine Haldol haloperidol Tenex guanafacine Orap pimozide

  18. BIPOLAR DISORDER

  19. BIPOLAR DISORDER A CLINICAL COURSE THAT IS CHARACTERIZED BY THE OCCURRENCE OF ONE OR MORE MANIC EPISODES OR MIXED EPISODES. OFTEN THE INDIVIDUAL HAS ALSO HAD ONE OR MORE MAJOR DEPRESSIVE EPISODES

  20. TYPES OF BIPOLAR DISORDER • BIPOLAR I: SINGLE MANIC EPISODE • BIPOLAR II: RECURRENT MAJOR DEPRESSIVE EPISODES WITH HYPOMANIC EPISODES

  21. BIPOLAR DISORDER IN CHILDREN AND ADOLESCENTS • OFTEN MORE RAPID CYCLING THAN WITH ADULTS • CYCLES INCLUDE: • DEPRESSION TO HYPOMANIC OR MANIC • CALM TO IRRITIBILITY TO RAGE

  22. TREATMENT FOR BIPOLAR DISORDER • FOR MANIC AND RAGE BEHAVIORS: • ANTI-CONVULSANT MEDICATIONS • ATYPICAL ANTIPSYCHOTIC MEDICATIONS • FOR DEPRESSION: • A NON-SSRI MEDICATION • MOST COMMONLY USED: WELLBUTRIN

  23. ANTICONVULSANT MEDICATIONS • DEPAKOTE • TEGRETAL • NEURONTIN • LAMICTAL • TRILEPTAL • GABRITRAL • (LITHIUM)

  24. ATYPICAL ANTIPSYCHOTIC MEDICATIONS • RESPERDAL • ZYPREXIA • GEODON • SEROQUIL • ABILIFY

  25. SIGNIFICANCE OF THE CONCEPT OF A CONTINUUM OF NEUROLOGICALLY-BASED DISORDERS

  26. IF ONE DIAGNOSIS IS FOUND, THE OTHER DIAGNOSES MUST BE LOOKED FOR. • UNLESS ALL DIAGNOSES ARE ADDRESSED, THE CLINICAL OUTCOME MAY BE LESS THEN DESIRED.