Pseudo-seizure, an Atypical Presentation of Attention-Deficit Hyperactivity Disorder in a Female: A Case Report.

BACKGROUND: This paper describes pseudo-seizure as an atypical presentation of attention-deficit hyperactivity disorder (ADHD) in an adolescent female in the context of psychosocial difficulties. We present the case, which explains the clinical dilemma in such situations, along with selective literature review. CASE PRESENTATION: An adolescent female, who is an academic high achiever, living with parents, presented with unresponsive spells which were initially treated with antiepileptics by the paediatrician without any significant improvement. Later, after further assessments and revision of her diagnosis to conversion disorder, she was referred to the child and youth mental health service team. Further evaluation revealed her symptoms to be a result of multiple psychosocial stressors in the context of her having undiagnosed ADHD. Individual therapy, treatment with stimulant, resulted in significant improvement in her school and home adjustments. CONCLUSIONS: This case demonstrates the diagnostic challenges that high-functioning girls with ADHD coloured by psychosocial stressors can pose and raises the need for reviewing our diagnostic approaches in these situations.

Management of stuttering using cognitive behavior therapy and mindfulness meditation.

Stuttering is a speech fluency disorder with varied etiological explanations. It is important to identify symptoms early so that adequate and timely intervention can be delivered with focus on management and recovery. Stuttering, besides affecting speech fluency, might have a number of negative psychosocial consequences for the sufferer that may lead to immense anxiety, besides other symptoms. Therefore, it is thus imperative to include multiple dimensions in the holistic treatment of stuttering. Cognitive behavior therapy and mindfulness equip the client with the skills to manage the problems that occur as a result of stuttering. Since the rate of relapse in this condition is high, the chosen therapeutic paradigm must involve booster sessions over a long term. Periodic, detailed assessment would update the therapist about the barriers in treatment and would help in devising appropriate methods to get rid of these hindrances.

Planning research in psychosocial interventions.

A number of research designs have been used to study the efficacy of psychosocial interventions in addictive disorders, including open label studies and randomised controlled trials. Only through a rigorously conducted research, evidence base for effectiveness of a psychosocial intervention can be established. However, research on these interventions are fraught with a number of challenges. It is imperative for researchers to ask appropriate research questions based on sound theoretical understanding of psychiatric disorders, psychosocial interventions and research designs. This would help in choosing the less studied, relevant areas for in depth study as well as in using pragmatic, realistic research designs. Defining intervention clearly is as crucial, as is its uniform implementation across various treatment arms. In addition, tapping the mediators, moderators and confounders of treatment using appropriate methods while assessing the factors that directly impact the outcome is important to determine actual effects of psychosocial intervention. Barriers at different stages must be gauged proactively and dealt with, wherever possible.

A descriptive study of behavioral problems in schoolgoing children.

BACKGROUND: Behavioral problems among schoolgoing children are of significant concern to teachers and parents. These are known to have both immediate and long-term unfavorable consequences. Despite the high prevalence, studies on psychiatric morbidity among school children are lacking in our country. MATERIALS AND METHODS: Five hundred children aged 6-18 years were randomly selected from a government school in Kanpur, Uttar Pradesh, and assessed for cognitive, emotional, or behavioral problems using standardized tools. RESULTS: About 22.7% of children showed behavioral, cognitive, or emotional problems. Additional screening and evaluation tools pointed toward a higher prevalence of externalizing symptoms among boys than girls. CONCLUSION: The study highlights the importance of regular screening of school children for preventive as well as timely remedial measures.

Cognitive behavior therapy for adults with attention-deficit/hyperactivity disorder: a review of recent randomized controlled trials.

To review the efficacy of cognitive behavioral therapy for adults with attention deficit hyperactivity disorder. Recent, controlled studies of the efficacy of Cognitive Behavior Therapy (CBT) treatment in adults with ADHD are reviewed. CBT is a feasible and acceptable treatment strategy in medicated adults with ADHD that leads to improvement in ADHD symptoms and co-morbid problems. CBT includes delivery of cognitive and/or emotional strategies to individuals or groups of 4 to 10 participants. The number of CBT sessions may vary from 6 to 14. Blinding may help reduce response bias. Coaching and homework may enhance motivation as well as help in generalizing strategies to patient's daily lives. Outcomes studied include participants' self-reports of symptoms and evaluator reports based on standardized measures of ADHD and its comorbidities. CBT is an effective treatment for adults with ADHD particularly when combined with medication.