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Old 06-01-2012
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Psyche An 18-year-old male college freshman with difficulty focusing

An 18-year-old male college freshman is brought for evaluation by his parents because of difficulty focusing and completing tasks during his first college semester. The patient did fairly well in high school but now reports being unable to concentrate, especially in his dormitory, where he is easily distracted by music, television, and other studentsí conversations. He also has difficulty completing assignments on time. Both parents had to supervise the patient in high school to make sure that he remained focused. His elementary school teachers reported that he was very bright but had difficulty paying attention and following directions. The patient drinks socially on weekends and does not use illicit drugs. He enjoys playing his guitar and attending fraternity parties. He does not feel depressed or anxious, other than worrying about his grades. Medical history is unremarkable, and he takes no medications. He is alert and oriented to person, place, and time, and physical examination is normal. Which of the following is the most likely diagnosis?

A Attention-deficit/hyperactivity disorder
B Generalized anxiety disorder
C Major depression
D Paranoid schizophrenia
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Originally Posted by Novobiocin View Post
An 18-year-old male college freshman is brought for evaluation by his parents because of difficulty focusing and completing tasks during his first college semester. The patient did fairly well in high school but now reports being unable to concentrate, especially in his dormitory, where he is easily distracted by music, television, and other studentsí conversations. He also has difficulty completing assignments on time. Both parents had to supervise the patient in high school to make sure that he remained focused. His elementary school teachers reported that he was very bright but had difficulty paying attention and following directions. The patient drinks socially on weekends and does not use illicit drugs. He enjoys playing his guitar and attending fraternity parties. He does not feel depressed or anxious, other than worrying about his grades. Medical history is unremarkable, and he takes no medications. He is alert and oriented to person, place, and time, and physical examination is normal. Which of the following is the most likely diagnosis?

A Attention-deficit/hyperactivity disorder
B Generalized anxiety disorder
C Major depression
D Paranoid schizophrenia
I think B......ADHD is in Children and <7 years of age....Right ???
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A Attention-deficit/hyperactivity disorder -- easily distracted; difficulty paying attention at a young age [per elementary teachers (a key finding)]; above average intelligence to compensate for inattentiveness as well as pressure from parents while still in high school; looks good

B Generalized anxiety disorder -- only worried about grades; doesn't meet dsm iv criteria

C Major depression -- doesn't meet dsm iv criteria; no loss of enjoyment from daily activities; lack of concentration likely not 2/2 depression

D Paranoid schizophrenia -- the patient denies illicit drugs, therefore he is likely not in college; college, the dorm, fraternities, music, television, and other students' conversations are the products of his schizophrenia; i was incorrect on A; the answer is D

Treatment: If I was in general practice I'd send him to a psychologist for an eval and a WAIS. I'd recommend study habit modification. I'd likely follow WAIS results with Adderall. I'd stress the power of positive thinking.
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I think B......ADHD is in Children and <7 years of age....Right ???
You can even diagnose in adolescents / adults sometimes, especially if it wasn't diagnosed before.
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You can even diagnose in adolescents / adults sometimes, especially if it wasn't diagnosed before.
ok....thanx...i didn't knew this....then its definitely A
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in ADHD 20% of children will have persistent sx until adulthood
Attention deficit persist
hyperactivity tends to decrease
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This patient’s presentation is suggestive of attention-deficit/hyperactivity disorder (ADHD). ADHD is characterized by difficulty paying attention, impulsivity, and motor restlessness or hyperactivity, with onset before the age of 7 years. There must also be some impairment in social, occupational, or academic functioning, and the symptoms must be manifest in at least two different environments, such as school and home. When diagnosing an adult with ADHD, the diagnosis should be established by a mental health professional because of the multiple symptoms that must be confirmed, the possible presence of comorbid mental disorders, and the need to verify that the symptoms began before the patient was 7 years old. Although evidence of symptoms dating back to age 7 years is required to make the diagnosis, patients are often identified in their first year of college or graduate school, presumably because they have been intelligent enough to compensate for the disorder until the level of work becomes too great.

Generalized anxiety disorder (GAD) is characterized by difficulty exercising control over worrying, as well as other symptoms such as fatigue, irritability, restlessness, sleep disturbance, and difficulty concentrating. This patient does not report worrying that is excessive or difficult to control, and his inability to concentrate, given the accompanying symptoms, is much better explained by ADHD than GAD.

Although impaired concentration is a feature of major depression, this patient does not present with depressed mood or anhedonia, and there is no report of appetite or sleep disturbance, fatigue, guilt, or suicidal ideation.

Although schizophrenia often presents at this age, there is no history provided of delusions, hallucinations, disorganized speech or behavior, or affective flattening to support the diagnosis
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