which Psych. residency is better for studying Adult ADHD / ADD + Affective

[Hauru]

Good morning everybody,
I finally registered here after 3 years of reading because I have this questions:

1) Which Psychitary residency program is better if 2 of my major interests in Psychiatry: Adult ADHD / ADD and Affective disorders (others are Personality Disorders and Human Sexuality studies), but in fact I enjoy studying all of Psychiatry

2) if the program is specializing in ADHD i'd like it to be on positive and appreciative side of it, not teaching to eradicate it as some sinful disability. That would mean relaxed non-strict philosophy and atmosphere.

3) I am in Los Angeles, preparing for USMLEs for match 2009-2010, so I'd also appreciate if anybody could recommend where to volunteer or work meanwhile? (more details about me are available if you click on my signature)

Thank you!

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[TheWowEffect]

Any program will prepare you well for treating affective disorders and most will do a great job with ADHD. Just go to one with a child psych fellowship and you are set to go. As for specilizing in ADHD, I don't know if you can do that, but you can certainly find a program with a good research group studying ADHD. There are numerous such groups across the country and google can be your best friend for this

Good luck

P.S.- I think the best way to find volunteer opportunities is to find researchers in your area and email them. They are always looking for extra hands.

 

[billypilgrim37]

Probably a difficult question for a non-specialist to answer. My process for figuring out who the big names in my field-to-be was literally to start looking at the papers that represented stuff I was interested in, look at the references, and start googling names. I think by the interview trail, I at least knew exactly WHO I should be talking to, and the ones I didn't talk to were by my choice (or because they were grumpy about responding to emails, and immediately identified as lousy future PIs).

For good places to start with adult ADHD, Joseph Biederman at MGH is head of their adult ADHD program, I believe (although he's a child psychiatrist, and is possibly most famous for being the base of one controversial pole of the pediatric bipolar debate). But the Biederman group has produced a ridiculous volume of extremely important literature, and I bet a pubmed search of adult ADHD with his name (and a little googling around the MGH/McLean sites) will get you far.

James McCracken at UCLA may be the biggest name in all of ADHD-dom, produces excellent work, and I believe has published and commented extensively on the adult side of things. There's an address that's like adhd.ucla.edu or something like that (not that exactly, and my postcall brain won't let me google it for you).

Those won't be the end all names for you to start with, but if you've got some googling and pubmed time, it should help you identify the big players in your field. Also, if you know of any subspecialty conferences about your field, sometimes a quick perusal of the speaker list can give you more leads. And if there are any books on your field, looking at chapter authors can give you a lot of information about individual specialties, as well as "who plays nice with each other" dynamics.

If you were just interested in the clinical side of things, your net can be much larger. Or heck, you can probably just find a local crank-mill family doc who could teach you more about "adult ADHD" than anybody in an accredited psych dept

 

[Hauru]

billypilgrim, thank you very much for details!
I was planing to do something like you described, but decided to try asking here, may be somebody from here is already working with ADHD.

And I'd like this topic to be also a collection of info about ADHD and it's comorbid conditions such as depression, anxiety, substance abuse and oppositional defiant disorder.

1) books by Edward M. Hallowell, MD and John J. Ratey, MD - about Adult ADD self help - seem to be well known by patients. Main location - Hallowell center is in Sudbury, MA. http://www.drhallowell.com

2) just today found about Adult ADHD conference in LA March 29
Saturday, March 15–Dearborn, Mich.
Saturday, March 29–Los Angeles
Saturday, April 5–Washington, D.C.
Saturday, April 12–New York


http://adultadhd-ddx.com/meetings.htm

but all their meetings are full and no registrations accepted. I write about it here in case somebody from forum went there and can share experience.

3) I really want to attend a Psychiatric Congress Regional Extension 2008 http://www.cmellc.com/psychcongress/extensions/
Los Angeles - April 5, 2008 - Los Angeles Marriott Downtown - $39*
they have 3 other cities: New York, Houston and Atlanta

as to "clinical side of things" - I wish I knew less then I do about symptoms of Adult ADD from my personal experience - seriously.
But it also seems to be very interesting phenomenon to study and possibly amazing patients.

 

[Hauru]

TheWowEffect, thank you for advice, I am going to google it thorowly

Just go to one with a child psych fellowship and you are set to go.

I am considering child psychiatry, as it's older and more established, but I was wondering may be somebody on forum knows about programs specializing in adult ADHD

 

[Hauru]

2) just today found about Adult ADHD conference in LA March 29
Saturday, March 15–Dearborn, Mich.
Saturday, March 29–Los Angeles
Saturday, April 5–Washington, D.C.
Saturday, April 12–New York


http://adultadhd-ddx.com/meetings.htm

but all their meetings are full and no registrations accepted. I write about it here in case somebody from forum went there and can share experience.

wanted to quote http://adultadhd-ddx.com/confounder_home.htm#comorbid
main issues with Adult ADHD in Psychiatry practice:

Lack of Training During Residency
Adult ADHD causes significant problems for millions of adults, and yet their doctors often miss it due to inadequate clinical training, inexperience and the lack of a well-validated screening tool. Only 34% of primary care physicians report being "very knowledgeable" or "extremely knowledgeable" about adult ADHD, compared to 92% who said the same for depression and 83% for generalized anxiety disorder (GAD). The results tell us that we need to do a better job of supporting primary care physicians who are on the frontlines of diagnosing adult ADHD

Lack of Clinical Practice Guidelines
Although some adults with ADHD were diagnosed as children, a significant amount are first diagnosed as adults. This poses particular challenges given the limited familiarity many adult mental health services have with ADHD. To combat this, several organizations, including the American Academy of Child and Adolescent Psychiatry and the National Institutes of Health, have developed practice guidelines for ADHD, but the emphasis remains on the childhood stage of the disorder. Physicians still need a set of revised criteria and clinical practice guidelines for adult ADHD which will lead to a comprehensive and accurate diagnosis.



How Symptoms Change Over Time
Most children with ADHD don’t outgrow their disorders; rather, they become disorganized, inattentive adults. Physicians need to understand that prominent symptoms and impairment related to ADHD persist into adulthood in approximately half of all cases. While a large portion of youth will lose full syndromic criteria for ADHD as they grow up, an even larger number will manifest symptomatic persistence of the disorder into adulthood.

Functional Impairment/Quality-Of-Life Impact
It is crucial that physicians recognize the significant impact of adult ADHD on an individual’s family, relationships, and educational and work performance. Potentially dangerous outcomes of untreated ADHD, such as accidents (motor vehicle and others), SUD and legal problems, are also now known. It is becoming clear that medical treatment of ADHD is effective not only in alleviating symptoms but also in improving overall functioning. It is imperative that primary care physicians are well versed in this disorder and its clinical features across the age groups. The primary care physician needs to be educated on how to screen, diagnose, educate and initiate medication management in patients with ADHD.



Comorbid Conditions
The presentation of adult ADHD is often complicated by the presence of comorbid conditions such as depression, anxiety, substance abuse and oppositional defiant disorder. Moreover, many symptoms of a comorbid condition may overlap with adult ADHD symptoms, further complicating the diagnosis of adult ADHD. Not only is the diagnosis of adult ADHD difficult in the presence of comorbidities, but treatment continues to be challenging as well. Physicians frequently struggle to understand how, when and what to treat first in patients with adult ADHD and comorbidities. Failure to treat co-existing conditions often leads to failure in treating the ADHD. And, crucially, when the ADHD symptoms are a secondary consequence of depression, anxiety, or some other psychiatric disorder, failure to detect this will result in incorrectly treating the individual for ADHD.



(yes i am really sorry i can't go there)

 

[OldPsychDoc]

You left out one item on this page:
"Supported by an educational grant from Eli Lilly and Company"

Maybe I am being excessively cynical, but like last year when Shire was rolling out Vyvanase and I was suddenly getting at least 2 pieces of mail a week reminding me that ADHD might be comorbid with depression in my patients, I can't help but notice that there's a heavy level of support for this educational activity from a company that "just happens" to have a product for sale (on patent, with no generic equivalent) to treat this disorder...

 

[TheWowEffect]

It always sounds great talking about the big names in the field and working with them, but I think for a beginner, it may be better to hook up with an emerging PI who is doing some pioneering work. Potentially be able to get your name as first or second author if you are able to show you value to that PI. In guess it's better to be a big fish in a small pond rather than vice versa.

 

[Anasazi23]

I'm sorry, but until the gold standard treatment for ADHD becomes a medication other than a stimulant, ADHD will continue to be "undertreated."

The resources to verify the diagnosis are thin, and I'm not giving a stimulant to every person that comes in reciting the criteria, how it applies to them, and is requesting a stimulant. By the way, they just happen to have a "not so serious" cocaine problem, and/or are nervous about college finals coming up.

You'll see an explosion in the diagnosis and treatment of the condition when an effective, non-stimulant treatment option surfaces.

The other day a homeless addict came to the clinic seeking treatment for his depression and (as always) toward the end of the interview, a stimulant for his ADHD. I asked him what he needed to concentrate on while in the shelter, where he has resided for 4 years. He didn't have an answer, and he also didn't get the stimulant, as it would likely be "stolen" or sold within minutes of his return to the shelter.

 

[TheWowEffect]

I asked him what he needed to concentrate on while in the shelter, where he has resided for 4 years. He didn't have an answer, and he also didn't get the stimulant, as it would likely be "stolen" or sold within minutes of his return to the shelter.

A good confrontational question. Take a note all ye newbies to residencies, but don't use it until you are more adapt at handling the patients.

 

[OldPsychDoc]

A good confrontational question. Take a note all ye newbies to residencies, but don't use it until you are more adapt at handling the patients.

I felt the same way (as a fresh PGY2) watching a senior resident suggest to a frequent flier that perhaps what she really needed was to get a job to keep her occupied... "We can really SAY that to patients!!??!!"

 

[worriedwell]

At Penn, the program director is one of the most prominent experts in the mid atlantic region and opened an ADHD evaluation clinic. The curriculum is set up so that one could spend two years working in that clinic if one desired (as their elective interest) and then be well set up for an academic or clinical career. Given their track record, it would be easy to publish frequently in residency and then have a lot of mobility in terms of future work.

Also, NYU has a great child study center where you'd do plenty of top notch evals for it with great clinicians (not sure how that works into adult ADHD).

Although the poster who mentioned that any program with a child fellowship will serve your needs well, as they all have people very well versed in diagnosing ADHD.

Best,
Worriedwell

 

[Hauru]

Thank you everybody for helpful replies! I am just beginning to explore ADHD (and I guess I naively haven't consider politics, careers, publications or money involved), so I have nothing yet to say of my own, except that I am exited by the condition itself , but I will keep this thread updated.