Temporal ADD

[DrMariano2]

Have you treated many patients with temporal ADD so far ?

While I’ve been diagnosed twice until now, I didn’t know until today what my subtype was.

How hard do you find those patients to treat overall ?

I’m caught between a rock and a hardplace. I’m not sure I’m capable of dealing with the pressure in completing my bachelor degree in nursing, but on the other hand, if I don’t, I’m facing nothing so far as a financial future. I met with head of department this morning about this, and she was very kind and understanding to me–that sure helped.

My question to you would be :

According to your clinical experience, would you think that I’m really going to cause more harm than good by pressing on ?

Here are some descriptions of “Temporal ADD” I have found:

http://www.second-hand-news.com/temporal.html

Temporal ADD
The temporal lobes are located under your temples and behind your eyes and are responsible for mood stability, memory, learning and temper control. People with Temporal Lobe ADD show decreased activity in the temporal lobes while performing tasks requiring concentration, which gives them a quick temper and causes them to suffer from frequent bouts of rage, panic, fear or paranoia.

http://www.aqeta.qc.ca/english/general/types/25.htm

Type 4: Temporal ADD
Symptoms:
inattentive, impulsive
emotionally instable, irritable
aggressive (sometimes violent)
negative thoughts (even suicidal)
somatic complaints
memory problems
learning disabilities (e.g., dyslexia) (Type 4 is most frequently seen in psychiatry)

SPECT: (underside surface view)
decreased activation in prefrontal cortex and in one or both temporal lobes (here + on left) during resting and concentration

Underlying cause:
deficiency of dopamine
dysfunction of the temporal lobe most frequently due to injury (perinatal, accidental, cyst, neoplasm)

Treatment:
dopamine stimulators (Ritalin etc.) plus
activators of the inhibitory neurotransmitter GABA, such a Tegretol, Epival, Neurontonin

From what I see so far, Temporal ADD is an attempt to explain why some people have mood problems and ADD, and to consider this condition as a subset of ADD.

Temporal ADD is one of the six types of ADHD defined by Dr. Daniel Amen.

I do not agree.

I also don’t agree with considering different conditions with attentional problems as a component as subtypes of ADHD. It is far easier to separate the components under the general known syndromes in psychiatry (e.g. mood disorders (which includes anxiety disorders), psychotic disorders, cognitive disorders, attention deficit and other dysruptive behavioral disorders, personality disorders, eating disorders, developmental disorders, etc.). The rational behind this is that there are somewhat distinct groups of pathophysiologies in each group. Thus the diagnostic group gives one a clue where to look for the causes of illness.

For temporal ADD,l one can separate the mood component from the attentional component, then consider the underlying problems.

From where I stand, I believe temporal ADD is either a mood disorder with attention deficit as a sign or symptom (e.g. Bipolar Disorder). Or it is attention deficit/hyperactivity disorder plus a mood disorder.

In either case, the psychiatric diagnosis is only a label.

Psychiatric Diagnoses are Labels. They do not imply a pathophysiology – i.e. the actual physiologic problems that cause the illness.

It is up to the physician to determine the actual pathophysiology underlying the condition. Since it has a mood component, it it is more than just a deficit in dopamine signaling.

Once the pathophysiology of the attentional component and the mood component is determined, a more successful treatment can be obtained.

When it comes to the mood component of “temporal ADD”, I would look at signaling problems involving the sympathetic nervous system (which gives rise to irritability and emotional instability), thyroid problems, and hypothalamic-pituitary-adrenal axis dysregulation as prime suspects. These can all lead to deficits in dopamine signaling.

I would also look for metabolic-nutritional deficits. These may contribute to both attentional and mood pathophysiologies.

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Note that the use of large doses of stimulants can often cause mood problems. The irritability, aggressiveness, and mood instability seen results from excessive norepinephrine signaling caused by the stimulant itself. This happens when the immune system becomes overactive (as exhibited by increased pro-inflammatory cytokine signaling) as a result of excessive norepinephrine signaling and the resultant hypothalamic-pituitary-adrenal axis dysregulation with low cortisol signaling.

Stimulants stop working when HPA Axis dysregulation occurs – and instead cause a mood disorder. Methamphetamine stops causing a high when HPA Axis dysregulation occurs and cortisol production drops past a certain point (usually levels near post-traumatic stress disorder levels).

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Note also that Attention Deficit/Hyperactivity Disorder is just a label. It does not describe the cause(s) of the illness.

ADHD is thought to be caused by a deficit of dopamine signaling and thus a stimulant is the primary treatment. But not always, from my point of view.

ADHD can occur from problems with the dopamine system. For example, there are inherited problems with dopamine receptors that can cause ADHD. In these patients, dopamine signaling is increased tremendously because there is dopamine resistance due to dopamine receptor mutations.

But dopamine deficits can occur from a variety of conditions – which are then the underlying cause(s) of ADHD.

For example:

• Iron deficiency results in impaired dopamine production.
• Suboptimal Thyroid signaling (not just hypothyroidism) can result in decreased dopamine production.
• HPA Axis Dysregulation with low cortisol production can cause not only a decrease in dopamine production, but it also affects filtering of emotional information in the amygdala – another cause of distractibility.
• Etc. Etc.

Often, a person with ADHD has many of these causes simultaneously.

All of these, I would consider ADHD. ADHD is the label for the illness. It is simply a description of the illness. The underlying causes as a group ARE the illness and constitute the target of treatment.

[chipdouglas]

What if someone has had a history of poor attentional span ever since childhood ? Poor attention span as in :

1. he doesn’t finish whatever he’s started
2. doesn’t pay attention
3. has his head in the clouds

Can we still consider AF (low cortisol) ?

In the face of normal thyroid labs, would impaired thyroid signaling be : nutrient deficiencies such as selenium and zinc as both are needed for proper thyroid function ?

Further, is it customary to see a mood disorder develop as a result of the frustration that patient experiences by dint of not being able to focus his attention, and taking 4 hours to carry out assignment that’d normally require 30 minutes ?

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