Attention deficit/ hyperactivity disorder is a common concern for college students today. ADHD symptoms show up in various situations, such as in the classroom, and may create problems getting work completed. Symptoms may also affect relationships with friends and family, ADHD symptoms begin in early childhood but occasionally go undiagnosed until adulthood. A person’s self-worth can be affected. They may think of themselves as “lazy” *dumb” or
“slow”, The hallmark symptoms of ADHD include:

• Difficulty focusing attention
• Hyperactivity
• Impulsivity

It is common for students to experience some of these symptoms at some point in their schooling. These characteristics alone are not reflective of ADHD. These symptoms have to be present in at least two or more settings including school, home, work and interfere significantly with daily functioning. There are other problems that can mimic ADHD, such as anxiety
disorders, sleep deprivation, sleep apnea, depression, traumatic
stress, alcohol or drug abuse.

Most children outgrow ADHD but it occasionally continues into
adulthood. If you have adult ADHD, it is important to continue
with your treatment and provide your local healthcare providers
with documentation of your past diagnosis and treatment. This
will provide continuity of care and maximize your opportunity
for success in school.

ADHD does not suddenly appear in a student’s adulthood. Yet
sometimes students are convinced they have ADHD and are
tempted to take medications offered to them by friends. Please
know that this will do you no good at all and, in some cases, can
actually cause you to harm and worsen your school performance.
Diagnosing an adult with ADHD involves a comprehensive
evaluation by professionals to avoid misdiagnosis and to
provide proper treatment.

Acknowledgments: Portions adapted from UTexas

Everyone gets nervous or anxious from time to time-when
speaking in public, for instance, or when going through financial
difficulty. For some people, however, anxiety becomes so frequent,
or so forceful, that it begins to take over their lives.

How can you tell if your everyday anxiety has crossed the line into a
disorder? It’s not easy. Anxiety comes in many different forms
such as panic attacks, phobia, and social anxiety–and the
the distinction between an official diagnosis and normal” anxiety isn’t
always clear.

Anxiety Disorders

• Specific phobia
• Social anxiety disorder (SAD)
• Panic disorder (PD)
• Agoraphobia
• Generalized anxiety disorder (GAD)
• Anxiety Disorder due to a General Medical Condition
• Substance-Induced Anxiety Disorder
• Anxiety Disorder NOS

Panic Disorder

Recurrent unexpected panic attacks and for a one month
period or more of:

• Persistent worry about having additional attacks
• Worry about the implications of the attacks
• The significant change in behavior because of the attacks

Social Anxiety Disorder

• Marked fear of one or more social or performance situations in which the person is exposed to the possible scrutiny of others and fears he will act in a way that will be humiliating
• Exposure to the feared situation almost invariably provokes anxiety
• Anxiety is out of proportion to the actual threat posed by the situation
• The anxiety lasts more than 6 months
• The feared situation is avoided or endured with distress
• The avoidance, fear, or distress significantly interferes with their routine or function

Generalized Anxiety Disorder

Excessive worry more days than not for at least 6 months about a number of events and they find it difficult to control the worry. 3 or more of the following
symptoms:

• Restlessness or feeling keyed up or on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
• Causes significant distress or impairment

Sleep is defined as a naturally recurring state characterized by altered consciousness. Good sleep plays an important role in physical health, mental health, and quality of life. It is vital to many of the body’s mechanisms including restoration of the immune, nervous, and musculoskeletal systems, and is important in maintaining mood, memory, and cognitive performance. The body resorts to an anabolic state during sleep, which allows these restorative processes to take over. The sleep state is also important in hormone regulation including insulin and plays a role in decreasing the risk for ailments such as heart disease, hypertension, and diabetes. Good sleep not only promotes improvements in cognitive function but also in better overall health outcomes, immune function, and weight maintenance.

Sleep is time for the development of new neuronal connections, and these pathways are essential to learning and remembering new information. Good sleep also promotes focus, concentration, decision-making, and emotional stability. This is especially important for students who rely on optimal focus

and retention of learned information to be successful. It’s clear that good sleep is needed for us to be at our best. However, sleep is often the first thing that busy (and stressed) people squeeze out of their schedules. Good sleep habits are practices that can help busy people in improving sleep quality.

1. Stick to a sleep schedule
   Go to bed and wake up at the same time every day to avoid disruption in sleep-wake rhythm. If you are awake in bed for more than
   20 or 30 minutes, get 1p out of bed and do a quiet activity such as light reading and return to bed when you feel that you could fall
   asleep with ease.

2. Pay attention to what you eat and drink
   Avoid large meals close to bedtime, but a light snack such as milk, cheese, or peanut butter can be helpful. Avoid alcohol, nicotine, and caffeine, especially in the evenings
   
3. Create a bedtime ritual
   Have a bedtime routine that incorporates relaxation practices. During this time, avoid artificial light provided by electronic devices. If you have difficulty quieting your thoughts, try setting aside some time in the evening specifically for thinking, planning, and problem-solving. Jot down your thoughts so you can set them aside for the next morning.
   
4. Limit daytime naps
   Avoid naps as this disrupts drive to sleep at night. But if you must, keep it before 3 pm and brief (ideally 30 minutes or less).
   
5. Include physical activity in your daily routine
   Spend some time outside every day. Get moderate physical activity, but avoid exercising right before bedtime.
   
   If you find you are not falling asleep, do not try” harder to go to sleep. This can backfire and stimulate you to be more awake. Just think of something soothing® and relaxing*
   
   Chronic insomnia affects 10-15% of the population. So if you are having trouble sleeping, know that you are not alone! There are numerous reasons for poor sleep including genetics, mental health problems, substance abuse, and sleep disorders such as sleep apnea, restless legs, narcolepsy, and circadian rhythm sleep disorders. Warning signs for sleep disorders include unrefreshing sleep with adequate sleep time, witnessing apneas, snoring, or falling asleep at inappropriate times such as while driving, or during a conversation. If you suspect that you have a sleep disorder or an untreated mood disorder affecting your sleep, please see your doctor for an evaluation.

We all know the physical benefits of regular exercise, but it can be easy to forget that exercise also plays a vital role in maintaining mental
wellness. People who consistently exercise sleep better at night, feel more energetic during the day, have higher self-esteem and have better
memory spans. Exercise can also play an integral role in the treatment of various mental illnesses.

Benefits in Mental Illnesses

Depression

Studies have shown that exercise can be as effective as
antidepressant medication when used to treat mild to moderate
depression. Additionally, regular exercise can help prevent a recurrent
depressive episode. How does it do this? By inducing neural growth,
reducing inflammation, and releasing endorphins, which are the happy
chemicals in your brain. Having a schedule and some quiet time to
yourself every day also helps fight depression.

Anxiety and PTSD

Exercise can be a wonderful mindfulness activity, and
mindfulness is an excellent treatment for anxiety. As you work out, pay
attention to all the sensations in your body and focus on the here and
now, rather than ruminating about past or future stressors. Mindfulness
as well as the exercise itself can both relieve tension and stress.

ADHD

Exercise increases the brain’s dopamine, norepinephrine, and
serotonin levels which leads to improved motivation, memory, mood,
and concentration. In milder cases of ADHD, exercise may effectively
replace stimulant medications.

Addiction

As mentioned above, exercise increases dopamine, which is the brain’s reward chemical also released by sex, drugs, alcohol, and
food. As a result, working out can aid in addiction recovery by providing a healthier way to release dopamine into the brain. Additionally, it
serves as a good distraction from using and helps to reset the body’s circadian rhythm, which is often thrown out of whack by substances.

Common Symptoms of Depression

Physical

• Changes in sleep patterns: much more or much less
• Changes in eating patterns; much more or much less
• Fatigue or loss of energy, feeling heavy
• Headaches, stomachaches, or other unexplained aches and pains

Behavioral/Attitude

• Loss of interest in & enjoyment of previously pleasurable activities sex, sports,
• hobbies, going out with friends, etc.
• Difficulty concentrating or making decisions being unable to remember what you have studied for hours!
• Neglecting responsibilities & personal appearance

Emotional

• Depressed mood, apathetic, irritable, pessimistic, negative, guilty, anxious. empty, etc
• Feeling hopeless & helpless
• Feeling worthless

What Causes Depression

Some people feel like they know why they are depressed. They just broke up with a partner, a pet died, an exam did not go well. Other times. the reasons may not be quite clear It may not be just one cause that leads us to feeling demoralized and hopeless.

by Kelly Kilgore, M.D., PGY-4 Psychiatry Resident

Sleep is defined as a naturally recurring state characterized by altered consciousness.  Good sleep plays an important role in physical health, mental health, and quality of life.  It is vital to many of the body’s mechanisms including restoration of the immune, nervous, and musculoskeletal systems and is important in maintaining mood, memory, and cognitive performance.  The body resorts to an anabolic state during sleep, which allows these restorative processes to take over.  The sleep state is also important in hormone regulation including insulin and plays a role in decreasing the risk for ailments such as heart disease, hypertension, and diabetes.  Good sleep not only promotes improvements in cognitive function but also better overall health outcomes, immune function, and weight maintenance.

Sleep is a time for the development of new neuronal connections, and these pathways are essential to learning and remembering new information. Good sleep also promotes focus, concentration, decision-making, and emotional stability.  This is especially important for students who rely on optimal focus and retention of learned information to be successful.  It’s clear that good sleep is needed for us to be at our best.  However, sleep is often the first thing that busy (and stressed) people squeeze out of their schedules.  Good sleep habits are practices that can help busy people in improving sleep quality.  Here are some tips:

• Go to bed and wake up at the same time every day to avoid disruption in the sleep-wake rhythm. 

• Use the bed for sleeping and sexual activity only. Make sure your bedroom is cool, quiet, and dark.  White noise machines, fans, eyeshades, blackout curtains, or earplugs can be helpful.

• Avoid large meals close to bedtime, but a light snack such as milk, cheese or peanut butter can be helpful. Avoid alcohol, nicotine, and caffeine, especially in the evenings.

• Spend some time outside every day. Get moderate physical activity, but avoid exercising right before bedtime.

• Avoid naps as this disrupts your drive to sleep at night.  But if you must, keep it before 3 pm and brief (ideally 30 minutes or less).

• Have a bedtime routine that incorporates relaxation practices.  During this time, avoid artificial light provided by electronic devices.  If you have difficulty quieting your thoughts, try setting aside some time in the evening specifically for thinking, planning, and problem-solving.  Jot down your thoughts so you can set them aside for the next morning.

• If you are awake in bed for more than 20 or 30 minutes, get up out of bed and do a quiet activity such as light reading and return to bed when you feel that you could fall asleep with ease. 

• If you find you are not falling asleep, do not “try” harder to go to sleep. This can backfire and stimulate you to be more awake.  Just think of something “soothing” and “relaxing”.

Chronic insomnia affects 10-15% of the population.  So if you are having trouble sleeping, know that you are not alone! There are numerous reasons for poor sleep including genetics, mental health problems, substance abuse, and sleep disorders such as sleep apnea, restless legs, narcolepsy, and circadian rhythm sleep disorders. Warning signs for sleep disorders include unrefreshing sleep with adequate sleep time, witnessing apneas, snoring, or falling asleep at inappropriate times such as while driving, or during a conversation.  If you suspect that you have a sleep disorder or an untreated mood disorder affecting your sleep, please see your doctor for an evaluation. 

by Holly Sherrill, M.D., PGY-4 Resident

We all know the physical benefits of regular exercise, but it can be easy to forget that exercise also plays a vital role in maintaining mental wellness. People who consistently exercise sleep better at night, feel more energetic during the day, have higher self-esteem, and have better memory spans. Exercise can also play an integral role in the treatment of various mental illnesses.

Benefits in mental illnesses

• Depression: Studies have shown that exercise can be as effective as antidepressant medication when used to treat mild to moderate depression. Additionally, regular exercise can help prevent a recurrent depressive episodes. How does it do this? By inducing neural growth, reducing inflammation, and releasing endorphins, which are the happy chemicals in your brain. Having a schedule and some quiet time to yourself every day also helps fight depression.
• Anxiety and PTSD: Exercise can be a wonderful mindfulness activity, and mindfulness is an excellent treatment for anxiety. As you work out, pay attention to all the sensations in your body and focus on the here and now, rather than ruminating about past or future stressors. Mindfulness as well as the exercise itself can both relieve tension and stress.
• ADHD: Exercise increases the brain’s dopamine, norepinephrine, and serotonin levels which leads to improved motivation, memory, mood, and concentration. In milder cases of ADHD, exercise may effectively replace stimulant medications.
• Addiction: As mentioned above, exercise increases dopamine, which is the brain’s reward chemical also released by sex, drugs, alcohol, and food. As a result, working out can aid in addiction recovery by providing a healthier way to release dopamine into the brain. Additionally, it serves as a good distraction from using and helps to reset the body’s circadian rhythm, which is often thrown out of whack by substances.

Tips for getting started

• A little activity is better than nothing. You don’t have to become a cross-fit junkie or a marathon runner to gain the benefits of exercise. A healthy dose of exercise would be five 30-minute sessions of moderate exercise per week. But if you can’t squeeze that in, a five minute yoga session or walk around the neighborhood is better than none at all. If fact, starting small is the smartest thing to do. If you push yourself too hard in the beginning, it will be difficult (and possibly dangerous) to maintain your new level of activity – which may lead to feelings of failure if you can’t follow through.
• You don’t have to make yourself miserable. If you feel like you can’t breathe, take a break. Don’t push yourself too hard. You should be able to comfortably chat with someone next to you, but aim for a slightly elevated hard rate and work of breathing than your baseline. You should feel warm as you exercise, but you don’t necessarily need to be extremely sweaty. If you start to feel overheated, take a break and grab some water. Make sure to schedule your workout at a time of day when you feel the best. If you’re not a morning person, don’t make yourself get up at 5 a.m. for a jog. You’ll start to dread that alarm clock, and it is unlikely you will maintain the routine.  Also, choose an activity you’re likely to enjoy – dance, yoga, jogging, biking, soccer, hiking – the possibilities are vast. If you hate running, don’t run. If you hate going to the gym and lifting weights, don’t do that.
• Recognize obstacles you are placing for yourself. It’s easy to make excuses about why we can’t exercise today – recognize these excuses and push through those barriers. Too tired? Good news: exercise boosts energy. Too overwhelmed? Take some time for yourself and go for a walk. In pain? Talk to your healthcare provider about safe options for your limitations, then keep in mind that movement can improve most causes of joint and/or muscle discomfort. Feeling hopeless about getting into shape? Remember that any little bit of exercise can help, and you have to start somewhere.

For more information and ideas about exercise and how to get started, visit https://www.helpguide.org/articles/healthy-living/how-to-start-exercising-and-stick-to-it.htm.