Adult Psychiatry

We at Serenity assist our clients with a host of different problems and disorders.
These include but are not limited to the following:


ADHD is currently understood as a neurobehavioral condition that is typically apparent in early childhood. Even if you were never diagnosed with ADD/ADHD as a child, that doesn’t mean you can’t be affected by it as an adult. ADHD affects 30-50% of adults who had ADHD in childhood.

Adults with ADHD have difficulty staying focused and attending to daily, mundane tasks. There are three subtypes to a diagnosis of ADHD which include predominantly hyperactive, predominantly inattentive, and mixed type.

ADHD first becomes apparent in childhood, although sometimes it may remain undiagnosed till late adolescence or adulthood. In children the symptoms are very characteristic and diagnosis can be reached easily. With progressive age, though, the symptoms show slight variations that can be attributed to changed lifestyle. For example, while children with ADHD and adults with ADHD have the same complaints of inability to pay attention for prolonged periods of time, focus on work, be distracted easily, but instead of abrupt, rude and hyperactive behavior, adults complain of restlessness, insomnia, anxiety and irritability spontaneously. In children this problem comes to the forefront more easily when a child’s grades drop or his performance in comparison to the rest of their class, or when his aggressive or out of control behavior cannot be attributed to ‘being spoilt’ anymore.

While diagnosis of ADHD may seem simple enough based on the characteristic symptoms, it takes knowledge and experience to correctly classify and diagnose ADHD and ADD. The approach to treatment depends solely on getting the right diagnosis. Dr. Koller ensures that ADHD is not being mistaken for another condition with masquerading symptoms, or to identity ADHD that is being wrongly treated as another condition. The initial evaluation takes into account clinical features, a complete comprehensive history, and neuropsychological testing which will help us give every patient the correct diagnosis, to both establish or rule out ADHD and ADD.

Depression and Bipolar Disorder

Depression and Bipolar disorder are both mood disorders. Mood disorders can’t be willed away or shaken off, thinking this way can prevent you from receiving the treatment you need to feel better. Without treatment symptoms can worsen and last longer.

Depression negatively affects how a person thinks, feels, and behaves. Depression typically first appears in late adolescence and early adulthood but can affect anyone, at any age.

  • Dysthymia: Less severe than major depression, dysthymia involves long-term chronic low-grade depressive symptoms that decrease functioning and quality of life, and increase the risk of a major depressive episode. Dysthymia is found in 3-6% of the population.
  • Major Depressive Disorder: Requires having at least one major depressive episode, and can be recurrent. More than just normal sadness, MDD is persistent and significantly interferes with life functioning. MDD affects nearly 1 in 10 adults, and twice as many women as men.
  • Seasonal Affective Disorder (SAD): Depression brought on by seasonal changes usually during the winter months, generally lifting during spring and summer.
  • Postpartum Depression: Depression resulting from hormonal changes after childbirth and parenting stress. An estimated 10-15% of women experience postpartum depression after giving birth.

Bipolar Disorders: Marked by extreme mood swings, severe highs (mania), and/or lows (depression), bipolar disorder causes unusual shifts in a person’s mood, energy levels, and ability to function. While everyone goes through ups and downs, bipolar symptoms are severe and each mood episode is a drastic change from a person’s usual mood and behavior. About 2.6% of the American population over age 18 have bipolar disorder in any given year. Bipolar typically develops in late adolescence or early adulthood, some may develop symptoms earlier or later in life. Episodes of mania and depression typically recur throughout your life, but there are usually periods that are symptom free.

  • Bipolar I– One or more extreme manic episodes, and one or more major depressive episodes
  • Bipolar II– One or more episodes of hypomania (less severe mania), and one or more major depressive episodes with periods of level mood.
  • NOS- Bipolar disorder that doesn’t follow a particular pattern.
  • Cyclothymia- A milder form of bipolar disorder with several hypomanic episodes (less severe mania) and less severe depression alternating over a period of at least 2 years.
  • Rapid Cycling- A descriptor of bipolar disorder when a person experiences four or more manic, hypomanic, or depressive episodes within a year.

Anxiety Disorders

We all experience mild and brief feelings of anxiety before or during a stressful event such as public speaking, or a first date. Someone with an anxiety disorder experiences intense anxiety over a period of more than six months.

Anxiety manifests in different ways for different people. For example, for one person it may influence their social life the most, while someone else may feel physical symptoms. Specific anxiety disorders each have different symptoms, but all anxiety disorders are centered around experiencing excessive, irrational fear and dread.

Generalized Anxiety Disorder: Being overly concerned or excessively worrying about everyday problems like health, family, money, disasters, and trouble at work. Can be difficult to relax, you may startle easily, and have difficulty concentrating. Physical symptoms of anxiety can include: fatigue, headaches, muscle tension, muscle aches, trouble swallowing, trembling or twitching, feeling irritable, sweating, nausea, lightheadedness, hot flashes, and trouble falling or staying asleep.

Panic Disorder: Sudden attacks of terror where a person experiences a pounding heart, sweatiness, weakness, faintness, or dizziness. May feel flushed or chilled. Hands may go numb or tingle. May experience nausea, chest pain, or a feeling of being smothered. An attack usually lasts 10 minutes, but symptoms can last longer.

Social Phobia: Feeling intense ongoing fear of being watched and judged by others, or doing something to embarrass yourself. Physical symptoms can include blushing, sweating, shaking, feeling nauseous, and having difficulty talking.

Specific Phobia: Common irrational fears include closed-in-places, heights, escalators, tunnels, highway driving, water, flying, dogs, and blood. Find facing, or even the thought of facing, the feared object or situation brings on panic or severe anxiety.

Causes of anxiety disorders are unknown, but research has suggested genes and environmental stresses combined can increase risk and brain chemistry may also play a role.

Adjustment Disorders

Adjustment disorders are a group of conditions that can occur when you have difficulty coping with a stressful life event. These can include the death of a loved one, relationship issues, or being fired from work. While everyone encounters stress, some people have trouble handling certain stressors.

The inability to adjust to the stressful event can cause one or more severe psychological symptoms and sometimes even physical symptoms. There are six types of adjustment disorders. Each type is associated with distinct symptoms and signs. Adjustment disorders can affect both adults and children.

  1. Adjustment disorder with depressed mood
    People diagnosed with this type of adjustment disorder tend to experience feelings of sadness and hopelessness. It’s also associated with crying. You may also find that you no longer enjoy activities that you formerly enjoyed.
  2. Adjustment disorder with anxiety
    Symptoms associated with adjustment disorder with anxiety include feeling overwhelmed, anxious, and worried. People with this disorder may also have problems with concentration and memory. For children, this diagnosis is usually associated with separation anxiety from parents and loved ones.
  3. Adjustment disorder with mixed anxiety and depressed mood
    People with this kind of adjustment disorder experience both depression and anxiety.
  4. Adjustment disorder with disturbance of conduct
    Symptoms of this type of adjustment disorder mainly involve behavioral issues like driving recklessly or starting fights. Teens with this disorder may steal or vandalize property. They might also start missing school.
  5. Adjustment disorder with mixed disturbance of emotions and conduct
    Symptoms linked to this type of adjustment disorder include depression, anxiety, and behavioral problems.
  6. Adjustment disorder unspecified
    Those diagnosed with adjustment disorder unspecified have symptoms that aren’t associated with the other types of adjustment disorder. These often include physical symptoms or problems with friends, family, work, or school.

Adjustment disorders are treated with therapy, medication, or a combination of both. With help, you can usually recover from an adjustment disorder quickly. The disorder typically doesn’t last more than six months, unless the stressor persists.

Traumatic Disorders

It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with a traumatic disorder.

Trauma-and stress-related disorders result from exposure to a traumatic or stressful event. Specific disorders include acute stress disorder and posttraumatic stress disorder. These disorders cause similar symptoms but differ in how long they last. Acute stress disorder typically begins immediately after the event and lasts from 3 days to 1 month. Posttraumatic stress disorder lasts for more than 1 month. It may develop as a continuation of acute stress disorder or develop separately up to 6 months after the event.

These disorders used to be considered Anxiety disorders, but are no longer considered anxiety disorders because many affected people do not have anxiety. They may have other symptoms, for example, they may be unable to experience pleasure, become aggressive, or feel restless and discontent, angry, numb, or disconnected from themselves.