Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

5. Psychiatry > 1- Pediatric Psych: ADHD > Flashcards

1- Pediatric Psych: ADHD Flashcards

1
Q

Females with ADHD present more often with what type of sxs?

A

Inattentive sxs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the etiology of ADHD?

A

Multifactorial (may include genetic factors and environmental factors)

(genetic: ↑ rate in first-degree relatives of affected individuals
environmental: low birth weight, smoking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is attention deficit hyperactivity disorder (ADHD) defined?

A

Persistent inattention, hyperactivity, and impulsivity

inconsistent with the patient’s developmental stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The diagnostic criteria of ADHD are a persistent pattern of inattention and/ or hyperactivity-impulsivity that interferes with functioning/ development as characterised by what?

A

6+ sxs for 6+ mos and inconsistent with developmental level and negatively impacts social/ academic/ occupational activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are sxs of inattention that contribute to a dx of ADHD? (must have 6+ for 6+ mos) (9)

A
  1. careless mistakes
  2. forgetful in daily activities
  3. difficulty sustaining attn
  4. easily distracted by extraneous stimuli
  5. avoid tasks that require sustained mental effort
  6. does not follow through/ finish work
  7. does not listen when spoken to directly
  8. difficulty w/ organization
  9. loses necessary items
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are sxs of hyperactivity-impulsivity that contribute to a dx of ADHD? (must have 6+ for 6+ mos) (9)

A
  1. fidgets
  2. leaves sit when inappropriate
  3. runs/ climbs excessively when inappropriate
  4. difficulty playing/ engaging in leisurely activities quietly
  5. “on the go”
  6. talks excessively
  7. blurts out answers prematurely
  8. difficulty awating turn
  9. interrupts/ intrudes others
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In addition to characteristic sxs of inattention/ hyperactivity-impulsivity, what are the other diagnostic criteria for ADHD?

A

Sxs present prior to age 12, sxs present in 2+ settings, clear evidence sxs interfere w/ reduce quality of social/ academic/ occupational functioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How are the types of ADHD specified?

A

Predominantly inattentive, predominantly hyperactive-impulsive, combined

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you specify whether a pt is in partial remission with ADHD?

A

< 6 sxs for 6+ mos, after previous full dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you specify ADHD severity?

A

Mild, moderate, severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In what populations is ADHD difficult to dx and why?

A

Younger children (<5) due to age-appropriate behaviors in active children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In what age group is ADHD most common?

A

Elementary school-aged children (obtain info from teachers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In adults, if ADHD is comorbid with SUD, mood disorder, or anti-social personality, the individual is at increased risk for what?

A

Suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why must one use caution in new diagnoses of ADHD in adults?

A

Pt childhood recall of ADHD unreliable (obtain school records)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some conditions that can co-occur (or be ddx) with ADHD?

A

Learning disorders, oppositional defiance disorder, conduct disorder, substance abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ADHD manifesting as a result of something such as a stressful home, inappropriate schools, or under-stimulation are what?

A

Environmental factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What must you be aware of when evaluating DDX of ADHD (in addition to co-occuring conditions and environmental factors)?

A

Medical conditions (that may manifest with sxs of ADHD)

ex. hearing/ visual impairments, sleep disorders, seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the purpose of a comprehensive medical, developmental education, and psychosocial eval for ADHD?

A

Confirm sxs, demonstrate functional complications, exclude ddxs, identify co-morbid conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Although there are several rating scales that may contribute to a dx of ADHD, they all still require what?

A

Validation with DSM5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the preferred rating scale for peds with ADHD?

A

Vanderbilt assessment scales

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the preferred rating scale for adults with ADHD?

A

ASRS (ADHD self report scale)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What should you ask a parent when evaluating for ADHD?

A
  • Performance in school
  • Teacher acknowledgement of learning problems
  • Happiness in school
  • Behavioral problems
  • Issues with completing assignments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What should you ask a teacher when evaluating for ADHD?

A
  • Behavior
  • Interventions required
  • Learning patterns
  • Functional impairment
  • Child interactions with other students
  • Work/ grades acceptable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the pathophysiology of ADHD?

A

Environmental factors, NT alterations, neuroanatomical changes in circuits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What does the RAS produce (ascending NT system)?

A

NE, serotonin, DA, ACh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the targets for the NTs produced by RAS?

A

Discrete nuclei within basal forebrain, limbic system, cerebral cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

With respect to NTs, what contributes to the overall psych/ behavior function of an individual?

A

Brain region + concentration of NT inputs + concentration of relative density of receptors = overall psych/ behavioral function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What type of modulation can occur pre- or post-synaptically at the target nuclei or production sites (therefore having different effects)?

A

Pharmacologic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Increased NE leads to what?

A

Increased alertness/ arousal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Where is NE produced?

A

Locus Coeruleus (LC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Where does NE target?

A

Throughout forebrain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What disorders are a/w NE imbalance?

A

Attention deficit disorders, mood disorders, anxiety disorders, drugs of abuse (psychostimulants)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How many receptor classes does NE have?

A

Two (and multiple subclasses)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

NE acting on the cortex/ hypothalamus/ brainstem influences what?

A

Arousal and sleep/wake cycles, consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

NE acting on the cortex only influences what?

A

Attention

36
Q

NE acting on the cortex/ limbic system influences what?

A

Mood, learning/ memory

37
Q

Where is serotonin produced?

A

Brainstem (raphe nuclei- dorsal)

38
Q

Where does serotonin target?

A

Throughout forebrain

39
Q

How many receptor classes does serotonin have?

A

Numerous (and multiple subclasses)

40
Q

Serotonin acting on the limbic system influences what?

A

Mood

41
Q

Serotonin acting on the cortex and thalamus influences what?

A

Sensation/ perception

42
Q

Serotonin acting on the hypothalamus influences what?

A

Circadian rhythms, appetite

43
Q

What disorders are a/w a 5-HT imbalance?

A

Mood disorders, impulse control disorders, OCD, anxiety disorders, eating disorders, drugs of abuse

44
Q

Where is dopamine produced?

A

In the midbrain (SN- substantia nigra, VTA- ventral tegmental area)

45
Q

Where does dopamine target?

A

Throughout forebrain

46
Q

Dopamine acting on the substantia nigra (SN) to basal nuclei influences what?

A

Motor control

47
Q

Dopamine acting on the ventral tegmental area (VTA) to limbic system and cortex influences what?

A

Reward, reinforcement, cognition

48
Q

How many receptor classes does dopamine have?

A

Multiple

49
Q

What disorders are a/w dopamine?

A

Psychotic disorders, substance use disorders, movement disorders, cognitive disorders, mood disorders

50
Q

What leads to positive sxs of psychosis?

A

Hallucinations and delusions

51
Q

Where is acetylcholine produced?

A

Basal forebrain (medial septum- MS, nucleus basalis of meynert- nBM)

52
Q

Where does ACh target?

A

Throughout forebrain

53
Q

How many receptors does ACh have?

A

Two receptor classes (and numerous subclasses)

54
Q

What disorders are a/w ACh imbalance?

A

Dementia and neurocognitive disorders

55
Q

ACh acting on the MS (medial septum) to hippocampus influences what?

A

Learning/ memory

56
Q

ACh acting on the NBM (nucleus basalis of meynert) to cortex influences what?

A

Attention

57
Q

Where is glutamate produced?

A

Throughout CNS

58
Q

Targets of glutamate are what?

A

Local and distributed

(primary excitatory NT of CNS)

59
Q

How many receptor classes does glutamate have?

A

3

60
Q

What disorders are a/w glutamate imbalances?

A

Psychotic disorders, bipolar disorders, substance abuse disorders, dementia (Alzheimers)

(theory for Alzheimers = glutamate receptor (NMDA) hypersensitive to stimulation in AD)

61
Q

Where is GABA produced?

A

Throughout CNS (interneurons, most ubiquitous NT in brain)

62
Q

Where does GABA target?

A

Local neurons

(primary inhibiory NT in CNS)

63
Q

How many receptor classes does GABA have?

A

2 (and numerous subclasses)

(receptors have binding sites for multiple chemicals)

64
Q

What disorders are a/w GABA imbalance?

A

Seizure disorders (anticonvulsants are GABA agonists), mood disorders, drugs of abuse (all depressants = GABA agonists), anxiety disorders

65
Q

What are the targets of ADHD meds?

A
  • Presynaptic modulation (NT release and reuptake)
  • Synaptic modulation (NT breakdown)
  • Postsynaptic modulation (receptor binding, signal transduction, genomic alterations)
66
Q

What treatments are used for ADHD?

A

Psychotherapy, pharmacotherapy, environmental manipulation, educational intervention, behavioral modification

67
Q

What is first line for management of ADHD in preschool children (4-5 yo)?

A

Behavioral therapy (meds only if needed)

(med = methylphenidate)

68
Q

What is first line for management of ADHD in school-aged children (≥ 6 yo) and adolescents?

A

Medication (then behavioral interventions added to meds)

69
Q

What is NOT recommended in the tx of ADHD?

A

Diets or supplements

70
Q

What is used in the management of ADHD in adults? (4)

A
  1. Medication (amphetamine salts)
  2. Atomoxetine (buproprion) if substance abuse is concern
  3. Antidepressants
  4. CBT as adjunct
71
Q

When treating ADHD in adults, if substance abuse is a concern, what things can be done to help manage this?

A

Controlled substance agreement with patient, urine drug screening

72
Q

Maintain daily schedule, minimize distractions, provide specific/ logical places to keep items, set small/ reachable goals, reward pos behavior, use charts/ checklists, limit choices, find activities in which the child can be successful, and using calm discipline are all examples of what type of management for ADHD?

A

Behavior modification

73
Q

Tutoring, individualized education programs (IEPs), write assignments on board, smaller class size, sit near teacher, frequent breaks, extra time to complete tasks/ tests, signal from teach when child is off task, and daily reports to parents are all examples of what kind of management for ADHD?

A

Educational intervention

74
Q

What do stimulants do and what are the most commonly used?

A

Increase release of DA and NE

Methylphenidate and dextroamphetamine most commonly used (controlled substances)

75
Q

Ritalin, Methylin, Concerta, Focalin, Metadate are all examples of what (generic name)?

A

Methylphenidate

76
Q

Dexedrine and Vyvanse are examples of what (generic name)?

A

Dextroamphetamine

77
Q

Adderall is an example of what (generic name)?

A

Mixed amphetamine salts

78
Q

What type of formulations are available for stimulants?

A

Short-acting and long-acting

(solution, pill, chewable tablet, patch)

79
Q

How are ADHD outcomes quantified?

A

Symptom severity, treatment retention, adverse events (decreased appetite most common)

80
Q

What are the SEs of stimulants?

A

Appetite disturbance, weight loss, personality changes, sudden cardiac death if underlying cardiac disease

(other: social withdrawal, irritability, nervousness, sleep disturbance, HA, stomach pain, tics, contact derm, increased HR/ BP)

81
Q

What is the MOA for atomoxetine?

A

SNRI

82
Q

Is atomoxetine a controlled substance?

A

No = less potential for abuse

83
Q

What is a disadvantage of atomoxetine?

A

More expensive than methylphenidate and dextroamphetamine and may not be as effective for some pts

84
Q

If pt has SEs to initial chosen stimulant, what should you do?

A

Choose another (be prepared to titrate dosages)

85
Q

Why should you get assent with adolescents in treating ADHD?

A

Pt preference is important

86
Q

What mood disorders are a/w a GABA imbalance?

A

Bipolar disorders

5. Psychiatry (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions