14: Medical treatment of Attention-Deficit Hyperactivity Disorder (ADHD)

Question 1

ADHD

Answer 1

AD (Attention deficit): attention deficit.

HD (hyperactivity disorder): hyperactivity, impulsivity

Question 2

Fordele og ulemper ved ADHD

Answer 2

Problemer
	• Eksekutive funktioner
	• Sprog
	• Styre følelser
	• Ufleksibel tænkning 
	• Social skills

Fordele 
	• Sport
	• Løb
	• Humor
	• Forestillingsevne (måske fantasi) 
	• Glemme konflikter
	• Huske sange 
	• Gode ideer

Question 3

Prevalence of ADHD

Answer 3

Stort increase de sidste årtier (7,2% i dag hos børn og unge) måske pga medicinering?

3-5 % alle aldre

Question 4

ICD-10 og DSM-5 diagnostic criteria for AD

Answer 4

Attention disorder (at least 6)

• Can not draw attention to detail, make careless mistakes.
• Often has difficulty sustaining attention in tasks or activities
• Often does not seem to listen when spoken to directly
• Often does not follow through on instructions and fails to finish schoolwork or workplace duties
• Often has difficulty organising tasks and activities
• Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort
• Often loses things necessary for tasks or activities.
• Is easily distracted by extraneous stimuli
• Is often forgetful in daily activities

(All symptoms present for at least 6 months and started before 7 years of age and must be present in more than one situation. Functionel impairment.)

Question 5

ICD-10 og DSM-5 diagnostic criteria for HD

Answer 5

Hyperactivity (mindst 3)

• Often fidgets with or taps hands and feet, or squirms in seat
• Often leaves seat in situations when remaining seated is expected
• Often runs and climbs in situations where it is inappropriate (in adolescents or adults, may be limited to feeling restless)
• Is often ‘on the go’, acting as if ‘driven by a motor’
• Noisy behavior by play has difficulty being quiet.

Impulsitivity (mindst 1)

• Often blurts out answers before a question has been completed
• Often has difficulty waiting their turn
• Often interrupts or intrudes on others
• Often talks excessively

(All symptoms present for at least 6 months and started before 7 years of age and must be present in more than one situation. Functionel impairment.)

Question 6

Hvordan ADHD påvirker hjernen

Answer 6

• Mindre hjernevolumen i alle regioner uanset om man modtager medicin (både grå og hvid substans)
• Volumen korrelerer med, hvor slem ADHD’en er

Question 7

CARMA(Children ADHD Resilience Mothers Attachment)

Answer 7

Projekt: hvor det skulle undersøges prognostiske faktorer hos børn med ADHD-symptomer og den potentielle sammenhæng mellem ADHD-symptomer og tilknytningsrepræsentation.

Question 8

Methylphenidate

Answer 8

Mest anvendte medicin mod ADHD.
Methylphendiate: (Ritalin, Concerta, Equasym, Medikinet)
Virker ved at blokere reuptaket af dopamin og norepinephrine (så der ligger mere i synapsekløften i længere tid)

Question 9

Hvilke transmitterstoffer man mangler når man har ADHD

Answer 9

Dopamin: associeres med motivation, nydelse, opmærksomhed
Norepinephrine: Hukommelse, opmærksomhed, indlæring
Manglen på disse stoffer resulterer så i uopmærksomhed, hyperaktivitet og impulsivitet (som er nogle af kernesymptomerne ved ADHD)

Question 10

Bivirkninger ved Methylphenidate

Answer 10

Sleep difficulties (17.9%)
Abdominal pain (10.7%)
Decreased appetite (31.1%)
Anxiety (18.4%)
and sadness (16.8%)
(Studies resultater: The Protocol: assessment of harmful effects in non-randomised studies - har low quality)

Question 11

Symptomer på ADHD

Answer 11

Attention:
• Ability to focus attention
• Working memory
• Flexible attention

Hyperaktivitet:
• Retslessness
• Difficulty playing quietly
• All the time in progress
• Talkative

Impulsivitet:
• Answer before the question is
finished
• Difficult to wait for turn
• Interrupt others