ADHD

Question 1

Definition?

Answer 1

childhood-onset developmental disturbance that
persists for at least six months and across different
situations, and comprises the three core symptoms in -
attentiveness, impulsivity, and/or motor unrest. These
core symptoms are present to an extent beyond what
would be expected for the patient’s age, developmental
level, and intelligence.

Question 2

epidemiology?

Answer 2

ADHD as defined by the DSM-IV criteria has a worldwide epidemiological prevalence of 5.3%

Question 3

comorbid disorders?

Answer 3

75% have an additional diagnosis: Thus, the age-dependent development of comorbid disorders often occurs in specific sequential steps (e.g.,
from oppositional disorders, through conduct disorder,
to depression with increased suicidality)

Circumscribed developmental disorders (motor function, language, scholastic skills), anxiety disorders, tic disorders, and oppositional- defiant disorder emerge early in child development. (anxiety/learning)

In contrast, depressive disorders and severe conduct disorders often emerge later on, toward the end of
the elementary school years and during the transition to
adolescence (depression/conduct)

Approximately one in four children receiving
treatment for ADHD also have an affective disorder (25%)

From preschool age up to age 13, the risk of suicidal ideation is almost 6 times
higher than in their peers (e18), and they show a fourfold-increased lifetime risk of suicide. Approximately 75% of persons with ADHD have an additional mental disorder

Question 4

most likely cause of death?

Answer 4

Accident-proneness, particularly
regarding road traffic accidents, is the major reason for
the 50% increase in mortality seen among persons with
ADHD across all age groups

Question 5

genetics

Answer 5

First-degree relatives have a five- to tenfold increased risk of developing ADHD.
Twin studies have revealed a
high degree of heritability: 70–80% of the phenotypic
variance is attributable to genetic factors

Question 6

biophysiology

Answer 6

genes encoding the receptors and transporters of the
catecholaminergic and serotonergic neurotransmitter
systems play a role in the etiology of the disorder

Question 7

genetic syndrome overlaps?

Answer 7

Moreover, there are a number of genetic syndromes
which are known to be associated with the symptoms of
ADHD, including fragile X syndrome, microdeletion
22q11 syndrome, tuberous sclerosis, and Williams–Beuren syndrome

Question 8

maternal environmental risk factors

Answer 8

maternal stress, smoking or alcohol consumption during
pregnancy, low birth weight, prematurity), environmental toxins (organophosphates, polychlorinated
biphenyls, lead), unfavorable psychosocial conditions
(severe early-childhood deprivation, maternal hostility), and dietetic factors

Question 9

neurodevelopmental?

Answer 9

neuropsychological impairments in the area of executive functions (inhibitory control, working memory,
planning ability) and non-executive functions (regulation of activation and arousal, temporal processing,
memory, reaction-time variability)

Question 10

structural and functional brain abnormalities?

Answer 10

Global brain volume is reduced by 3–5%, with the gray
matter preferentially affected. is seen in the prefrontal areas, the basal ganglia, and the cerebellum. Functional imaging reveals hypoactive activation patterns in the prefrontal cortical areas, the anterior cingulate gyrus, and associated
parietal, striatal, and cerebellar structures

Question 11

diagnostic criteria 1

Answer 11

1. Five or more symptoms of inattention and/or ≥5 symptoms of hyperactivity/impulsivity must have persisted for ≥6 months to a degree that is inconsistent with the developmental level and negatively impacts social and academic/occupational activities.
2. Several symptoms (inattentive or hyperactive/impulsive) were present before the age of 12 years.
3. Several symptoms (inattentive or hyperactive/impulsive) must be present in ≥2 settings (eg, at home, school, or work; with friends or relatives; in other activities).
4. There is clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning.
5. Symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder, and are not better explained by another mental disorder (eg, mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication, or withdrawal).

Question 12

first line treatment

Answer 12

methylphenidate (appetite loss, increasing in blood pressure)
Dexamphetamine (psychosyimulant)

Question 13

second line unless comorbid anxiety, tic or substance disorder

Answer 13

atomoxetine, guanfacine,