ADHD

Question 1

What is the prevalence of ADHD

Answer 1

2%-7%

Question 2

What risks are increased in children with ADHD

Answer 2

Accidental injuries

Poor relationship with peers and parents

Worse quality of life

Impaired school performance

Question 3

which gender is more likely to be diagnosed with ADHD and why

Answer 3

Boys

As they show more hyperactivity whist females

Question 4

How is ADHD diagnosed

Answer 4

Symptoms must

1. Meet DSM-5 or ICD-10
2. Causes moderate physiological, social, educational or occupational impairment
3. Must occur in 2 or more important settings
4. assess persons needs and co-existing conditions

Question 5

According to DSM-5 how many symptoms of inattention, Hyperactivity and impulsivity need to be present in children and adults for a diagnosis of ADHD to be made

Answer 5

Children up to 16: six or more

Adults from the age of 17: five or more

Question 6

How long do the symptoms need to be presents

Answer 6

At least 6 months

Question 7

According to DSM-5 what other conditions need to be meet for a ADHD diagnosis

Answer 7

1- Inattentively, hyperactive and impulsive symptoms must be present before age 12

2- setting are present in two or more settings: school/ work or with friends or relatives

3- Clear evidence that symptoms interfere with quality of social, school and work functionality

4- symptoms not explained by another mental disorder

5- Does not happen only during SCH or psychotic disorder

Question 8

What are the 3 types of ADHD presentation

Answer 8

1-Combined

2- Predominantly inattentive presentation

3- Predominantly Hyperactive-Impulsive presentation

Question 9

Which brain regions are involved in ADHD

Answer 9

Prefrontal cortex

Basal ganglia:

Cerebellum

Question 10

Is ADHD hereditary

Question 10

ADHD inheritable: TRUE OR FALSE?

Answer 10

True: 74% inheritability

Question 11

What dopamine pathways are involved in ADHD

Answer 11

DAT
DRD4
DRD5
TAAR1
MAOA
COMT
DBH

Question 12

Which serotonin pathways are involved ADHD

Answer 12

SERT
5HT1B
TPH2

Question 13

Which Noradrenaline pathways are involved ADHD

Answer 13

ADRA2A

Question 14

In terms of NT, why does inattention occur

Answer 14

Partially due to Noradrenaline deficit in PFC neurons

Question 15

which neurotransmitter pathway causes hyperactivity and impulsivity

Answer 15

Mesocorticolimbic dopamine pathway
- Ventral tegmental dopaminergic neurons
- Ventral Striatum

Question 16

List the medication used in children over 5

Answer 16

Methylphenidate

Lisdexamfetamine

Dexamfetamine

Atomoxetine

Guanfacine

Question 17

Describe the mechanism of action of Methylphenidate

Answer 17

Inhibits the transporters of NA and DA
Increases the amount in the PFC

Question 18

What are the side effects of Methylphenidate

Answer 18

-Small increase in BP and heart rate
-Loss of appetite leading to weight loss or poor weight gain
-Trouble sleeping
-Headaches
-Stomach aches
-Feeling aggressive, irritable, depressed, anxious or tense

Question 19

Pharmacology of Lisdexamphetamine

Answer 19

-Prodrug
-Converted into dextroamphetamine and L-lysine
-Slow onset
-Longer duration of action
-Reduced abuse potential

Question 20

What are the side affects of Lisdexamphetamine

Answer 20

Decreased appetite
Aggression
Drowsiness
Dizziness
Headaches
Diarrhoea
Nausea and vomiting

Question 20

MOAs of Dextroamphetamine

Answer 20

1. Bind to Monoamine transporter DAT and NAT, decreasing their reuptake
2. Cause Trace amine-associated receptor 1 to phosphorylate DAT.
   
   • The new P-DAT is internalised into the presynaptic neuron which decreases removal of DA
3. Enters the presynaptic monoamine vesicle and cause the release of NA and DA TOWARDS THE SYBAPES

Question 21

MOA of Atomoxetine

Answer 21

Binds to norepinephrine transporter and inhibits the retake of NA and DA

Question 22

Benefit of Atomoxetine

Answer 22

Not in other reward Circuit so had less abuse potential

Question 23

Side effects of Atomoxetine

Answer 23

Small increase in BP and HR
Nausea and vomiting
Stomach aches
Trouble sleeping
dizziness
headaches
Irritability
Linked to suicidal thoughts and liver damage

Question 24

What other condition is guanfacine used for

Answer 24

High BP

Question 25

MOA of Guanfacine

Answer 25

Agonist of post synaptic alpha 2A adrenoceptor on dendritic spines of PFC pyramidal neurons

cAMP mediated opening of HCN and KCNQ channels are inhibited

Increase of PFC synaptic connectivity and neuronal firing

Question 26

What are the side effects of Guanfacine

Answer 26

Tiredness
Headaches
Abdominal pain
Dry mouth