ADHD Flashcards
DEFINE ADHD (Attention-deficit hyperactivity disorder)
A chronic childhood behavioural disorder characterised by developmentally inappropriate ATTENTION SKILLS, HYPERACTIVITY and IMPULSIVITY
EXPLAIN ATTENTION SKILLS
Behavioural and cognitive process of selectively focussing on specific task or information, and ignoring other perceivable information
EXPLAIN HYPERACTIVITY
To move about constantly, including in situations when it is not appropriate, or excessively fidgets, taps, or talks.
EXPLAIN IMPULSIVITY
a tendency to act with little or no forethought, reflection, or consideration of the consequences
Prevalence globally ——-, with an average of around 5%.
Diagnosed approximately twice as often in —– than in ——- (1.6 times more often in —– than in —-)
girls present with slightly different symptoms, more —– than ——
2% AND 7%
Boys than girls
men than women\more inattention than hyperactivity
Children with ADHD show an increased risk of what?
ACCIDENTAL INJURIES, POOR RELATIONSHIP WITH PEERS AND PARENTS, WORSE QUALITY OF LIFE, and IMPAIRED SCHOOL PERFORMANCE.
how do you diagnose symptoms of ADHD?
1)must meet DSM‑5 or ICD‑10 diagnostic criteria
2) cause at least moderate psychological, social and/or educational or occupational impairment
3) be pervasive, occurring in 2 or more important settings including social, familial, educational and/or occupational settings.
4) include an assessment of the person’s needs, coexisting conditions, social, familial and educational or occupational circumstances and physical health.
There is no single test to diagnose ADHD. true or false?
true
what are the other conditions that have similar symptoms to ADHD?
sleep disorders
anxiety
depression
and certain types of learning disabilities,
ADHD must show a persistent pattern of —— and/or ——– , ——- that interferes with functioning or development
inattention
hyperactivity
impulsivity
DSM 5 FOR INATTENTION must have how many symptoms for children up to 16years?
6 or more symptoms
DSM 5 FOR INATTENTION must have how many symptoms for adolescents age 17 years and older and adults?
5 or more
Symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level. WHAT ARE THEY?
Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
Often has trouble organising tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted
Is often forgetful in daily activities.
DSM 5 FOR HYPERACTIVITY-IMPULSIVITY must have how many symptoms for children up to 16yrs
6 or more
DSM 5 for HYPERSCTIVITY-IMPULSIVITY must have how many symptoms for adolescents age 17 years and older and adults
5 or more
Symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level. WHAT ARE THEY?
Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Is often “on the go” acting as if “driven by a motor”.
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has trouble waiting their turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games)
In addition to DSM 5, what are the additional conditions that must be met in other to diagnose ADHD?
Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).
There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).
The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
To diagnose ADHD in adults and adolescents age 17 years or older, only —- symptoms are needed instead of the —- needed for younger children
5 instead of 6
ADHD often lasts into adulthood. TRUE or FALSE
TRUE
Symptoms might look different in older ages. Give an example.
in adults, hyperactivity may appear as extreme restlessness or wearing others out with their activity.
What are the three kinds of ADHD presentation?
1) Combined Presentation
if enough symptoms of INATTENTION AND HYPERACTIVITY-IMPULSIVITY were present for the past 6 months
2) Predominantly Inattentive Presentation
if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
3) Predominantly Hyperactive-Impulsive Presentation
if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.
symptoms and presentations can change over time. TRUE OR FALSE?
TRUE
What are the neurobiology of involved in ADHD symptoms?
Genes
Neurotransmitter (noradrenaline, dopamine, serotonin)
brain circuits/region
brain processes (motivation function, executive function)
ADHD is ——– and highly ——-
familial and heritable
what is a polygenic condition which is linked to ADHD?
arises through the combination of many gene variants which each have a small effect
what are the dopamine genes implicated in ADHD
DAT, DRD4, DRD5, TAAR1, MAOA, COMT, and DBH
WHAT ARE THE SEROTONIN GENES IMPLICATED
SERT, 5HT1B, TPH2
what are the noradrenaline genes implicated
ADRA2A
what are the neurotransmitter pathways and what they do?
LOCUS COERULEUS (LC)-NORADRENERGIC SYSTEM
LC neurons project to whole brain and provide major source of NA.
LC firing rate, and thus NA release, correlates with optimal performance of cognitive tasks requiring concentration and attention.
This LC neuronal activity is modulated by inputs from prefrontal cortex (PFC) neurons
Inattention due in part to deficits in NA modulation of PFC neurons
MESOCORTICOLIMBIC DOPAMINE PATHWAY
Ventral tegmental dopaminergic neurons innervating PFC (executive functions) and ventral striatum (reward/impulsivity) neurons.
Hyperactivity and impulsivity
What are the brain regions involved in ADHD?
1) Prefrontal Cortex (PFC)
Involves in EXECUTIVE FUNCTIONS (planning, decision making, short-term memory), PERSONALITY EXPRESSION, CONTROLLING SOCIAL BEHAVIOUR, SPEECH AND LANGUAGE
2) Posterior Parietal Cortex (PPC)
involves in PLANNED MOVEMENTS, SPATIAL REASONING, ATTENTION
what changes in activity of brain networks?
DEFICITS in RESPONSE INHIBITION,
VIGILANCE,
WORKING MEMORY,
PLANNING
what other changes in activity happens?
Differences in connections between prefrontal cortex and striatum
Deficits in focussing on long-term over short-term rewards, and exhibit impulsive behaviour for short-term rewards
Changes in behaviour due to imbalances in different brain circuits which enhance or suppress ——, —— AND ——
ATTENTION, ACTIVITY AND IMPULSIVITY
what are the functional circuits involved in the pathophysiology of ADHD
Attentional network
The fronto-striatal network
Executive function network
Fronto-cerebellar network
Reward network.
What is the FIRST LINE Medication choice for children aged 5years and over and young people
Methylphenidate
What is the SECOND LINE Medication choice for children aged 5years and over and young people
Lisdexamfetamine
What is the THIRD LINE Medication choice for children aged 5years and over and young people
Dexamfetamine
What is the FOURTH LINE Medication choice for children aged 5years and over and young people
Atomoxetine
Or
Guanfacine
what is the FIRST LINE medication choice for adults
Lisdexamfetamine
or
Methylphenidate
what is the SECOND LINE for adults
Dexamfetamine
what is the THIRD LINE for adults
Atomoxetine
What is the pharmacology of METHYLPHENIDATE
Belongs to the class of CNS stimulant drugs
Mechanism of action
Inhibits transporters for both noradrenaline (NA) and dopamine (DA)
Increase in synaptic levels of NA and DA
increased DA and NA activity in the prefrontal cortex thought to contribute to its efficacy in ADHD.
Unlike the amphetamines, methylphenidate is not a substrate for these transporters and thus does not enter the nerve terminals to facilitate noradrenaline (NA) and dopamine (DA) release less potential for abuse?
Side effect of METHYLPHENIDATE
a small increase in blood pressure and heart rate
loss of appetite, which can lead to weight loss or poor weight gain
trouble sleeping
headaches
stomach aches
feeling aggressive, irritable, depressed, anxious or tense
Pharmacology of LISDEXAMPHETAMINE and MOA for AMPHETAMINE
Belongs to the class of CNS stimulant drugs
An inactive prodrug that is active only after being converted by the body into dextroamphetamine + L-lysine (essential amino acid).
Requires metabolism to release dextroamphetamine (the active ingredient)
Slower onset, and longer duration of action a reduced abuse potential
Mechanism of action of Dextroamphetamine (and amphetamine)
Dextroamphetamine is an optical isomer of amphetamine
at least three mechanisms of action:
1) Are substrates for the monoamine transporters DAT and NET, thus competing with those neurotransmitters and decreasing their reuptake from the synapse.
2) causes trace amine-associated receptor 1 (TAAR1) to phosphorylate DAT. P-DAT internalised into the presynaptic neuron thereby decreasing removal of DA.
3) Enters the presynaptic monoamine vesicle and causing release of NA and DA towards the synapse.
what are the side effects of lisdexamphetamine
decreased appetite, which can lead to change in weight
aggression
drowsiness
dizziness
headaches
diarrhoea
nausea and vomiting
Pharmacology of ATOMOXETINE
Uses include
ADHD
a cognitive enhancer to improve alertness, attention, and memory
Mechanism of action
binds to norepinephrine transporter (NET), inhibiting the reuptake of norepinephrine increased NA levels in PFC.
In the prefrontal cortex, where there is much less expression of dopamine transporter (DAT), dopamine reuptake by NET is also inhibited increased DA levels in PFC, but not in other reward circuits less abuse potential
Side effect of atomoxetine
a small increase in blood pressure and heart rate
nausea and vomiting
stomach aches
trouble sleeping
dizziness
headaches
Irritability
NB: linked to suicidal thoughts and liver damage.
pharmacology of GUANFACINE
Guanfacine improves working memory and regulates attention, cognitive performance, and behavioural inhibition
Uses include
ADHD
high blood pressure
Mechanism of action
Agonist at post-synaptic α2A adrenoceptors on dendritic spines of PFC pyramidal neurons.
cAMP-mediated opening of HCN and KCNQ (inhibitory) channels is inhibited.
Increases PFC synaptic connectivity and neuronal firing.
Side effects of guanfacine
tiredness or fatigue
headache
abdominal pain
dry mouth
