ADHD Flashcards

1
Q

DEFINE ADHD (Attention-deficit hyperactivity disorder)

A

A chronic childhood behavioural disorder characterised by developmentally inappropriate ATTENTION SKILLS, HYPERACTIVITY and IMPULSIVITY

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2
Q

EXPLAIN ATTENTION SKILLS

A

Behavioural and cognitive process of selectively focussing on specific task or information, and ignoring other perceivable information

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3
Q

EXPLAIN HYPERACTIVITY

A

To move about constantly, including in situations when it is not appropriate, or excessively fidgets, taps, or talks.

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4
Q

EXPLAIN IMPULSIVITY

A

a tendency to act with little or no forethought, reflection, or consideration of the consequences

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5
Q

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 ——

A

2% AND 7%
Boys than girls
men than women\more inattention than hyperactivity

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6
Q

Children with ADHD show an increased risk of what?

A

ACCIDENTAL INJURIES, POOR RELATIONSHIP WITH PEERS AND PARENTS, WORSE QUALITY OF LIFE, and IMPAIRED SCHOOL PERFORMANCE.

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7
Q

how do you diagnose symptoms of ADHD?

A

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.

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8
Q

There is no single test to diagnose ADHD. true or false?

A

true

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9
Q

what are the other conditions that have similar symptoms to ADHD?

A

sleep disorders
anxiety
depression
and certain types of learning disabilities,

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10
Q

ADHD must show a persistent pattern of —— and/or ——– , ——- that interferes with functioning or development

A

inattention
hyperactivity
impulsivity

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11
Q

DSM 5 FOR INATTENTION must have how many symptoms for children up to 16years?

A

6 or more symptoms

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12
Q

DSM 5 FOR INATTENTION must have how many symptoms for adolescents age 17 years and older and adults?

A

5 or more

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13
Q

Symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level. WHAT ARE THEY?

A

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.

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14
Q

DSM 5 FOR HYPERACTIVITY-IMPULSIVITY must have how many symptoms for children up to 16yrs

A

6 or more

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15
Q

DSM 5 for HYPERSCTIVITY-IMPULSIVITY must have how many symptoms for adolescents age 17 years and older and adults

A

5 or more

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16
Q

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?

A

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)

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17
Q

In addition to DSM 5, what are the additional conditions that must be met in other to diagnose ADHD?

A

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.

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18
Q

To diagnose ADHD in adults and adolescents age 17 years or older, only —- symptoms are needed instead of the —- needed for younger children

A

5 instead of 6

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19
Q

ADHD often lasts into adulthood. TRUE or FALSE

A

TRUE

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20
Q

Symptoms might look different in older ages. Give an example.

A

in adults, hyperactivity may appear as extreme restlessness or wearing others out with their activity.

21
Q

What are the three kinds of ADHD presentation?

A

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.

22
Q

symptoms and presentations can change over time. TRUE OR FALSE?

A

TRUE

23
Q

What are the neurobiology of involved in ADHD symptoms?

A

Genes
Neurotransmitter (noradrenaline, dopamine, serotonin)
brain circuits/region
brain processes (motivation function, executive function)

24
Q

ADHD is ——– and highly ——-

A

familial and heritable

25
Q

what is a polygenic condition which is linked to ADHD?

A

arises through the combination of many gene variants which each have a small effect

26
Q

what are the dopamine genes implicated in ADHD

A

DAT, DRD4, DRD5, TAAR1, MAOA, COMT, and DBH

27
Q

WHAT ARE THE SEROTONIN GENES IMPLICATED

A

SERT, 5HT1B, TPH2

28
Q

what are the noradrenaline genes implicated

A

ADRA2A

29
Q

what are the neurotransmitter pathways and what they do?

A

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

30
Q

What are the brain regions involved in ADHD?

A

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

31
Q

what changes in activity of brain networks?

A

DEFICITS in RESPONSE INHIBITION,
VIGILANCE,
WORKING MEMORY,
PLANNING

32
Q

what other changes in activity happens?

A

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

33
Q

Changes in behaviour due to imbalances in different brain circuits which enhance or suppress ——, —— AND ——

A

ATTENTION, ACTIVITY AND IMPULSIVITY

34
Q

what are the functional circuits involved in the pathophysiology of ADHD

A

Attentional network
The fronto-striatal network
Executive function network
Fronto-cerebellar network
Reward network.

35
Q

What is the FIRST LINE Medication choice for children aged 5years and over and young people

A

Methylphenidate

36
Q

What is the SECOND LINE Medication choice for children aged 5years and over and young people

A

Lisdexamfetamine

37
Q

What is the THIRD LINE Medication choice for children aged 5years and over and young people

A

Dexamfetamine

38
Q

What is the FOURTH LINE Medication choice for children aged 5years and over and young people

A

Atomoxetine
Or
Guanfacine

39
Q

what is the FIRST LINE medication choice for adults

A

Lisdexamfetamine
or
Methylphenidate

40
Q

what is the SECOND LINE for adults

A

Dexamfetamine

41
Q

what is the THIRD LINE for adults

A

Atomoxetine

42
Q

What is the pharmacology of METHYLPHENIDATE

A

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?

43
Q

Side effect of METHYLPHENIDATE

A

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

44
Q

Pharmacology of LISDEXAMPHETAMINE and MOA for AMPHETAMINE

A

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.

45
Q

what are the side effects of lisdexamphetamine

A

decreased appetite, which can lead to change in weight
aggression
drowsiness
dizziness
headaches
diarrhoea
nausea and vomiting

46
Q

Pharmacology of ATOMOXETINE

A

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

47
Q

Side effect of atomoxetine

A

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.

48
Q

pharmacology of GUANFACINE

A

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.

49
Q

Side effects of guanfacine

A

tiredness or fatigue
headache
abdominal pain
dry mouth