ADHD

Question 1

What is the clinical definition of ADHD?

Answer 1

A chronic childhood behavioural disorder- characterised by developmentally inappropriate attention skills, hyperactivity and impulsivity.

Question 2

ADHD is diagnosed twice as often in boys than girls, what is different about the symptoms girls present?

Answer 2

Less hyperactivity and more lack of attention.

Question 3

Children with ADHD show an increased risk of, what?

Answer 3

-Accidental injuries
-Poor relationship with peers and parents
-Worse quality of life
-Impaired school performance.

Question 4

What criteria is used to diagnose ADHD?

Answer 4

Meet DSM-5 or ICD-10

Question 5

What is the main signs of ADHD?

Answer 5

A persistent pattern of inattention and / or hyperactivity and impulsivity that interferes with daily functioning or development.

Question 6

What are 5 ADHD drugs?

Answer 6

1. Methylphenidate
2. Lisdexamphetamine
3. Dexamphetamine
4. Atomoxetine
5. Guanfacine

Question 7

What are the first, second, third and fourth line treatments for ADHD in CHILDREN?

Answer 7

1st: Methylphenidate
2nd: Lisdexamphetamine
3rd: Dexamphetamine
4th: Atomoxetine + Guanfacine

Question 8

What are the first, second and third line treatments for ADHD in ADULTS?

Answer 8

1st: Lisdexamphetamine or Methylphenidate
2nd: Dexamphetamine
3rd: Atomoxetine

Question 9

How long must symptoms of ADHD be present for before being diagnosed with ADHD?

Answer 9

AT LEAST 6 months to an extent that it is disruptive and inappropriate too persons development.

Question 10

Name some of the symptoms associated with inattention.

Answer 10

1. Easily distracted
   2.Often forgetful in daily activities
2. Often loses things necessary for tasks and activities
3. Often has trouble holding attention on tasks or play activities
4. Often has trouble organising tasks and activities
5. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work or with other activities.
6. Reluctant to do tasks that require mental effort over a long period of time

Question 11

Name some of the symptoms associated with hyperactivity & impulsivity

Answer 11

1. Talks excessively
2. Often blurts out an answer before question has been completed
3. Is often “on the go” acting as if driven by motor.
4. Often fidgets or taps hands or feet, squirming in seat.
5. Often runs about or climbs in situations where it is not appropriate
   6.Often unable to play or take part in activities silently.
6. Has problems waiting for their turn

Question 12

Which pathways/ systems are linked to the neurobiology of ADHD?

Answer 12

Locus coeruleus noradrenergic system

Mesocorticolimbic dopamine pathway

Question 13

What is the prefrontal cortex in charge of?

Answer 13

Executive function (Planning, decision making, short-term memory)
Personality expression
Controlling social behaviour
Speech and language

Question 14

What is the posterior parietal cortex in charge of?

Answer 14

Planned movements
Spatial reasoning
Attention

Question 15

The Locus Coeruleus system projects neurons to the whole brain, what neurotransmitter do they release?

Answer 15

Noradrenaline- noradrenaline release is linked to good cognitive execution and optimal concentration/ attention.

Question 16

Locus Coeruleus neuronal activity is modulated by what part of the brain?

Answer 16

Prefrontal Cortex

Question 17

Deficits in noradrenaline release is linked to?

Answer 17

Inattention

Question 18

Which neurons are involved in the Mesocorticolimbic dopamine pathway?

Answer 18

Ventral Tegmental dopaminergic neurons found in the PFC and ventral striatum.

Question 19

Excessive release of neurotransmitters from the Mesocorticolimbic dopamine pathway is linked to…?

Answer 19

hyperactivity and impulsivity

Question 20

The attentional network activity are pathways between…

Answer 20

the Prefrontal Cortex and Posterior Parietal Cortex

Question 21

What is the MOA of methylphenidate?

Answer 21

1. Inhibits transporters for both noradrenaline (NA) and dopamine (DA)
2. Increase in synaptic levels of NA and DA
3. Increased DA and NA activity in the prefrontal cortex thought to contribute to its efficacy in ADHD.

Question 22

What are some side effects of Methylphenidate?

Answer 22

-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

Question 23

what is the difference between amphetamines and methylphenidate?

Answer 23

Methylphenidate is not a substrate for NA/ DA transporters and does not facilitate the release of their neurotransmitters= thus has less potential for abuse.

Question 24

Lisdexamphetamine is a prodrug for …?

Answer 24

Dextroamphetamine

Question 25

What are the three MOA of Dextroamphetamine?

Answer 25

1. 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 to phosphorylate DAT. P-DAT internalised into the presynaptic neuron they by decreasing removal of DA.
3. Enters the presynaptic monoamine vesicle and causing release of NA and DA towards the synapse.

Question 26

What are the side effects of Lisdexamphetamine?

Answer 26

-Decreased appetite
-Aggression
-Drowsiness
-Dizziness
-Headaches
-Diarrhoea
- N and V

Question 27

What is Atomoxetine indicated for?

Answer 27

Cognitive enhancer to improve alertness, attention and memory

Question 28

What is the MOA of Atomoxetine?

Answer 28

Binds to the norepinephrine transporter inhibiting the reuptake of norepinephrine which increases NA levels in the pre frontal cortex.

Question 29

What are the side effects of Atomoxetine?

Answer 29

-small increase in blood pressure and HR
-N and V
-Stomach aches
-Trouble sleeping
-Dizziness
-Headaches
-Irritability
-Liver damage and suicidal thoughts

Question 30

What is Guanfacine indicated for?

Answer 30

Improved working memory
Regulates attention
Cognitive performance
Behavioural inhibition

Question 31

What are the side effects for Guanfacine?

Answer 31

Tiredness or fatigue
headaches
abdominal pain
dry mouth