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7. Child and adolescent psychiatry > ADHD > Flashcards

ADHD Flashcards

1
Q

Cardinal features of ADHD

A

Hyperactivity
Impulsivity
Inattention

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2
Q

Age at which symptoms should be present for a diagnosis of ADHD in DSM V

A

12

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2
Q

Age at which symptoms should be present for a diagnosis of ADHD in DSM V

A

12

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3
Q

Change for DSM V regarding ADHD and ASD in combination

A

Comorbid diagnosis now allowed

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4
Q

Questionnaire used to get information for teachers to investigate ADHD symptoms

A

Connor’s questionnaire

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5
Q

Number of settings symptoms must be present in for a diagnosis of ADHD

A

2 or more

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6
Q

Length of time ADHD symptoms should persist before a diagnosis

A

6 months

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7
Q

Prevalence of ADHD in UK school aged children by DSM IV criteria

A

3-4%

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8
Q

Prevalence of ADHD in school aged children by ICD 10 criteria

A

1-2%

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9
Q

Rate of ADHD in boys compared to girls

A

3:1

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10
Q

Increased risk of ADHD with an affected sibling

A

2-3x higher

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11
Q

Heritability of ADHD

A

80%

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12
Q

Concordance of ADHD in monozygotic twins

A

79%

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13
Q

Concordance of ADHD in dizygotic twins

A

32%

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14
Q

Genes associated with ADHD

A

Dopamine transporter gene (DAT1)
Dopamine D4 receptor gene
SNAP-25

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15
Q

Functional imaging findings in children with ADHD

A

Lower cerebral blood flow to frontal areas
In teenage girls - globally lower glucose metabolism

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16
Q

Neurotransmitters involved in ADHD

A

Dopamine and noradrenaline dysregulation in the prefrontal cortex

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17
Q

Potential environmental factors involved in ADHD

A

Obstetric complications
Low birth weight
Prematurity
Prenatal exposure to alcohol, nicotine, and benzodiazepines
Poor attachment
Early deprivation
Living in an institution

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18
Q

Percentage of children with ADHD who have comorbid conduct disorder

A

14%

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19
Q

Percentage of children with ADHD who have comorbid oppositional defiant disorder

A

40%

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20
Q

Percentage of children with ADHD who have comorbid anxiety disorder

A

34%

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21
Q

Percentage of children with ADHD who have comorbid tics

A

11%

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22
Q

Percentage of children with ADHD who have comorbid mood disorder

A

6%

23
Q

Percentage of children with ADHD who meet diagnostic criteria in adulthood

A

50%

24
Q

Percentage of children with ADHD who develop substance misuse problems as adults

A

15-20%

25
Q

Mechanism of action of stimulant treatments of ADHD

A

Release noradrenaline, dopamine and serotonin
Increase extracellular dopamine which inhibits impulses

26
Q

Reason for withdrawal of pimoline for ADHD treatment

A

Abnormal LFTs
Occasionally liver failure

27
Q

Most rapid stimulant ADHD treatment

A

Methylphenidate

28
Q

Daily dose range of methylphenidate

A

5-60mg daily

29
Q

Mechanism of action of atomoxetine

A

Noradrenaline reuptake inhibitor
Increases noradrenaline in the synaptic cleft

30
Q

Monitoring required for methylphenidate and atomoxetine

A

Height
Weight
BP
HR
3 monthly then 6 monthly
For atomoxetine - LFT monitoring recommended

31
Q

Relationship between ADHD medications and tics

A

Methylphenidate can cause tics; atomoxetine does not

32
Q

Adverse effects of methylphenidate

A

Decreased appetite and weight loss
Growth slowing for first 2 years
Sleep disturbance
Cramps
Headaches
BP and pulse increase
Emotional blunting
Tics
Depression
Hallucinations

33
Q

Adverse effects of atomoxetine

A

Decreased appetite and weight loss
Mild growth slowing
GI symptoms
Fatigue
Dizziness

34
Q

Medications which may improve ADHD symptoms other than stimulants or atomoxetine

A

TCA
Alpha 2 agonists
Antipsychotics

35
Q

Benefits of using TCAs for ADHD

A

Treats comorbid depression and anxiety
May be useful for stimulant non-responders

36
Q

Monitoring required for TCA treatment of ADHD

A

ECG

37
Q

Adverse effects of TCAs used to treat ADHD

A

Sedation
Changes in BP (up or down)
Dizziness
Dry mouth
Heart block

38
Q

Benefits of alpha 2 agonists to treat ADHD

A

Treat comorbid tic disorder or aggression
Useful for those who are over-aroused
Can be useful for stimulant non-responders

39
Q

Adverse effects of alpha 2 agonists used to treat ADHD

A

Delayed response
Sedation
Postural hypotension
Dry mouth
Hallucinations
Hypertensive rebound if doses missed

40
Q

Male:female ratio of ADHD

A

4:1

41
Q

Environmental risk factors for ADHD

A

Prematurity
Maternal alcohol use during pregnancy
Maternal smoking during pregnancy
Head injury

42
Q

First line medication for a child with ADHD and a congenital heart condition

A

Atomoxetine

43
Q

Symptoms most likely to resolve first in childhood ADHD

A

Hyperactivity

44
Q

Percentage of children with ADHD who have comorbid ASD

A

59%

45
Q

Percentage of children with ADHD who have specific learning disorders

A

70%

46
Q

Class of medication which can be used for ADHD with comorbid depression/anxiety

A

TCA

47
Q

Length of time a trial of methylphenidate or lisdexamphetamine should last

A

6 weeks

48
Q

Percentage of children who have ADHD

A

5-7%

49
Q

Percentage of adults who have ADHD

A

2.5-3.5%

50
Q

ADHD medication which should be avoided if there is hepatic impairment

A

Atomoxetine

51
Q

Medication suggested for ADHD with comorbid tics

A

Alpha 2 adrenergic agonist e.g. clonidine

52
Q

First line medication for adult ADHD

A

Methylphenidate

53
Q

Neural pathway implicated in ADHD

A

Frontostriatal

54
Q

First line treatment for ADHD if there are substance misuse concerns

A

Atomoxetine

55
Q

Second line treatment for ADHD if there are substance misuse concerns and atomoxetine is not suitable

A

Modified release methylphenidate e.g. Medikinet XL

7. Child and adolescent psychiatry (9 decks)

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