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Neurobiology of Disease > ADHD > Flashcards

ADHD Flashcards

1
Q

What are the two types of ADHD?(3 lol)

A
  1. Inattentive
  2. Hyperactivity/impulsivity
  3. (Combined)
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2
Q

What is the DSM-V?

A
  • Diagnostic and Statistical manual of Mental Disorders
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3
Q

What are the symptoms/criteria for inattentive DSM-V?

A
  • Lack of attention to detail
  • Difficulty to sustain attention
  • Does not listen
  • Not follow through on instruction
  • Diff organising task
  • Avoid sustained attention
  • Lose or misplace objects
  • Easily distracted
  • Forgetful
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4
Q

What are the symptoms/criteria for Hyperactivity DSM-V?

A
  • Fidgeting
  • Restless during activities
  • Running about
  • Excessively loud
  • Always ‘on the go’
  • Talks excessively
  • Blurts out answers
  • Interrupts or intrudes on others
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5
Q

What is the DSM-V criteria?

A
  • > 6 inattention and/or hyperactivity features for 6 months before age 12
  • Symptoms present in at least 2 life areas(school,home,work,social)
  • Defining criteria are developmentally inapp behaviours (age 4 vs 12)
  • DIFFICULT to assess in adults, DSM-V ≥ 5 symptoms.
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6
Q

What is the aetiology of ADHD?

A
  • Genetic and environmental
  • 70-90% heritability in twins
  • 5x inc risk in first degree relative
  • (80% heritability, among the most heritable of neuro disorders)
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7
Q

What are environmental factors of ADHD?

A
  • Neonatal hypoxia
  • Maternal smoking
  • Premature birth
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8
Q

Describe the neurobiology of ADHD?

A
  • On MRI-smaller less active fronto-striatal complex
  • PET-reduced striatal metabolism
  • Hyperactive sensory cortex
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9
Q

What is the prevalence of ADHD?

A
  • ADHD (DSM-V) 3-5%
  • USA defining hyperkinetic disorder 0.5-1.5%
  • Boys>girls 2:1
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10
Q

What increases prevalence of ADHD?

A
  • Extreme prematurity and low birth weight
  • Maternal smoking/alcohol
  • Low social class groups/social deprivation
  • Learning disability
  • Institutional rearing
  • Other brain diseases/neurological disorders
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11
Q

Explain the developmental impact of ADHD.

A
  • Nursery-Behavioural disturbance
  • Primary-“, academic impair,poor social, peer acceptance
  • Adolescent-See above+Low self-esteem,smoking,criminality
  • Uni-Academic failure,occupational diff,low self,alcohol+sub abuse, Injury/accidents
  • Adult-Unemp,Low-self,Relationship prob, Motor acc, MArital discord, Alcohol+sub abuse
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12
Q

Explain ADHD and co-morbidity.

A
  • Very high co-morbidity
  • Only 31% is ADHD alone
  • Other conditions involve anxiety 34%, ODD, tics, conduct disorder and Mood disorder-(Depression).
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13
Q

Explain the neuroanatomy of ADHD?

A
  • Smaller brain (~4%):Right frontal lobe (~8%)
  • Smaller basal ganglia (~6%)->Normalisation~18Yo
  • Smaller cerebellum (~12%) ->More pronounced ~18Yo
  • Volumetric diff (Features not diagnostic)
    1. Manifest early (~6Yo)
    2. Correlate with ADHD severity
    3. Are irrespective of medication status
    4. Are irrespective of co-morbidities
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14
Q

How are key elements of cognitive networks affected by ADHD?

A

ALL show functional abnormalities in ADHD

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15
Q

What is the genetics of ADHD?

A
  • Primary candidate genes are linked to dopaminergic or serotinergic neurotransmission
  • Caused by multiple genes-each gene may code for specific phenotypic trait
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16
Q

What is the D4 gene?

A
  • Dopamine D4 receptor
  • Prevalent in frontal-cortical networks
  • High risk allele:48BP repeat
  • Results in attenuated cAMP response to dopamine
  • May correlate best with symp of inattention
17
Q

What is DAT1 gene?

A
  • Dopamine transporter 1 gene
  • Site of action: stimulant drug and elevated in ADHD
  • High risk allele:480BP
  • May affect striatal DAT expression
18
Q

What is methylphenidate?

A
  • Blocks DAT, less dopamine reuptake=good short term
  • However long-term exposure causes compensatory inc in DAT-dec treatment efficacy
19
Q

How do gene and environmental factors interact in ADHD?

A
  • Gene polymorphisms and early life adversity lead to Fronto-striatal monoamine dysfunction
  • This leads to dev imapp, hyperactive, impulsive, inatt behaviour, and therefore ADHD.
20
Q

What are medications for ADHD?

A
  • Psychostimulants-bind to DA-transporter(DAT)
    1. Methylphenidate-ritalin(DAT&NAT inhib?)
    2. Dexamphetamine-Dexedrine and adderall
    3. Lis-dexamphetamine-VyVanse
  • Non-stimulants-noradrenaline uptake inhibitors
    1. Atomoxetine-strattera (NAT inhibitor)
21
Q

What are some recently liscenced ADHD treatments?

A
  • Clondine and guanfacine-A2 adrenoreceptor agonists
  • Tricyclic antidepressants -NAT inhib
22
Q

What are some glutametergic targets for ADHD?

A
  • Memantine-NMDA receptor antagonist, imp ADHD symp in patients
  • Fasoracetam-Non-selective mGluR activator
23
Q

Explain ADHD drug action.

Neurobiology of Disease (22 decks)

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