ADHD Flashcards
What are the inattention criteria of ADHD?
At least 6 of the following for 6 months:
- Poor attention to detail
- Cannot sustain attention
- Does not listen
- Does not follow through
- Does not organize
- Avoids tasks
- Loses things
- Is distracted
- Is forgetful
What are the hyperactive/impuslive criteria of ADHD?
At least 6 of the following for 6 months:
- Fidgets
- Leaves seat
- Runs/climbs
- Not quiet
- Talks a lot
- Blurts out
- Cannot wait turn
- Interrupts
What persists in adulthood with those who have ADHD?
Generally inattentiveness persists compared to hyperactivity/impulsivity
Etiology of ADHD
- Genetics
- Neuronal/Neurotransmitter abnormalities
- Environmental Factors
- Psych Factors
Describe the continuum of transmitter/receptor complexes and neuronal firing relating to specific psychoses
Low activity results in schizophrenia, MDD, and Negative Syx; Medium Low - ADHD; Medium High - Hypervigilance; High - Psychosis
What part of the brain shows underactivation in a person with ADHD?
Anterior Cingulate Cortex
What neurotransmission is decreased in ADHD?
Decreased NE firing in PFC; Decreased DA firing in PFC
What are ADHD patients primarily misdiagnosed as?
Anxiety disorder
What is the primary strategy for ADHD treatment?
Raise DA and NE activity in the brain
What is the general course of treatment in preschoolers for ADHD?
Behavioral therapy, then amphetamines, then methylphenidate
How are methylphenidate and amphetamine different?
MPH antagonize DAT (reuptake) and to a lesser degree NE reuptake; Amphetamines do this as well but can also reverse pump and release DA excessively into synapse
What is the treatment strategy for children/adolescents?
SR MPH, SR Amphetamines, Immediate Release Amphetamines, Atomoxetine/Clonidine ER/Gaunfacine ER
What is your Tx strategy for adults?
Essentially the reverse of children (addictive ones last): Atomoxetine/Modafinil/Guanfacine ER/Clonidine ER -> SR Amphs -> SR MPH -> IR Stimulants
How do the non-stimulants atomoxetine and guanfacine ER/clonidine ER work?
- Atomoxetine - NET inhibitor
- G/C - Agonize Alpha2 NER - Receptors on glutamate pyramidal neurons (heteroreceptors) and help to improve signal to noise ratio allowing neurons to fire appropriately
Describe the DA/NE Alpha2 agonist theory. How does guaneficine and clonidine work into this theory?
DA opens ion channels allowing to dissipate. Ne closes ino channels increasing signal strength to the neuron. The clonidine/guaneficine may work to improve the signal half of the system
