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spectrum disorders > ADHD > Flashcards

ADHD Flashcards

1
Q

3 main symptoms of adhd

A

inatentiveness, (impulsivity, hyperactivity) - usually cluster together

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2
Q

Diagnostic Tests

A

ICD-11 international classifiaction of mental and behavioural disorders 11th
DSM-V (broadly used) diagnostic and statistical manual of mental disorders 5th edition

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3
Q

Innatention

A

significant difficulty in sustaining attention to tasks that do not provide high level of stimulation or frequent rewards, easily distracted and problems woth organisation

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4
Q

Hyperactivity

A

excessive motor activity and difficulty remaining still, most evident in structured situations that require behavioural self control

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5
Q

impulsivity

A

tendency to act in response to immediate stimuli without deliberation or consideration of the risks and consequences

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6
Q

Why can’t ADHD be considered a catergorical diagnosis

A
  • symptoms can overlap with other related disorders
    -in children - mood,conduct, learning disorders, motor control,anxiety disorders
    -in adults - personality disorders bipolar, OCD, substance misuse
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7
Q

Diagnostic criteria ICD-11

A

Inattention, impulsivity, overactivity must all be present from early age, persist in ore than one setting, and impair social function, learning, and normal development

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8
Q

inattentive symptoms

A
  • fails to have attention to details
    -difficulty keeping attention during tasks
    -does not seem to listen when speaking to them
    -no follow through on tasks
    -often loses things and is forgetful
    -easily distracted
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9
Q

Hyperactivity symptoms

A

-fidgets/squirms
-cant sit still
runs/climbs in innapropriate situations
-difficulty playing quietly
-often “on the go”

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10
Q

impulsivity symptoms

A

-blurts out answers before question is finished
-difficulty awaiting turn
- interupts or intrudes

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11
Q

what % of children are diagnosed with ADHD

A

Very common to see in practise, 6% of all children are diagnosed with ADHD and is 30-50% of all child mental health cases

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12
Q

People with _____ are more likely to have ADHD

A
  • born preterm
    -children in care
    -those with conduct disorders, ODD, Mood disorders
    -close family with ADHD
    -epilepsy
    -neurodevelopment disorders eg autism
  • adukts with mental health conditions
    -substance misuse
    -people who have been involved in crime/ gone to prison
    -brain injuries
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13
Q

why is ADHD underrecognised in girls?

A

usually misdiagnosed with other mental health disorders

girls less likely to be referred

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14
Q

What type of condition is ADHD

A

chronic

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15
Q

Initial managemnt of ADHD

A

extensive and comprehensive mental helath assessment by a specialist clinician
AND
full assessemnt by educational and/or clinical psychologist

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16
Q

onset of ADHD

A

-usually before 3 years old
- atleast 6 months of aladaptive level
-clinically severe in atleast 2 different settings

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17
Q

1st line treatment - Non pharmaceutical intervention

A

-education and advice
-parent training / family centered therapy
- Behavioural interventions (school/preschool)

18
Q

Why is it hard to have medications for syndromal control rather than just managing symptoms?

A

-experiemental studies are difficult both ethically and practically

19
Q

why are most drugs used off -license

A

pharma’kinetics pharma’dynamics extrapolated from adults only
- must openly disucss with parents/carers
-must obtain INFORMED consent

20
Q

Why are adult drugs not hazardous towards children

A
  • decreases bioavailability as children have greater metabolism
  • greater distrubution as relatively larger extracellular fluid
    -can cross BBB rapidly
21
Q

how should medication dosages be prescribed

A

mg/kg to reflect adult/child differences

22
Q

ideal properties of ADHD medication

A
  • long duration of action
  • not addictive
  • easy administration
  • no affect on appetite
  • rapid onset of action
    -effective in treating symptoms
  • dissipates rapidly as to not induce insomnia
23
Q

what criteria does the patient need to meet to be able to initiate medication?

A
  • they continue to meet criteria for ADHD and need treatment
    -presence of co-existing health and social circumstances
    -current educational and or employment circumstances
    -risk assessment for substance abuse
    -care needs

plus baseline physicals test (see monitoring requirements)

24
Q

1st line treatment for children aged 5 and over

A

Methylphenidate (not licensed in children under 6) if after 6 week trial does not show desired benefit you can switch

25
Q

methylphenidate MoA

A

inhibits uptake of monamines into presynaptic neurone, thereby increasing dopamine hit at presynaptic receptor sites

26
Q

methylphenidate dosing regime

A

5-10mg OD/BD, increase weekly by 5-10mg until reach 60mg, if no response after 1 month decrement dose and stop

concerta XL 18,36mg tablets

stimulants usually withdrawn during or after puberty

27
Q

methylphenidate adverse affects

A

insomnia, decreases appetite, euphoria,depression/anxiety, in rare cases : psychosis, hepatic dysfunction

28
Q

2nd line treatment

A

lisdexamfetamine - >=6yrs
dexamfetamine - >=3yrs

29
Q

(lis)dexamfetamine MoA

A

amfetamines are non-catecholamine sympathomimetic amines (mimics sympathetic nervous system) with CNS stimulant acitivity

thought to block the reuptake of norepinephrine and dopamine into presynaptic neurones and increase release of monaines into extra-neuronal space.

30
Q

lidexamfetamine dosing

A

-individualised according to therapeutoc needs and response to patient

  • initially start on 30mg OM some start on 20mg OM
  • can increase 10-20mg weekly

-should take the lowest most effective dose max 70mg per day

31
Q

dexamfetamine dosing

A

start at lowest possible dose - 5mg OD/BD
-increase by 5mg weekly only if necessary
-tolerability and efficacy should be observed

max dose is 20mg in some speicialist circumstances upto 40mg

should be taken when most needed (eg combat school/social behavioural needs)

usually AM and lunchtime as later in the day can cause sleep disturbance

32
Q

atomoxetine MoA and dosing

A

highly slective inhibitor of the pre synaptic noradrenaline transporter, minimal effect on sertonogernic or doperminergic transporters

0.5mg/kg

children <70kg - after 7 days 1.2mg/kg

children >70kg - 40mg and after 7 days 80mg maintenance dose

adults - 40mg 7 days then 80-120mg maintenance

33
Q

guanfacine MoA

A

selective alpha2A-adrenergic receptor agonist

non stimulant - modulates pfc and bg signalling through direct modification of synaptic noradrenline transmission at alpha 2 adrenergic receptors

antihypertensive - reduces sympathetic nerve impulses from vasomoter centre to the heart and blood vessels = lower vasucular resistance, blood pressure, heart rate

34
Q

guanfacine dosing

A

dose titration and monitoring is neccassary - patients shoul be advised about this particularly at initiation of treatment

somolence and sedation are clinically significant or persistant decrease dose or discontinue

side affects : syncope, hypotension, bradychardia, somolence, sedation

sustained orthostatic hypotension or fainting episodes reduce/switch medication

35
Q

monitoring of ADHD drugs

A
  • monitor effectiveness of medication and side affects
    -patient should monitor their own side affects
    -use rating scales MADRS YMRS
    -regular reviews regardless of on medication or not
    -height and weight

-heart monitoring (comparisons to normal range) before and after each dose change and every 6 months

if tachychardic, arrythmias or systolic BP >95th percentile measured on 2 occasions - reduce dose and refer to paed hypertension specialist

  • sleep- use sleep diary
    -sexual dysfunctunction (switch to amoxetine)
    -epilepsy (stop review gradual re-intro)
    -worsening behavior
36
Q

how often should height and weight be monitored

A

height every 6 months
weight every 3 months (<=10yrs)
every 6 months (>10yrs)

should be plotted on a growth chart

37
Q

what should you do if patient develops Tics from stimulants

A

switch to guanfacine ,amoxetine or clomidine

38
Q

other medications that can be used

A

TCAs (imipramine)
Clomidine
Rispiredone
buprioprion
modafinel

39
Q

what %of parents with ADHD have children with it

A

40-60

40
Q

what % of children with ADHD have a parent with it

A

25%

spectrum disorders (2 decks)

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