ADHD

Question 1

ADHD symptoms

Answer 1

1. Problems with concentration, such as making careless mistakes, difficulty remaining focused, and needing to be more focused.
2. Avoid tasks that require sustained mental effort, such as reading a book or completing a long assignment, misplace items, and be messy.
3. Children may fidget, run, or climb when not appropriate, interrupt conversations, or talk excessively about a single topic.
   It’s important to note that while children may exhibit more physical symptoms like fidgeting, running, or climbing inappropriately, adults may present with more internal restlessness than physical impulsivity.

Question 2

ADHD Assessment

Answer 2

1. The nurse may notice high-level fidgeting activity in the child & behaviors.
2. Teachers may notice difficulty paying attention, disruptive behavior, and inconsistent or messy assignments.
3. School nurses may see students in their office repeatedly d/t disruptive behaviors and minor injuries for impulsive behaviors.

Question 3

ADHD Diagnosis

Answer 3

–Teacher & School psychologists may recommend eval for dx.
–PCP may dx & tx uncomplicated ADHD.
- If symptoms worsen, a referral to a Psychiatric Nurse Practitioner or Child Psychiatrist is recommended.
- Questionnaires and the VANDERBILT ASSESSMENT SCALES are used to identify children with ADHD and measure treatment progress.

Question 4

ADHD: Implementation

Answer 4

Interventions:
1. Behavior Modification therapy
2. Parent training
3. School accommodations
4. Pharmacologic agents that address Inattention & hyperactive & impulsive behaviors.

Question 5

CNS Stimulants

Answer 5

1. ^ The activity of CNS neurons
2. Enhance neuronal excitation; a few suppress neuronal inhibition.
3. In sufficient doses, all can cause seizures.
4. Limited clinical applications.

Question 6

CNS Stimulants (ADHD tx)

Answer 6

1. Amphetamines
2. Methylphenidate & Dexmethylphenidate
3. Methylxanthines
4. Miscellaneous stimulants

Question 7

Amphetamines-mechanism of action

Answer 7

1. Release norepinephrine
2. Release dopamine

Question 8

Amphetamines Pharmacologic effects

Answer 8

-CNS
-Cardiovascular system

Question 9

Amphetamines Tolerance

Answer 9

With regular use, tolerance develops to elevation of mood, suppression of appetite, and stimulation of heart and blood vessels.

Question 10

Amphetamines Physical dependence

Answer 10

Abstinence syndrome with abrupt withdrawal.

Question 11

Amphetamine Abuse

Answer 11

High potential for abuse due to Euphoria.

Question 12

Amphetamines Adverse effects

Answer 12

1. CNS stimulation
2. Wt loss
3. Cardiovascular effects
4. Psychosis

Question 13

Amphetamines (Acute Toxicity)

Answer 13

-Dizziness
-confusion
- hallucinations
-paranoid delusions
-palpitations-
dysrhythmias
-HTN
-Death is rare
-Fatal overdose: Convulsions, coma, and cerebral hemorrhage

Question 14

Amphetamine Treatment

Answer 14

Hallucinations: Chlorpromazine

HTN: Alpha adrenergic blocker(Phentolamine); Chlorpromazine helps lower BP

Seizures: Diazepam

Acidifying the urine can accelerate Amphetamine excretion.

Question 15

Amphetamines (therapeutic uses)

Answer 15

ADHD

Narcolepsy

Question 16

Methylphenidate (Ritalin, Metadate, Methylin, Concerta, Daytrana, Biphentin) tx for?

Answer 16

ADHD & Narcolepsy

Question 17

ADHD symptoms arise from?

Answer 17

Symptoms arise in part from abnormalities in various circuits involving the prefrontal cortex.

Question 18

Dorsolateral prefrontal cortex (ADHD)-matching symptoms to circuits

Answer 18

-Problems with sustained attention are linked to inefficient information processing in DLPFC.
-Inactivation of DLPFC can lead to difficulty following through or finishing tasks, disorganization, and trouble sustaining mental effort.
-Tests like n-back are used to measure sustained attention and problem-solving abilities. Participants look at a number on a screen and press a button to indicate the number. Higher n values are correlated with increased difficulty in the test.

Question 19

Dorsal Anterior Cingulate Cortex (dACC) ADHD-matching symptoms to circuits

Answer 19

-Problems with selective attention are believed to be linked to inefficient information processing in dACC.
-Inefficient activation of dACC can result in symptoms such as paying little attention to detail, making careless mistakes, not listening, losing, being distracted, and forgetting things.
-Stroop task: An example test requires participants to name the color with which a word is written. If a blue name is written in orange, the color would be orange, not blue.

Question 20

Prefrontal motor cortex (ADHD) matching symptoms to circuits

Answer 20

-The prefrontal motor cortex may modulate hyperactivity.
-Common symptoms of hyperactivity in children with ADHD include fidgeting, leaving one’s seat, running/climbing, being constantly on the go, and having trouble playing quietly.

Question 21

The orbitofrontal cortex (ADHD)-matching symptoms to circuit

Answer 21

-Impulsivity may be modulated by the orbitofrontal cortex (OFC).
-Examples of impulsive symptoms in ADHD include talking excessively, blurting things out, not waiting one’s turn, and interrupting.