ADHD Flashcards
How is ADHD different in the DSMV as compared to the DSMIV?
Must start before age 12 (not age 8), Must occur in multiple settings, Must cause social disability
How many symptoms of inattention must be present? For how long? How many for hyperactive/impulsive symptoms? For how long? Use combinations to define the disease subclasses.
6 inattention symptoms for 6 month. 6 hyperactive/impulsive symptoms for 6 months. ADHD combined: 6 of each. ADHD inattentive: 6 inattention symptoms, <6 inattentive symptoms.
What are the inattention symptoms?
Forgetful, avoids tasks/sustained mental effort, Distracted, Cannot sustain attention, Loses things, Poor attention to detail leading to mistakes, Does not listen, Does not follow through, Does not organize tasks/activities
What are the hyperactive/impulsive symptoms?
Runs/Climbs Inappropriately, Interrupts, “Blurts out,” Cannot wait turn, Not quiet (cannot play quietly), Talks excessively, Leaves seat, Acts as if motor-driven, Fidgets
When/how is ADHD noticed? What is the course?
Most apparent at young age when age appropriate norms for paying attention & delaying gratification are not met. Milder cases may not be noticed until later when demands increase. Inattentive persists greater than hyperactivity.
Is ADHD inheritable? What systems are involved? What is DA doing?
Largely inheritable (76%). Chromosome 16. DA system deficient. Ne system deficient. 5HT involved. Neurotransmission/neuronal plasticity deficient. DA is too low on the “inverted U-shaped curve.”
Area of the brain that is “cold” in ADHD patients?
Anterior Cingulate
What is the most commonly associated condition with ADHD?
Anxiety Disorder
What class of drugs is generally used to treat ADHD? What is the MOA, and what are general side effects?
Stimulants (Amphetamines & Methylphenidate) – Promote DA & NE activity. Amphetamines block DAT, reverse DAT, and increase VMATe. Methylphenidate blocks DAT. Side effects: Risk of addiction, paranoia, stunt growth, weight loss, cardiac issues (?)
What is atomexetine?
NE Reuptake Inhibitor
What are Guanfacine ER & Clonidine ER? How do they help treat ADHD?
Alpha-2 Adrenergic (NE) Agonists. NE Alpha-2 receptors are located on glutamate pyramidal neurons in the frontal cortex, and binidng here closes ion channels, increasing signal strength, and allows neurons to fire appropriately when faced with multiple environmental stimuli. This is a “fine-tuning” effect and increases the signal-noise ratio when used in combination with a DA agonist that will open channel and allow noise to dissipate.
Treatment protocol for preschoolers?
Behavioral therapy –> Amphetamines –> Methylphenidate (only Amphetamines are approved in preschool ADHD)
Treatment protocol in children & adolescents?
Slow Release Methylphenidate –> Slow Release Amphetamines –> Immediate Release Stimulants –> Non-Stimulants (Clonidine ER, Guanfacine ER, Atomoxetine)
Treatment protocol in adults?
Non-Stimulants (Atomoxetine, Guanfacine ER?, Clonidine ER?, Modafinil?) –> Slow Release Amphetamines –> Slow Release MPH –> Immediate Release Stimulants
