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Pathophysiology > ADHD > Flashcards

ADHD Flashcards

1
Q

Describe ADHD

A
  • inattention
  • distractibility
  • impulsivity
  • hyperactivity
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2
Q

What is the minimum time requirement that one must show these symptoms for before being diagnosed with ADHD ??

A

6 months

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3
Q

Is a quick initiation of medication a good or bad idea when referring to ADHD patients?

A

BAD

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4
Q

What is associated with ADHD?

A
  • more injuries
  • lower grades
  • lower driving record
  • increased drug abuse
  • more antisocial
  • decreased job performance and status
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5
Q

What comorbidities are common with ADHD?

A
  • tourette’s disorder
  • learning disability
  • oppositional or conduct disorder
  • anxiety
  • depression
  • enuresis (involuntary urination)
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6
Q

What two types of symptoms exist in ADHD?

A
  1. inattentive

2. hyperactive

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7
Q

Describe the inattentive symptoms

A
  • distractibility
  • forgetfulness
  • poor organization
  • impersistence
  • mistake-prone
  • work avoidance
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8
Q

Describe the hyperactive symptoms

A
  • fidgetiness
  • intrusiveness
  • restlessness
  • noisiness
  • talkativeness
  • inappropriate activity
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9
Q

What are percentages of remission for this disease (percent of how many people will get rid of these symptoms)

A

from ages 12-20: 20% will remit, 60% will partially remit

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10
Q

What symptoms go away first?

A

The hyperactive symptoms go away first. The inattentive symptoms usually follow, but not always.

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11
Q

How many kids have ADHD? (according to US stats)

A

8%

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12
Q

How many adults have ADHD? (according to US stats)

A

3-5%

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13
Q

Describe the etiology (origination) of this disease

A
  • genetics
  • right sided hypofrontality
  • locus ceruleus “underperforms”
  • fall birthdays (this is questionable)
  • worsened by stressors
  • more evident in routinized setting (School)
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14
Q

Describe the neuropathology and neuroimaging involved with this disease.

A
  • small increase in cerebrum growth (10%) at 1-3 yrs
  • reduced numbers of cerebellar purkinje neurons (30%)
  • reduced cell size and increased cell density in the limbic areas of the brain
  • modified genes/proteins impairing the balance of excitatory vs. inhibitory synaptic singling in local and extended circuits
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15
Q

What is the risk associated with first degree relatives?

A

4-8X

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16
Q

What increases a person’s risk of developing ADHD?

A
  • FAS (fetal alcohol syndrome)
  • lead poisoning
  • infantile meningits
  • obstetric adversity
  • maternal smoking
  • adverse or absent parent-child relationship
17
Q

What are triggers associated with ADHD?

A
  • artificial colors, flavours, or additives
  • refined sugar, sodas, caffeine
  • food allergy or intolerance
  • increased use in advanced technology (more video games, movies, screen time)
  • essential fatty acid deficiency
  • iron and zinc deficiency
18
Q

Describe the “multimodal” approach to treating ADHD

A
  • avoid triggers if known
  • chiropractic approach
  • when meds are needed use a combination treatment (drugs without support = low success rate)
  • behavioral - parent, family, classroom, (structures, checklists, attainable goals)
19
Q

List some treatment goals for patients with ADHD

A
  • make sure they are realistic, achievable, and measurable
  • may include relationship factors, academic performance, rule following
  • clarity, immediacy, predictability, consistency, responsibility - VITAL
20
Q

What is arousal dysregulation ?

A

-insufficient alertness alternating with overarousal

21
Q

What are the main neurochemical targets associated with ADHD drug treatment?

A
  • noradrenergic tracts
  • dopaminergic tracts
  • *these are both underperforming in patients with ADHD

Stimulants which augment both of these systems are considered 1st line treatment!!

22
Q

regulated arousal = ?

A

improved perfomance

23
Q

increased control = ?

A

reduced hyperactivity and/or aggression

24
Q

What are possible psychostimulants that could be used in ADHD?

A
  • methylphenidate (ritalin, adderall, biphentin)

- amphetamines

25
Q

How do psychostimulants help patients with ADHD?

A
  • all block norepinephrine and dopamine reuptake
  • the increases NE/DA activity in locus ceruleus improves attention, ability to focus or select
  • amphetamines also promote DA and NE release from presynaptic neutrons
    • by blocking reuptake we increase the activity of the neurotransmission
26
Q

What are some adverse effects associated with stimulants?

A
  • decrease appetite
  • increase BP, anxiety, irritability, difficulty falling asleep, stomach complaints, headache
  • MAY WORSEN TICS ? - what are TICs…(ex. tourette’s disease)
  • can flatten personality or elevate risk of sudden cardiac death
27
Q

Describe an alternative such as atomoxetine.

A
  • enhances the activity of norepinephrine by inhibiting the reuptake from the synapse, with minimal direct effect on Dopamine
  • slower onset
  • no abuse potential
  • expensive
28
Q

Describe the alternative bupropion.

A
  • weak DA(dopamine) and NE reuptake inhibitor
  • primarily used as an antidepressant or an aid in smoking cessation
  • augments DA and NE, has shown value for some persons with ADHD
  • less appetite effects than with stimulants
  • no abuse potential!!
29
Q

What are important points involving dose adjustment?

A

-doses may need to be changed with growth, with symptoms or which changing adverse effects

30
Q

What are drug holidays? Are they good or bad in ADHD patients?

A
  • drug holidays are when patients stop their medication for a certain period of time.
  • they are good for ADHD patients and highly recommended to reassess treatment and allow for growth rebound

Pathophysiology (15 decks)

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