ADHD Flashcards
What are the 3 components of ADHD?
Inattention
Impulsivity (not having success socially)
Hyperactivity
Which one of the 3 components tends to persist in adulthood?
Inattentive
Which of the 3 components is most present in preschool/elementary?
Hyperactivity
Which of the 3 components is most common in girls?
Inattentive
What is occurring physiologically in ADHD?
increased reuptake of dopamine
When doing a ROS, what do we need to ask about?
Can they see the board? = eyes
Sleep apnea = pulm
R/O absence seizure = neuro
R/O Anxiety & Depression = psych
Heme = Anemia/Toxic exposure (lead, fetal ETOH)
What are some of the comorbid disorders associated with ADHD?
Learning disabilities, oppositional defiant disorder, anxiety, depressive, or bipolar
What screening tools can you use when diagnosing ADHD?
Vanderbilt scale & Connors’ rating scale
How do you treat ADHD?
Stimulants (Methylphenidate or Amphetamine products)
Meth lasts 4 hours
Adderall lasts 6 hours
Should have 80% improvement with a single stimulant
Don’t forget behavioral treatment! We are MANAGING this disorder, not curing it
How do ADHD meds work?
Inhibit reuptake of NE & DA (causing increased release of presynaptic NE/DA)
What are some of the S/E of stimulants?
Insomnias, weight loss/decreased appetite, HA, tics!
What are the 3 P’s of tics that are triggers for being concerned?
Pain;
Personality (child is teased & ashamed); Performance (like they can’t write well.
How do you diagnose PTSD?
Traumatic Re-experiencing (flashbacks), Avoidance, and Increased states of arousal
What’s one of the significant symptoms associated with depression?
Lack of interest in things that previously interested them
What are the classic sxs of depression?
SIGECAPS Sleep, Interests, Guilt (hopelessness), Energy, Concentration, Appetite, Psychomotor depression, Suicidal
So does everyone with concentration issues have depression?
No, concentration problems ALL THE TIME = ADHD
Concentration problems happen at a certain time = Depression
What are the components of a major depressive episode?
5 or more of the SIGECAPS
With MARKED functional impairment
How do depressed sxs present in adults vs. youth?
Irritable or cranky, identification with songs or death = Youth
Depressed mood most of the day = Adults
How do MAJOR depression symptoms present in adults vs. youth?
Youth = Loss of interest in sports, video games, and activities. Often complaining of stomach aches, or just focus on fun things (sport, games, etc). Refusal to awake for school. Persistent boredom, increased risk taking behavior. Aggression or suicidal (rather than guilt in adult). Decline in school performance. Anorexia/Bulimia.
When we have someone with depression, what do we need to keep on our differentials?
Grief/bereavement; substance abuse; traumatic stress; medical – hypothyroidism, anemia, sleep apnea
If a child is depressed, what percentage will attempt a suicide?
50% (boys die by suicide 4x as often as girls; but girls attempt more)
2-3% will actually kill themselves
What are the 2 key risk factors for suicide?
- Presence of 1+ diagnosable mental disorders (depression) occurring alone or co-morbid like alcohol or drug use
- Prior suicide attempt
What meds can we use in kids to treat depression?
Fluoxetine & Escitralopram
What meds can you use in kids to treat OCD?
Fluoxetine, sertraline, fluvoxamine, and clomipramine
What’s the black box warning with antidepressants (aka SSRI’s)?
Suicide!! So need to follow-up every week for the first 4 weeks
What is the single most predictive risk factor of depression?
Genetic family loading
How long must you try antidepressants?
6 weeks
If a person is responsive to antidepressants, how long should you keep them on for?
4-6 months minimum
What is best in combination for treating depression?
CBT
How many patients will you treat with an SSRI for depression in order to improve one patient?
10! Thus you might need to try a different anti-depressant or increase the dose
If the patient is getting worse, remember, it’s NOT the med
What are the 2 biggest mistakes you can make with anti-depressants?
They don’t try them long enough
Would need to increase the dose after 6 weeks
