ADHD

Question 1

ADHD: Mulitiple Possible Etiologies

Answer 1

CNS dysregulation

Head injury

Genes: 50% heritability

Environmental: Lead intoxication, poor nutrition

Question 2

ADHD: Course

Answer 2

Symptoms persist into adolescence and adulthood for majority of patients

Hyperactivity decreases first, then impulsivity

Inattentiveness symptoms are most chronic

Question 3

ADHD: Incidence, considerations

Answer 3

4.4 million (as of 2003)
50% on medication

Is the number of cases actually on the rise?

More sensitive during initial screening?

Have we loosened the diagnostic criteria?
*Probably not: DSM-5 requires symptoms to be present in multiple environments

Question 4

ADHD: real life consequences

Answer 4

Increased rates of:

Divorce

Arrest

Recreational drug use
*Non-medicated ADHD more likely to self-medicate later in life

High school dropout

Unemployment

Question 5

ADHD: Neurochemistry

Answer 5

ADHD is linked to sub-performance of DA and NE (catecholemines) in the prefrontal cortex

Medications for ADHD are either dopaminergic or noradrenergic

Question 6

ADHD Cognitive deficits: Self-regulatory functioning

Answer 6

Inhibition

Motivation

Memory

Question 7

Psychostimulants, general

Answer 7

Increase DA and NE in prefrontal cortex to improve self-regulatory and executive functioning

“Increase signal, decrease noise”

Therapeutic effects only present when quantity of drug is increasing in the blood

Question 8

Signal vs Noise

Answer 8

NE Increases signal detection

DA Increases ability to filter out extraneous stimuli

Question 9

Psychostimulant Half-life development

Answer 9

In the past, stimulants used to have very short half-lives

Slowed, or timed, releases now possible due to salts or osmosis in the pills

Altered pill coatings can provide small immediate release while rest of pill metabolizes more slowly

e.g. Adderall XR consists of tiny individual beads which metabolize at different rates

Question 10

ADHD Tx: 3 Classes of Drugs

Answer 10

1. Amphetamines
2. Methylphenidates
3. Non-stimulants

No class is more effective than another–individual response variability

Best treatment = psychostimulants + CBT

Question 11

Amphetamines

Answer 11

Increase DA and NE

Adderall

Dexedrine

Vyvanse
*decreased abuse potential

Question 12

Methylphenidates

Answer 12

Inhibit DA and NE reuptake

Ritalin

Concerta

Daytrana (transdermal patch)

Question 13

Non-stimulants

Answer 13

Atomoxetine (Strattera)

Guanfacine (Intuniv)

Question 14

Aversive Effects of Stimulants

Answer 14

Rebound effect

Insomnia, Headache, Irritability

Decreased appetite–stunted growth

Cardiac toxicity

Development of tics

Question 15

Rebound effect

Answer 15

Discontinuation results in increased ADHD symptoms
*worse than sx levels prior to pharmacotx

Rebound effect naturally decreases overtime

Question 16

ADHD Cognitive deficits: Executive functioning

Answer 16

Organizing

Reasoning

Planning

Problem solving

Question 17

ADHD dx in childhood associated with increased risk for later development of…

Answer 17

Bipolar Disorder

Depression

Substance abuse

Panic disorder

Question 18

Psychostimulant Side Effects: preliminary consideration

Answer 18

Same/Similar symptoms may already be high prior to initiation of stimulant

*Measure baseline for accurate assessment of sfx

Question 19

Amphetamines: Vyvanse’s unique characteristic

Answer 19

Prevents abuse potential of nasal absorption

Must be digested