ADHD Flashcards
part of brain most involved in ADHD
prefrontal cortex
when does the prefrontal cortex finish myelination
25
Genetics and ADHD
- Genetic imbalance in dopamine and noradrenergic systems
- Strong genetic influence
Environment and ADHD
- Increased risk with prenatal smoking exposure
- Prematurity, Brain injury, fetal alcohol, lead
- Dietary factors do not play a role in majority of children
when must symptoms of ADHD be present
by 12 years of age
how many symptoms must be present to have ADHD
6/9
criteria symptoms for inattentive ADHD
- careless mistakes
- Difficulty sustaining attention
- Does not seem to listen
- Does not follow through on tasks
- Not organized
- Avoids sustained mental effort
- Loses things
- Is easily distracted
- forgetful
criteria symtpoms for hyperactive/impulsivity ADHD
- Fidgets or squirms
- Inappropriately leaves seat
- inappropriately runs or climbs
- Has difficulty playing quietly
- is “on the go”
- Talks excessively
- Blurts out answers
- Has Difficultly waiting his or her turn
- Interrupts or intrudes on others
time frame for ADHD
present for over 6 months
Comorbidities with ADHD?
- Learning disorder (10-30%)
- Opposition defiant disorder/Conduct disorder
- Anxiety or mood disorder
- Tourette’s and tic disorders
- coordination problems
- substance abuse
- sleep problems
- Triad of psychiatry
- PANDA’s
What is the triad of psychiatry
- ADHD
- Tourette’s syndrome
- OCD
What is PANDA’s
post infectious state that looks like Triad of psychiatry
Primary MOA of stimulants
- block reuptake pump
- increases dopamine and NE
What action does amphetamine have that other stimulants don’t
-cause presynaptic release into synapse
Common side effects of stimulants
- Decreased appetite - give with or after meals
- Difficulty falling asleep
- Tics
- upset stomach . .give with food
- Headaches
Less common side effects of stimulants
- Moodiness or irritability
- Overly quiet “Zombie effect”
- Weight loss
- small decrease in height velocity
- Rebound symptoms as med wears off
- Mild increase in heart rate and BP
- Rare risk of mania or hallucinations
- Priapism . .trazadone
FDA concern about stimlulant use
- don’t use if heart disease, arrhythmia, or FH of arrhythmia
- EEG not needed if carciac hx is negative
MOA of Atomoxetine (straterra)
-selective NE reuptake inhibitor
Atomoxetine is useful in ADHD with what
anxiety or depression
Side effects of Atomoxetine
- Somnolence: can give in evening or divide dose
- Anorexia, GI upset, weight loss - give with food , divide dose
- Dizziness
- Rare risk of liver disease
- Increased risk of suicidal ideation
What are the alpha 2 agonists used to treat ADHD
Clonidine and Guanfacine
describe Clonidine and Guanfacine and how they work
- useful for sleep, tics, aggression, hyperarousal
- not as effective for inattention
- Used as adjunctive
- Work on POST SYNAPTIC ALPHA 2 receptor as agonist
Side effects of The alpha 2 agonists
- Sedation (especially with clonidine)
- Dry mouth
- depression
- low BP
- headache
Withdrawal symptoms of the alpha 2 agonists if suddenly stopped
- high pulse
- BP
- headache
- agitation
Treatment of ADHD with anxiety
- responds to stimulants
- May need to add SSRI
- another option is atomexetine
Treatment of ADHD and tics
- Stimulants and clonidine
- Atomoxetine
Treatment of ADHD and aggression
-Stimulant and clonidine/guanfacine
