ADHD Flashcards
Describe some adolescent changes in brain development?
- Pre-frontal cortex matures and logic and inhibiting inappropriate behaviour comes into play instead of relaying on emotions to make decisions.
- Neuronal growth occurs before puberty. After this synaptic pruining occur to eliminate unused axons to strengthen neurocircuitary.
- Myelination occurs to optimise communication. Begins at the back to the front so pre-frontal cortex is last.
What is neuroplasticity?
Ability to make new connections.
High in adolesence.
Allows new talents and skills to be developed more easily.
Describe adolescent changes in neurotransmitters?
Dopamine decreases = mood swings, difficulty regulating emotions.
Seratonin decreases = anxiety, decreased impulse control.
Melatonin is released later = affects carcadian rhythm and sleep cycles.
What is Attention Deficit Hyperactivity Disorder?
A group of behavioural symptoms that include;
Inattentiveness - short attention span
Hyperactivity - constant restlessness
Impulsiveness - acting without forethought.
What clinical features are seen in ADHD?
Hyperactive since before 7 years old
Excessive for childs age and development
Pervasive - evident in more than one environment
Significant impairment in school or work
Symptoms for over 6 months
May worsen in the afternoon
List comorbidities often found in ADHD?
Sleep disorders Learning difficulties - OCD/ODD Communication problems Anxiety Mood problems Tourettes or tics.
List examples of susceptibility genes for ADHD?
DRD5 - dopamine receptor gene
DAT1 - Dopamine transporter gene
5HTT - serotonin transporter gene associated with emotional volatility.
Describe brain changes seen in the ADHD population?
smaller brain by 3%
Smaller basal ganglia
frontal and parietal cortex affected
Smaller cerebellar vermis
How is ADHD Diagnosed?
Speak to parents and school and do Conners structured questionairre.
Ask about the pregnancy - e.g. any alcohol, drugs, smoking.
Check medical history and family history for seizures, cardiac events, head injury, hearing problems, faints, medication.
Check if any current stressors on the family.
Observe them at school.
Additional tests: Hearing, vision, ECG, baseline height and weight, baseline BP and heart sounds.
How is ADHD managed in mild/moderate/severe?
Pre-school children or mild ADHD get behavioural therapy.
Moderate/severe ADHD get medications and behavioural therapy.
Describe behavioural therapy in ADHD?
Environment management: No distraction, calm, maintain supervision.
Behaviour Training Programmes: Teach parents to be firm, use routine, countdowns, reminders, have clear rules, timeouts, reinforce good behaviour, and support for parents.
Behaviour Management: Gain attention before giving instructions, be clear, get child to repeat instructions back, plan for problem situations, improve concentration skills using things the child likes.
Describe first line drug treatment of ADHD?
Psyhchostimulants
- Methylphenidate: Blocks dopamine reuptake.
- Dexamphetamine: Releases dopamine in pre-synaptic vesicles and blocks dopamine reuptake transporter.
- Elvanse: Is a prodrug of dexamphetamine tha is taken orally for a sustained release.
Have a rapid onset and notice a difference within days.
Side Effects: decrease appetite so can inhibit growth, sleep problems.
Describe 2nd line drug treatment of ADHD?
Atomoxetine
Inhibits NA reuptake in the prefrontal cortex. Builds up in system so its there 24h a day.
Takes 4 weeks to build up to an adequate level and cause effect.
Has less effect on appetite and sleep, but mood swings, increased HR and BP, suicidal ideation, nausea.
Describe 3rd line drug treatments of ADHD?
Clonidine and Guanfacine: alpha-2 adrenergic receptor agonist. Increases NA in the pre-frontal cortex.
Clonidine is immediate release and guanfacine is sustained release.
Takes 4-6 weeks to work, causes sedation, dizziness, hypotension.
Antidepressents, modafinil.
Why must you check other medication before prescribing clonidine and guanfacine?
AS they are a CYP 3A4 substrate which is an enzyme often manipulated by other meds.
