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PSYCHIATRY > ADHD > Flashcards

ADHD Flashcards

1
Q

What is the triad of difficulties found in ADHD?

A

Inattention
Hyperactivity
Impulsivity

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2
Q

From what age do symptoms of ADHD tend to appear?

A

Age 5 (may not necessarily be diagnosed at this age)

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3
Q

ADHD can occur in one setting and not in others. e.g. can occur at school, but not at home. TRUE/FALSE?

A

FALSE

must be across ALL settings

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4
Q

How do symptoms of ADHD in adults differ fromt hat ni children?

A

Adults = less obvious symptoms of hyperactivity/ impulsivity

They possess more inattentive symptoms

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5
Q

Is ADHD thought to be over or under diagnosed in the UK?

A

Underdiagnosed and undertreated

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6
Q

Children who are brought to clinic by their parents often do not recognise that there is a problem with their behaviour. TRUE/FALSE?

A

TRUE

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7
Q

How can ADHD impact someones childhood?

A
  • Parenting difficulties => increased level of home stress
  • Relationship difficulties with peers
  • Reckless behaviour
  • Inappropriate decision making due to poor problem solving ability
  • Barrier to learning/ potential exclusion from school
  • Higher likelihood of antisocial behaviours
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8
Q

How can ADHD impact an adults life if they have not been diagnosed/treated?

A
  • increase in psychiatric comorbidity
  • Higher levels of criminality, antisocial behaviour
  • Higher level of substance misuse
  • Impairments in occupational function that could easily be accommodated
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9
Q

What social factors suffer when ADHD goes undiagnosed and untreated?

A
  • Family => parental divorce/separation, early parenthood
  • Society => Substance use, Less likely to quit smoking
  • Work => ↓ productivity
  • Healthcare => increase in accidents and ER visits
  • School => suspended/ drop out
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10
Q

Why do adults present with residual ADHD features but not enough for a diagnosis?

A

They “grow out of it”

  • Improvement in cortical thickness (maturation)
    => allows brain to compensate for cognitive deficits e.g. impulses can be regulated better
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11
Q

Does ADHD have a genetic component?

A

Yes research found hyperactivity tends to aggregate in families
=> “familial clustering”

increased risk (60%) if patient is offspring of adults with ADHD

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12
Q

What neurotransmitter genes are involved in ADHD?

A

Dopamine and serotonin transporter genes are involved

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13
Q

Why is the ADHD reviewal clinic badly attended?

A

Parents of children with ADHD potentially have hyperactive/ inattentive traits
=> forget their child must attend the appointment

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14
Q

What peri-natal factors may increase the risk of a child developing ADHD?

A
  • tobacco/alcohol/ illicit drug use during pregnancy

- prematurity and perinatal hypoxia

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15
Q

What other perinatal complications can cause presentations like ADHD?

A
  • unusually short or long labour
  • foetal distress
  • low forceps delivery
  • eclampsia
  • Exposure to viral infection during first trimester?
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16
Q

Do any parenting styles particularly increase the risk of ADHD?

A

Not any particular one BUT there can be an issue if parents have conflicting parenting styles
i.e. one is very disciplined whilst the other is not

17
Q

What social situations in childhood can potentially increase the risk of someone developing ADHD?

A
  • parental divorce/separation
  • low social class
  • large family size
  • paternal criminality
  • maternal mental disorder
  • maltreatment / emotional trauma
18
Q

What area of the brain is shown to be dysfunctioning in ADHD, and what is this area responsible for?

A

FRONTAL LOBE

  • Reasoning and Planning
  • Impulse control
  • Judgement
  • Initiation of actions
  • Social/Sexual behaviour
  • Long term memory
19
Q

Explain the neurochemistry of ADHD and why dopamine is involved?

A
  • excessively efficient dopamine-removal system (higher concentration of dopamine transporters)
    => Less dopamine in reward pathway
    => less rewards found in normal behaviour
    => inattention to one task, need to keep swapping for reward
    OR use risky behaviour to get dopamine reward
20
Q

What other neurotransmitters are decreased in ADHD?

A

Noradrenaline => can affect attention

Serotonin => can affect mood/ behaviour/sleep/memory

21
Q

How is a presentation of presumed ADHD in a child usually assessed?

A
  • school observation
  • Screening questionnaires
  • Background information regarding risk factors, developmental hx and family hx
22
Q

How is a new presentation of presumed ADHD in an adult usually assessed?

A
  • Historical concerns about behaviour
  • Specific adult screening tools used
  • Clinical picture consistent with symptoms of ADHD both NOW and BEFORE (not just historical difficulties)
  • Cognitive difficulties/ ability to function evaluated for impairment
  • Comorbidities?
23
Q

What is the diagnostic criteria for ADHD in a child?

A
  • 6 or more symptoms of inattentiveness AND/OR
  • 6 or more symptoms of hyperactivity/impulsivity
  • Present before age 5y
  • Reported by parents, school and seen in clinic (across all situations)
24
Q

What is the usual diagnostic criteria for ADHD in adults?

A
  • 5 or more symptoms of inattentiveness AND/OR
  • 5 or more hyperactivity and impulsiveness symptoms
  • Historical concerns since early age
25
Q

Adults must have an impairment of function to be diagnosed with the disorder. WHat tasks may be impaired?

A
  • underachieving at work/ education
  • driving dangerously
  • difficulty making/keeping friends
  • difficulty in relationships with partners
26
Q

What psychosocial interventions may be used in addition to pharmacological treatment in ADHD?

A

Parent training
Social skills training
Behavioural classroom management strategies

27
Q

List the 1st to 4th line pharmacological interventions for ADHD?

A

1st Line = Stimulants e.g. methylphenidate
2nd Line = SNRI e.g. Atomoxetine
3rd Line = Alpha agonist e.g. Clonidine
4th Line = Antidepressants e.g. imipramine/ Antipsychotics e.g. risperidone

28
Q

How do stimulant treatments for ADHD work?

A
  • increase dopamine by blocking its transporter

- Dexamphetamine also increases extracellular noradrenaline andpossibly serotonin

29
Q

What is the number needed to treat for stimulants in ADHD? And is this good or bad?

A

NNT = 4
=> for every 4 children given stimulant treatment, one will show improvement

=> this is a GOOD NNT

PSYCHIATRY (35 decks)

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