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Psychiatry > ADHD > Flashcards

ADHD Flashcards

1
Q

What are the triad of difficulties on ADHD?

A

Inattention, hyperactivity, impulsivity

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2
Q

What do the triad of ADHD symptoms frequently co-occur with?

A

A cluster of impairing symptoms relating to self regulation

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3
Q

What is the criteria for symptoms to be diagnosed as ADHD?

A

Developmentally inappropriate symptoms
Impair function and pervasive across setting
Longstanding from age 5

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4
Q

How is ADHD considered to be a spectrum?

A

Symptoms cluster on a continuum in the general population

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5
Q

What is the cut off for ADHD symptoms based on?

A

Clinical determination = aided by screening and assessment tools generally based on level of impairment

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6
Q

How does adult ADHD differ from childhood ADHD?

A

Less obvious symptoms of hyperactivity or impulsivity and more inattentive symptoms

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7
Q

What is the impact of childhood ADHD?

A

Significant difficulties parenting children with ADHD
Increased level of home stress and high emotions
Higher likelihood of antisocial behaviours

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8
Q

What does emotional dysregulation in ADHD lead to?

A

Difficulties in peer relationships and reckless or dangerous behaviour

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9
Q

What effect does ADHD have on education?

A

Poor problem solving ability leading to developmentally inappropriate decision making
Significant barrier to learning and potentially exclusion from education

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10
Q

What are the impacts of adult ADHD?

A

Increase in frequency of psychiatric comorbidity
Higher level off criminality and antisocial behaviour
Higher level of substance misuse
Significant impairment in occupational function

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11
Q

What are some issues that untreated ADHD can have on school and family?

A 
School = 60% suspended, 32% drop out, lower occupational status
family = 3-5x increase in parental divorce/separation, increased risk of early parenthood
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12
Q

What are some issues of untreated ADHD in society and the healthcare system?

A 
Society = 2x increase in substance misuse disorder plus earlier onset, less likely to quit smoking
Healthcare = 50% increase in bike accidents, increased A & E visits, 4x more vehicle crashes
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13
Q

Why do adults present with residual symptoms that don’t meet the diagnostic criteria?

A

Possibly due to improvement in cortical thickness allowing brain to compensate for cognitive deficits

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14
Q

How does ADHD affect families?

A

Hyperactivity tends to aggregate in families

ADHD shows familial clustering both within and across generations

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15
Q

How does a family member having ADHD increase the risk of developing the condition in other family members?

A

60% increased risk in offspring of adults with ADHD

15% increased risk in siblings of children with ADHD

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16
Q

What genes are involved in ADHD?

A

Mainly dopamine and serotonin transporter genes

17
Q

What are some perinatal factors in the development of ADHD?

A

Tobacco/alcohol use during pregnancy
Significant prematurity and perinatal hypoxia
Unusually short/long labour
Foetal distress, eclampsia and low forceps delivery

18
Q

What are some conditions that have ADHD-like symptoms?

A

Foetal alcohol syndrome and use of other illicit substances

19
Q

What are some psychosocial factors that increases risk of ADHD?

A

Severe marital discord, low social class, large family size, parental criminality, maternal mental disorder, maltreatment, emotional trauma

20
Q

What does the typical brainmap pattern in children with ADHD show?

A

Underactive function in the frontal lobe

21
Q

What are the functions of the frontal lobe?

A

Reasoning, planning, impulse control, judgement, initiation of action, social/sexual behaviour, long term memory

22
Q

How are neurotransmitters involved in ADHD?

A

Excessively efficient dopamine removal system = higher concentration of dopamine transporters
Symptoms can be caused by reduction of norepinephrine and serotonin

23
Q

How are children assessed for ADHD?

A

Mainly driven by parents or school
Ideally school observation
Screening and structured diagnostic questionnaires
Exploration of early history and attachment style

24
Q

How are adults assessed for ADHD?

A

Driven by patient = historical concerns are present
Specific adult screening tools available
Comorbidities common
Current clinical picture should fit with ADHD symptoms
Cognitive difficulties and ability to function need to be evaluated

25
Q

What is the diagnostic criteria for children with ADHD?

A

6 or more symptoms of inattentiveness and/or 6 or more symptoms of hyperactivity and impulsiveness
Present before age 5
Reported by parents/school and seen in clinic
Symptoms get in the way of daily life

26
Q

What is the diagnostic criteria for adults with ADHD?

A

5 or more symptoms of inattentiveness and/or 5 or more of hyperactivity and impulsiveness
Historical concerns since early age
Symptoms have moderate effect on different areas of life

27
Q

What are some psychosocial interventions used to treat children?

A

Parent training, social skills training, sleep and diet interventions, behavioural classroom management strategies, specific educational interventions

28
Q

When is pharmacological treatment indicated for ADHD?

A

Only for moderate or severe cases

29
Q

What are the pharmacological treatments for ADHD?

A 
1st line (stimulants) = methylphenidate, dexamfetamine
2nd line (SNRIs) = atomexetine
3rd line (alpha agonists) = clonidine, guanfacine
4th line = antidepressants (imipramine), antipsychotics (resperidone)
30
Q

How does methylphenidate work?

A

Increase dopamine by blocking its transporter

31
Q

How does dexamphetamine work?

A

Same action as methylphenidate plus increases extracellular norepinephrine and possibly serotonin

32
Q

What is the action of SNRIs?

A

Increase norepinephrine by blocking its transporter or by reducing sympathetic stimulation

Psychiatry (36 decks)

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