ADHD - Meiri Flashcards
What is the prevalence of ADHD?
3-7% of school aged children
Male:Female 4:1 (girls often underdiagnosed)
60% diagnosed in childhood continue into adulthood
What are the 3 subtypes of ADHD?
- Predominantly Inattentive Subtype
- Predominantly Hyperactive-Impuslive Subtype (rare)
- Combined Subtype (Hyperactive-Impuslive and Inattentive) - Most common
What are the diagnostic criteria of ADHD?
- At least 6/9 listed symptoms for hyperactivity/impulsivity.
- Symptoms caused impairment before age 7
- Some impairment in two or more settings (school, home, work, clinic-just one not enough)
- Clear evidence of clinically significant impairment in social, academic, or occupational functioning
- Symptoms do not occur exclusively during another mental disorder and are not better accounted for by another disorder (like hypomanic bipolar or personality disorder, or anxiety or other potential comorbidity-need to stabilize then assess if comorbidity)
What are the theories of the brain mechanisms in ADHD?
- Decreased NE transmission
Decreased release of dopamine from presynaptic vessels
Ritalin acts as increased release in these synapses - Transfusion of neurotransmitters
Posterior attention system and anterior executive system may have abnormally signals
Overactive frontostriatal insular network
Decreased PET scan metabolism
What is the treatment for ADHD?
Medications:
Ritalin 10 mg
Ritalin SR 20 mg
Ritalin LA 20 mg
Concerta 18mg, 36mg, 54mg
Second line – TCA, Atamoxetine (SNRI-takes weeks for effects)
More effective when combined with CAM
Side effects:
Anxiety, psychosis (problemaatic with comorbidities)
What are the comorbidities with ADHD?
Tic (increases with meds)
Oppositional Defiant Disorder (40%)
Conduct Disorder
Anxiety Disorders (34%)
Mood disorders
