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Mental Health 1 > Attention Deficit Hyperactivity Disorder > Flashcards

Attention Deficit Hyperactivity Disorder Flashcards

Define ADHD and its criteria Outline the concept of co-morbidity List the co-morbid conditions in ADHD Outline genetic and psychosocial aetiological factors Relate the neuropsychology of ADHD to its neurobiology Describe the management options and how they might work

1
Q

Define ADHD

A

The triad of inattention, hyperactivity, and impulsivity, present for over 6 months before the age of 7 and causing significant distress or social impairment

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2
Q

State the criteria for inattention

A

At least 6 of: failure to sustain attention, failure to complete instructions or work, failure to listen, losing things, careless errors, easy distractibility, avoidance of tasks requiring mental error, forgetfulness and poor planning

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3
Q

State the criteria for hyperactivity

A

At least 3 of: fidgeting or squirming, undue noisiness, leaving seat in class, excess running about, excess motor activity

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4
Q

State the criteria for impulsivity

A

At least 1 of: blurting out answers to questions, excess talking, failure to wait one’s turn, poor self-control, interrupting or intruding on others, risk-taking

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5
Q

What percentage of patients with ADHD have comorbid conduct disorder?

A

25-50%

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6
Q

What percentage of patients with ADHD have comorbid anxiety disorder?

A

25%

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7
Q

What percentage of patients with ADHD have comorbid learning difficulties?

A

30%

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8
Q

State a difficulty comorbidities pose in diagnosing ADHD

A

The symptoms often overlap - for example, inattention is a feature of ADHD, depression, anxiety, and autism spectrum disorder

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9
Q

State the difference in ADHD prevalence between the UK and US

A

US: 8.8% diagnosed, 6.1% on medication
UK: 1.7% diagnosed, 0.8% on medication

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10
Q

State the ratio of ADHD in males to females

A

3:1

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11
Q

Is there evidence that ADHD incidence is increasing?

A

No - but the number of individuals presenting to clinic and taking medication has

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12
Q

State 3 population groups with higher prevalence of ADHD

A

Inner cities, lower socio-economic classes, prisons

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13
Q

How much more at risk of developing ADHD is the child of a parent with ADHD than the child of a parent without ADHD?

A

8x

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14
Q

What is the ADHD concordance rate between monozygotic twins?

A

80%

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15
Q

State the approximate heritability of ADHD

A

75%

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16
Q

Give at least 2 candidate genes for involvement in ADHD

A

Tyrosine hydroxylase (involved in DOPA synthesis), dopamine receptors D2, D3, and D5, catecholamine methyl transferase (COMT), nicotinic receptors, SNAP-25 (involved in axonal growth)

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17
Q

State a potential prenatal risk factor for ADHD

A

Maternal smoking, maternal alcohol or substance misuse, maternal stress

18
Q

State a perinatal risk factor for ADHD

A

Very low birthweight

19
Q

State a potential postnatal risk factor for ADHD

A

Environmental lead, zinc deficiency, magnesium deficiency, organophosphates

20
Q

State at least 3 psychosocial environmental risk factors for ADHD

A

High numbers of critical comments, poor encouragement, inconsistent parenting, low sensitivity to child’s needs, maltreatment or physical discipline, maternal depression

21
Q

Give 3 examples of executive functions

A

Planning, flexible strategy, impulse control, orientation to salient stimuli, suppression of inappropriate actions

22
Q

Name 2 tests of impulse control

A

Wisconsin card sorting test, Stroop test

23
Q

Describe the Stroop test

A

The words of colours flash up in different colours and the individual has to say the colour instead of the word (e.g. if orange was written in green, say green)

24
Q

Name a gene variant associated with decreased executive function

A

COMT gene variant val/val159met

25
Q

Describe the differences in the prefrontal cortex of an individual with ADHD on MRI

A

Decreased brain size (but also seen in non-ADHD siblings) and delay of brain development by 2-3 years

26
Q

Describe the differences in the prefrontal cortex of an individual with ADHD on SPECT MRI

A

Decreased blood flow (but also seen in non-ADHD siblings)

27
Q

Describe the differences in the prefrontal cortex of an individual with ADHD on fMRI

A

Increased dopaminergic transporter density, so dopamine is cleared more rapidly from the synapse

28
Q

Describe the differences in the prefrontal cortex of an individual with ADHD on diffusion tensor imaging

A

Decreased white matter (but also in non-ADHD parents), with connectivity relative to cognitive performance

29
Q

Describe the basal ganglia and cerebellum of ADHD patients on MRI

A

Reduced in volume, with decreased blood flow to these areas

30
Q

Name a risk gene for ADHD which influences basal ganglia volume

A

A 7-repeat allele for dopamine transporter 1 (DAT1)

31
Q

What is the first line treatment for behaviour management in ADHD?

A

Environmental modification - school support, adaptations, parenting programs

32
Q

What do parenting programs for ADHD involve?

A

Teaching the importance of realistic expectations, praise and reward, clear rules and expectations, keeping calm, quality time, and ‘time out’

33
Q

When is medication appropriate for treating ADHD? (NICE, 2018)

A

When there are ongoing problematic symptoms despite attempts at environmental modification

34
Q

What are the first-line medications for ADHD?

A

Methylphenidate and dexamphetamine

35
Q

What is the second-line medication for ADHD?

A

Atomoxetine, a noradrenaline reuptake inhibitor with some action on dopamine reuptake

36
Q

How do stimulants treat ADHD?

A

They readdress pathological underactivity by increasing synaptic dopamine

37
Q

State some side effects of stimulants used in ADHD

A

Decreased appetite, weight, and growth, sleep changes, mood changes, slight increases in heart rate and blood pressure

38
Q

What are the baseline tests before prescribing a stimulant for ADHD?

A

Height, weight, pulse, blood pressure, cardiac examination

39
Q

What is the prognosis for untreated ADHD?

A

90% of untreated cases in childhood go on to develop conduct disorder

40
Q

How many individuals still meet the diagnostic criteria for ADHD in adulthood?

A

15-33%

Mental Health 1 (35 decks)

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