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Behavioral Health II > Bauer- ADHD > Flashcards

Bauer- ADHD Flashcards

1
Q

How do you diagnose ADHD?

A

It is often before age 12.
Multiple settings (academic/social/family).
Not because of psychoses, depression, or anxiety.

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2
Q

What are the types of ADHD?

A

Mixed- Inattentive and Hyper/impulsive (boys)
Inattentive- girls
Hyper/impulsive- least common

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3
Q

How does family genetics relate to ADHD?

A

In utero exposure (nicotine, alcohol, cannabis)
Birth trauma-anoxia
Frontal lobe trauma- heavy metal poisoning

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4
Q

What is the differential diagnosis for ADHD?

A 
Learning Disorders
Behavioral Disorders
Anxiety Disorders
Mood Disorders
Psychotic (rare)
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5
Q

What are medical causes of ADHD?

A

Neuro seizures, Tics/tourettes, Migraines
Endocrine, thyroid, diabetes
Chronic drug use
Sleep disorders

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6
Q

How do you test for ADHD?

A

Formal (CPT) vs Practical (Video Games/Movies)
Tests of executive funtion w/ learning disorder screens.
Trails part A and B
Wisconsin card sorting test

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7
Q

What are the Cloninger Dimensions of personality?

A

Increased risk taking
decreased harm avoidance
Reward dependence

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8
Q

What do you do at Stage 0 of ADHD?

A 
Nonpharmacological treatment
Consistency and structure
Behavior modification
Individual therapy
Dietary treatment
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9
Q

What is the treatment for Stage 1 and 2 of ADHD?

A

Methylphenidate (.5-1 mg/kg) or Amphetemine (.3-.6 mg/kg)

“The Gold Standard”- psychostimulants

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10
Q

What is Methylphenidate and how does it relate to dextroamphetamine sulfate?

A

Ritalin- mildest, shortest duration (1-4 hrs), long acting (concerta)

Dextroamphetamine Sulfate-more potent, 2-6 hour half life

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11
Q

What is Adderall?

A

“Mixed Amphetamine Salts” Amphet + Dextroamphet

Potent and longest acting, acts up to 8 hours in older kids and adolescents

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12
Q

What are the risks associated w/ stimulants?

A

Cardiovascular
Tics, Tourettes
Anxiety/Depression
Psychosis/Mania

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13
Q

In terms of long-acting psychostimulants, which ones are biphasic and which are continuous?

A

Biphasic: Focalin, Adderall, Ritalin, Metadate (FARM)

Continuous: Concerta, Daytrana Patch, Vyvanse

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14
Q

What is the strategy for treating ADHD w/ depression?

A

Treat which ever disorder is MOST SEVERE FIRST than add treatment for SECOND disorder.

(Use stimulant to treat ADHD first, then add SSRI if depressive sx to not remit)

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15
Q

What drugs are used to treat stage 3 and 4 ADHD?

A
  1. Non stimulants: Atomoxetine-selective NE reuptake inhibitor (nausea/agitation)
  2. Atypical antidepressants: Buproprion- NE/DA inhibitor (seizure, appetite)
  3. Venlafaxine, duloxetine- NE/5HT RI (Nausea, agitation), work when welbutrin doesn’t work
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16
Q

What drugs are used to treat stage 4 and 5 ADHD? What are the side effects?

A 
TCA
Despiramine- least sedating (cardiace death)
Imipramine
Amitriptyline/Nortriptyline
Mirtazepine

20-80% have cardiac arrhythmia and cholinergic side effects

17
Q

What drugs are sued to treat stage 6 ADHD?

A

Alpha 2 agonists- BP agents calm hyperactivity, impulsivity, little focus

Clonidine
Guanfacine

18
Q

How does Clonidine affect ADHD compared to Guanfacine?

A

Clonidine- short acting (4-6 hours), patch lasts 5 days

Guanfacine- longer acting, mild 12-14 hr half life in children, 24 hr in adults

19
Q

How do you treat ADHD w/ anxiety?

A

Atomoxetine
Treats both ADHD and anxiety

OR

Treat ADHD w/ stimulant then add SSRI for anxiety

20
Q

How do you treat the 4 stages of ADHD w/ TIC disorders?

A

1- Stimulant monotherapy
2- Stim + alpha agonists if Tics cnt
3- Add atypical antipsychotic
4- add pimozide/haloperidol only after failure of several atypical antipsychotics

21
Q

How do you treat the 5 stages of ADHD w/ aggression?

A

1- treat ADHD, does agg resolve?
2- add behavioral intervention to stimulant
3- add atypical antipsychotic to stimulant
4- add Li or divalproex Na to stimulant
5- Add agent not used in stage 4

22
Q

How do you treat ADHD w/ chemical dependency?

A
  • chemical dependency tx and recovery programs
  • Strattera vs. Bupropion
  • treatment agreement including random urine testing, no early refills, and limits if not in compliance

Behavioral Health II (20 decks)

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