Impulse 4

Question 1

A stroke in what part of the brain is associated with development of OCD?

What about Tourettes?

Answer 1

OCD =Basal ganglia (Putamen and caudate nucleus)

Tourettes = Anterior Cingulate Cortex

Question 2

What is the M:F of ADHD in children? Adults?

Answer 2

5: 1 in children (M:F)
1: 1 in adults

Question 3

In any given grade level…what is the relationship to age and ADHD?

Answer 3

The youngest children at each grade level are nearly 2X more likely to get dx with ADHD than their older counterpart.

(Could teacher conflate ADHD and immaturity?)

Question 4

What is the main neuroimaging finding for children with ADHD?

Answer 4

Brain volume is smaller for ADHD compared to control. More prominent in the FRONTAL LOBE.

Question 5

What is the ONLY validated psychotherapy treatment for ADHD?

Answer 5

Parent teacher behavioral therapy

Question 6

What is the treatment algorithm of ADHD?

Answer 6

First line = Stimulant (methylphenidate (ritalin) or amphetamine (Adderall)) 
Second line = Another Stimulant
Third Line = Atomoxetine
Fourth line = Bupoprion
Fifth line = Clonidine or Guanfacine.

Question 7

What is the Mechanism of Action for the following Stimulants:

Methylphenidate?

Amphetamine?

Answer 7

Methylphenidate:
- Blocks DA and NE reuptake

Amphetamines:
- Blocks DA and NE reuptake
AND
- Releases DA and NE

Question 8

Both methylphenidate and Amphetamines come in IR and ER formulations. What are the advantages of ER vs IR formulation?

Answer 8

IR

• less appetite suppression
• Less insomnia

ER

• Less “on off” and high effect
• Less jitteriness
• Less dyspepsia

Question 9

Children on Stimulants for ADHD are at an increase risk of what catastrophic problem?

Answer 9

Sudden death!!

That is why FDA recommends getting a cardiac history for ALL, and getting a EKG if family or personal hx of Cardiac problems.

Question 10

What is the mechanism of action of Atomoxetine?

What is the black box warning?

Answer 10

SNRI

Increased suicidality in Adolescents