Lecture 12: Stimulants and ADHD Medication Flashcards
Prevalence ADHD (2)
- 6-9% children, 4% adults
- boys 2x a likely - Kentucky ranks second in percent of 4-17 year olds with prescribed medications for ADHD (10.1%)
Diagnostic criteria ADHD
- persistent pattern if inattention and/or hyperactivity/impulsivity that interferes with functioning or development as characterized by
a. inattention
- 6 + symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and negatively impacts directly on social and academic/occupational activities
b. hyperactivity and impulsivity
- 6+ symptoms for 6 months to a degree that is inconsistent with developmental level and negatively impacts social/academic/occupation al activities
Signs/Sx ADHD: inattention (9)
- fail to give close attention to details
- makes carless mistakes - has difficulty sustaining attention in tasks
- does not seem to listen when spoken to directly
- does not follow through on instructions and fails to finish schoolwork, chores, duties, in workplace
- often has difficulty organizing tasks and activities
- avoids, dislikes, reluctant to engage in tasks that require sustained metal effor
- losses things
- easily distracted by extraneous stimuli
- forgetful in daily activities
Signs/Sx ADHD: Hyperactivity/impulsivity (9)
- fidget or tap hands or feet or squirms in seat
- often leaves seat in situations when remaining seated ix expected
- runs about or climbs in situations when it is inappropriate
- often unable to play or engage in leisure activities quietly
- “on the go” “driven by motor”
- talks excessively
- blurts out answer before question is completed
- difficulty waiting their turn
- often interrupts or intruded on others
ADHD Screening tools: kids
Vanderbilt ADHD rating scales
- free online
- separate for teachers and parents
ADHD Screening tools: adults
Adult ADHD self report scale
- 6 questions, self-rates
- if 4 or more are positive can complete additional 12 questions for further symptom eval
ADHD Pathophysiology (7)
- deficits in function of prefrontal cortex
a. manifest as impulsivity, poor problem solving, hyperactivity - dysfunction of dopamine transmission related to genetic defects in the transporter (DAT) and receptors
- low dopamine decreases arousal and every signal, inlacing important stimuli as “background noise”
- inattentiveness, fidgeting - increase in dopamine then increases arousal and allows important stimuli to “break through”
- individual can thus focus on pertinent tasks - individuals with ADHD have increased PFC activation, possibly to compensate
- may come across as “pulses” of DA, in response to environmental cues, possibly manifested as hyperactivity - dysfunction of noradrenergic transmission, notably the post-synaptic alpha 2a receptors
- engaging these receptors helps the prefrontal cortex to identify appropriate stimuli
Other conditions from excess dopamine/NE
- PTSD
- Schizophrenia
* balance dopamine/NE key
Tx recommendations 4-5 yrs (2)
- should rx behavior therapy
- may rx methylphenidate
- limit for moderate to severe dysfunction
tx recommendations 6-11 years (1)
- Should prescribe FDA approved medications and/or (preferably) behavioral therapy
Tx recommendation 12-18 years old (2)
- should prescribe FDA-approved medications
2. encouraged to prescribe behavioral therapy
ADHD into adult hood (2)
- 60-70% retain the diagnosis after puberty into adulthood
- less occurrence of hyperactivity, with inattention predominant
- manifested as legal trouble and difficulties in workplace and classroom
DDX ADHD (4)
- bipolar d/o
- increased psycomotor activity - PTSD
- negative alterations in cognition - Major depressive d/o
- cognitive impairment - Traumatic brain injury (TBI)
- cognitive impairment
Medication Options ADHD (2)
- stimulants
2. non-stimulant
Stimulants for ADHD (5)
- Methylphenidate
- Dexmethylphenidate
- Amphetamine/dextroamphetamine
- dextroamphetamine
- lisdexamfetamine