Lecture 4-ADHD

Question 1

Attention Deficit Hyperactivity Disorder is Now called _______ Disorder

Answer 1

Neurodevelopmental

Question 2

ADHD combined =

ADHD inattentive =

ADHD hyperactive/impulsive =

Answer 2

ADHD combined: innatention & hyperactive/ impulsive

ADHD inattentive: innatention only

ADHD hyperactive/impulsive: hyperactive/ impulsive only

Question 3

ADHD definition:

Starts before age ___

Symptoms must be in _____ since brain is messed up all the time

Must cause ____ disability

Answer 3

12; multiple settings; Social

Question 4

6 _____ symptoms for _____ months:

Poor attention to details -> mistakes

Cannot sustain attention

Does not listen

Does not follow through

Does not organize

Avoids tasks

Loses things

Is distracted

Is forgetful

Answer 4

inattention; 6

Question 5

_____ hyperactive/impulsive symptoms:

Fidgets

Leaves seat

Runs/climbs

Not quiet

Talks a lot

Blurts out

Cannot wait turn

interrupts

Answer 5

6

Question 6

Most often apparent at _____ age where age appropriate norms for paying attention and delaying gratification are not met

Milder and more ______ cases may not be noticed until later in life when demands are greater

Inattentiveness tends to persist greater then hyperactivity/impulsivity, so the more adult you get the ______ hyperactive you get

Answer 6

young; inattentive; less

Question 7

ADHD is _____, one inherits bad genes for _____ receptors and _____ transmission.

Answer 7

heritable; DA/ NE; DA/ NE

Question 8

____ = vigilance & fires in normal people. ____ does not fire as much in ADHD (hypoactive).

Answer 8

ACC; ACC

Question 9

In ADHD you get what low neurotransmitters?

Answer 9

NE & DA

Question 10

_____ Factors that look like ADHD:

Cigarette use/alcohol use in pregnancy

Lead poisoning

Head injuries

High sugar?

Food color additives?

A learned behavior?

A reaction to stress?

Answer 10

Environmental

Question 11

The most co-occuring disease with ADHD is _____ disorder.

Answer 11

Anxiety

Question 12

What type of medications do we give for ADHD? What neurotransmitters do they act on? Side effects?

Answer 12

The stimulant class has great efficacy in adults, teens, children.

They promote DA and NE increase activity. Stimulants block the DA & NE reuptake pumps.

Most carry risk of addiction,Paranoia in misuse, Stunt growth, & weight loss

Question 13

Name the non-stimulant ADHD drugs (3). Risk of addiction? Side effects? As effective as stimulants?

Answer 13

The non-stimulants (atomoxetine (NE reuptake inhibitor) and (Guanfacine ER and Clonidine ER (alpha-2 NE agonists) have less efficacy.

But carry no addiction risk. Anything that does dopamine reuptake inhibition may become addicting.

Interestingly all are often sedating.

Guanfacine ER and Clonidine ER may lower blood pressure.

These are not as effective as stimulants?

Question 14

Cognitive behavioral therapy is effective in helping _____ ADHD symtoms.

Answer 14

subside

Question 15

You try behavioral therapy ____. Then you go to _____.

Answer 15

first; stimulants

Question 16

Slow release Methylphenidate and Amphetamines are less addicting (since slow release so slow kick) and less embarrassing (no nurses office visits) & are used for ____ and ___ first.

Adults get ___ addictive and _____ effective meds first since ADHD is a Dx of exclusion.

Answer 16

kids and teens; non; lesser

Question 17

Non stimulants:

______ is a norepi reuptake inhibitor only, which makes _____ neurotransmission better!

_____ ER and _____ ER Agonize or stimulate the alpha-2 norepinephrine receptor, which make _____ neurotransmission better!

Answer 17

Atomoxetine; Glutamate; Guanfacine; clonidine; Glutamate

Question 18

Discuss some negative effects of living with ADHD.

Answer 18

ADHD patients tend to have less school, less powerful jobs, lower self esteem, greater antisocial behavior, greater addiction rates, greater divorce rates but equal rates of medical illness

Question 19

A 19 year old college student presents and meets criteria for ADHD inattentive type. What other psychiatric disorder will he most likely have outside of his ADHD?

A. Anxiety

B. Bipolar

C. Depression

D. Alcoholism

Answer 19

A. Anxiety

Anxiety is the number one co-occurring illness with ADHD.

Question 20

A 30 year old ADHD patient has failed to respond to methylphenidate (Ritalin), which of the following likely has a stronger effect on dopamine release in the brain?

A. Guanfacine ER

B. Atomoxetine

C. Amphetamine

D. Clonidine ER

Answer 20

C. Amphetamine

Question 21

A 15 year old with ADHD combined type has a functional MRI (fMRI) scan. What is the most likely finding?

A. Hyperactive amygdala

B. Hypoactive cerebellum

C. Hyperactive orbitofrontal cortex

D. Hypoactive anterior cingulates

Answer 21

D. Hypoactive anterior cingulates

Question 22

Concerned parents ask you why their 14 year old son has ADHD and want to know if there is problem with his brain, you can suggest theoretically that

A. At age 2 he had synaptic pruning too quickly

B. At age 8 he had excessive pruning

C. At age 14 his brain may be a few years behind his peers in maturing by way of appropriate synaptic pruning

Answer 22

C. At age 14 his brain may be a few years behind his peers in maturing by way of appropriate synaptic pruning

There is a 2 yr delay compared to peers without ADHD