Lecture 4-ADHD Flashcards
Attention Deficit Hyperactivity Disorder is Now called _______ Disorder
Neurodevelopmental
ADHD combined =
ADHD inattentive =
ADHD hyperactive/impulsive =
ADHD combined: innatention & hyperactive/ impulsive
ADHD inattentive: innatention only
ADHD hyperactive/impulsive: hyperactive/ impulsive only
ADHD definition:
Starts before age ___
Symptoms must be in _____ since brain is messed up all the time
Must cause ____ disability
12; multiple settings; Social
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
inattention; 6
_____ hyperactive/impulsive symptoms:
Fidgets
Leaves seat
Runs/climbs
Not quiet
Talks a lot
Blurts out
Cannot wait turn
interrupts
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
young; inattentive; less
ADHD is _____, one inherits bad genes for _____ receptors and _____ transmission.
heritable; DA/ NE; DA/ NE
____ = vigilance & fires in normal people. ____ does not fire as much in ADHD (hypoactive).
ACC; ACC
In ADHD you get what low neurotransmitters?
NE & DA
_____ 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?
Environmental
The most co-occuring disease with ADHD is _____ disorder.
Anxiety
What type of medications do we give for ADHD? What neurotransmitters do they act on? Side effects?
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
Name the non-stimulant ADHD drugs (3). Risk of addiction? Side effects? As effective as stimulants?
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?
Cognitive behavioral therapy is effective in helping _____ ADHD symtoms.
subside
You try behavioral therapy ____. Then you go to _____.
first; stimulants
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.
kids and teens; non; lesser
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!
Atomoxetine; Glutamate; Guanfacine; clonidine; Glutamate
Discuss some negative effects of living with ADHD.
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
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
A. Anxiety
Anxiety is the number one co-occurring illness with ADHD.
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
C. Amphetamine
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
D. Hypoactive anterior cingulates
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
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
