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Pathophysiology - Midterm > Lecture 6: ADHD & Schizophrenia > Flashcards

Lecture 6: ADHD & Schizophrenia Flashcards

1
Q

What is needed for a diagnosis of ADHD?

A

A thorough assessment by a highly skilled practitioner with a global approach

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2
Q

What are common comorbidities with ADHD?

A

Tourette’s disorder, learning disability, oppositional disorder, anxiety, depression, and enuresis (bed wetting)

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3
Q

What are inattentive symptoms of ADHD?

A

Distractibility, forgetfulness, poor organization, impersistence, mistake-prone, and work avoidance

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4
Q

What are hyperactive symptoms of ADHD?

A

Fidgetiness, intrusiveness, restlessness, noisiness, talkativeness, and inappropriate activity

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5
Q

True or false: ADHD symptoms are generally mixed between the inattentive and hyperactive categories.

A

True

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6
Q

What is the general age of onset for ADHD?

A

12

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7
Q

What type of symptoms first and what type occur last in ADHD?

A

Hyperkinesis first; inattention last and least to remit

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8
Q

What are risk factors for ADHD persistence?

A

Positive family history and comorbid disorders

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9
Q

How many children with ADHD go on to manifest symptoms in adulthood?

A

About 50%

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10
Q

What type of ADHD symptoms are typically found in adults?

A

Distractibility and inattention

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11
Q

What are 4 causes of ADHD?

A

1) Genetics
2) Right-sided “hypofrontality”
3) Locus ceruleus underperforming
4) Worsened by stressors

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12
Q

In what setting is ADHD more obvious?

A

Routinized settings (ex: school)

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13
Q

What are 4 changes in the neuropathology of a patient with ADHD?

A

1) Small increase in cerebrum growth at age 1-3
2) Decreased number of cerebellar Purkinje neurons
3) Decreased cell size and increased cell density in limbic areas
4) Modified genes impairing balance of excitatory and inhibitory synaptic signalling

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14
Q

How likely is someone to have ADHD if they have a first-degree relative with it?

A

4-8x greater

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15
Q

What factors increase the risk of having ADHD?

A

FAS, lead poisoning, infantile meningitis, obstetric adversity, maternal smoking, and adverse or absent parent-child relationship

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16
Q

What are 4 triggers for ADHD?

A

1) Artificial colours, flavours, and additives
2) Refined sugar, sodas, and caffeine
3) Food allergy
4) Essential fatty acid or iron and zinc deficiency

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17
Q

What are suggested treatments for ADHD?

A

1) Parent, family, and classroom “contingency” rewards and privileges
2) Avoiding triggers (if known)
3) Chiropractor
4) Combining meds with support

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18
Q

What are the goals of ADHD treatment?

A
  • Collaborative support system between family and school
  • Realistic, achievable goals
  • Clarity, immediacy, predictability, consistency, and responsibility
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19
Q

What are common deficits found in ADHD?

A
  • Inability to control behaviour
  • Inability to resist distractions
  • Inability to develop an awareness of space and time
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20
Q

What is considered first-line treatment for ADHD?

A

Stimulants which augment dopaminergic and noradrenergic tracts

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21
Q

What can improval of “gating” ability do for patients with ADHD?

A

Increase behaviour control, executive function, and regulate arousal

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22
Q

In regards to ADHD treatment, what is desired instead of increasing physical stimulation?

A

Ability to select restraint and to mentally focus

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23
Q

What does regulated arousal mean in ADHD?

A

Increased performance

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24
Q

What does increased control mean in ADHD?

A

Decreased hyperactivity and/or aggression

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25
Q

What are 2 examples of psychostimulants?

A

Methylphenidate and amphetamines

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26
Q

What are examples of methylphenidate and what is the difference between them?

A
  • Ritalin, biphentin, and Adderall

- All have different release pharmacokinetics

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27
Q

What do methylphenidate and amphetamines do?

A

Block norepinephrine and dopamine reuptake

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28
Q

What does increased norepinephrine and dopamine activity in locus ceruleus lead to?

A

Improved attention and ability to focus

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29
Q

What is a function of amphetamines but not methylphenidate?

A

Promotes dopamine and norepinephrine release from presynaptic neurons

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30
Q

What are 4 side effects of stimulants?

A

1) Decrease appetite
2) Increase BP, anxiety, irritability, difficulty falling asleep, or headaches
3) Worsen tics
4) Rarely may “flatten” personality or increase risk of sudden cardiac death

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31
Q

What is the function of atomoxetine?

A

Enhances activity of norepinephrine by inhibiting reuptake from synapse

32
Q

What is 1 advantage and 1 disadvantage to atomoxetine?

A
  • No abuse potential

- More costly

33
Q

What is bupropion?

A

A weak dopamine and NE reuptake inhibitor

34
Q

What is bupropion primarily used for?

A

As an antidepressant or an aid to smoking cessation

35
Q

What are 2 advantages to bupropion?

A
  • Less appetite effects than stimulants

- No abuse potential

36
Q

What can cause the need for dose adjustments?

A

Growth, symptoms, or adverse effects

37
Q

What can have a major impact on good and bad outcomes of medications for ADHD?

A

When and what form is taken

38
Q

What is not a good idea when using stimulants for ADHD?

A

Forced substitution of medications

39
Q

What is recommended for ADHD treatment?

A

Drug holidays to reassess treatment and allow for frowth rebound

40
Q

What is neurosis (in general terms)?

A

A characteristic

41
Q

What is psychosis (in general terms)?

A

A mental state or symptom (a “now” descriptor)

42
Q

What is schizophrenia (in general terms)?

A

A diagnosis of a complex and usually chronic illness

43
Q

What is the primary goal of schizophrenia treatment?

A

Ensure safety

44
Q

What are secondary goals of schizophrenia treatment?

A
  • Decrease agitation, hostility, anxiety, tension, and aggression
  • Normalize sleeping and eating pattern
  • Convey empathy and caring
45
Q

True or false: eliminating hallucinations and delusions is a reasonable expectation for treatment

A

False, it may not be realistic or possible

46
Q

True or false: schizophrenia is NOT the same as split or multiple personality

A

True

47
Q

What are the symptom clusters of schizophrenia?

A

Positive, negative, and cognitive

48
Q

What are the main areas affected by schizophrenia?

A

Thought, behaviour, mood, perception, cognition, and impairing function

49
Q

What is the typical age of onset for schizophrenia in males?

A

19-25

50
Q

What is the typical age of onset for schizophrenia in females?

A

24-32

51
Q

What are the known causes of schizophrenia?

A
  • Genetic influence
  • Abnormality on CNS scans (brain asymmetry, abnormal neuronal pruning)
  • Neurotransmitter imbalance (dopamine)
52
Q

When is the suicide risk for schizophrenia the highest?

A

The first 5 years of diagnosis

53
Q

Schizophrenia has a wide range of _____

A

Symptoms and functional status

54
Q

What is schizophrenia functional impairment primarily related to?

A

Prolonged impact of negative and cognitive symptoms

55
Q

What does the degree of functional impairment from schizophrenia correlate with?

A

Time and severity of poorly-controlled symptoms

56
Q

What are 8 “positive” symptoms of schizophrenia?

A

Hallucinations; ideas of reference; agitation; hostility; bizarre actions/statements; distractible; paranoia; suicidal

57
Q

What is the most common symptom of schizophrenia?

A

Hallucinations

58
Q

True or false: hallucinations are only experienced in one sense, visual

A

False, hallucinations may be experienced in more than 1 sense, such as auditory, visual, tactile, or olfactory

59
Q

What is most commonly experienced with hallucinations?

A

Voices

60
Q

What are delusions?

A

False, often fixed beliefs which persist despite “proof” of falseness or illogic

61
Q

What are 4 symptoms of a thought disorder?

A

Disorganized; garbled speech; thought blocking or “removal”; made-up words

62
Q

Are positive or negative symptoms of schizophrenia more devastating?

A

Negative

63
Q

What are 10 “negative” symptoms of schizophrenia?

A

Immobile facial expression; monotonous voice; anhedonia; diminished ability to initiate and sustain planned activity; speaking infrequently; poor judgement and hygiene; withdrawn; socially isolated; impaired concentration; suicidal

64
Q

What is cognitive impairment in schizophrenia related to?

A

Acute symptoms and prolonged neurotransmission imbalance

65
Q

What is chlorpromazine?

A

Sedating phenothiazine

66
Q

What does chlorpromazine help with?

A

Acute psychosis

67
Q

What type of drugs FIRST showed antipsychotic potential?

A

Dopamine antagonists

68
Q

What is the target of first generation antipsychotics?

A

Blockade of dopamine, specifically the D2 receptor

69
Q

What will blocking dopamine in the nigrostriatal portion of the brain cause?

A

Movement disorder

70
Q

What will blocking dopamine in the mesolimbic portion of the brain cause?

A

Psychosis relief

71
Q

What will blocking dopamine in the mesocortical portion of the brain cause?

A

Psychosis relief and restlessness

72
Q

What will blocking dopamine in the tuberoinfundibular portion of the brain cause?

A

Increased prolactin

73
Q

What will blocking dopamine in the frontotemporal portion of the brain cause?

A

Cognitive impairment

74
Q

What is the target of second generation antipsychotics and what does this do?

A
  • Serotonin, specifically the 5HT2A receptor

- Decreases movement disorders that are a risk with antipsychotics

75
Q

What is the most favourable antipsychotic?

A

One that has affinity for both serotonin and dopamine receptors

76
Q

What medications can work quickly on positive symptoms of schizophrenia?

A

Antipsychotics and benzodiazepines

77
Q

What is a pharmacist’s role in schizophrenia management?

A
  • Help patient give meds a chance to help
  • Reinforce value of adherence
  • Ease fears
  • Manage side effects
  • Reduce stigma

Pathophysiology - Midterm (11 decks)

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