People and illness Flashcards
Define ADHD.
A developmental disorder characterized by grossly excessive levels of activity and a marked impairment of the ability to attend and concentrate.
Describe the clinical features of ADHD.
Inattention
Poor concentration - moves from one task to another
Excessive activity- disorganised, fidgety
Impulsivity - poor assessment of danger and accident prone, poor peer relationships.
Name the susceptibility genes associated with ADHD.
DRD4 Receptor 7-Repeat Alleles DAT1 – Dopamine Transporter gene DRD5 - Dopamine receptor gene 5HTT – Serotonin Transporter gene HTR1B - Serotonin receptor gene
What is the link between genetics and environment in the development of ADHD.
Genetic factors contribute to the development of behavioural symptoms on a background of high environmental adversity.
Name some of the organic factors that contribute towards ADHD.
smaller brain volume – frontal & parietal cortex
smaller basal ganglia
right dorso-lateral prefrontal lobe reduced
smaller cerebellar vermis
List some of the co-morbidities associated with ADHD.
Sleep disorders ODD OCD Specific learning disabilities - i.e. dyslexia Dyspraxia Social communication difficulties Anxiety Tourette syndrome Depression
How is ADHD assessed?
no specific diagnostic test direct observations in >1 setting psychoeducational assessment structured questionnaires Identifying co-morbidities developmental history
What additional tests should be performed in assessment of ADHD?
hearing and vision screening checks
screening for neurological signs and physical anomalies
Baseline height & weight (record on growth chart)
Baseline blood pressure and heart sounds
What is the mechanism of action of psychostimulants in the treatment of ADHD? Give two examples of this type of drug.
Acts on D1 receptors in the prefrontal cortex and D2 in the striatum.
Methylphenidate (Ritalin)
Dexamphetamine
What is the mechanism of action of Atomoxetine in the treatment of ADHD?
Noradrenaline reuptake inhibitor. Enhances transmission of Noradrenaline in the prefrontal cortex.
What type of drug is Clonidine and what condition is it used to treat?
alpha-2 adrenergic receptor agonist
ADHD
What type of drug is Guanfacine and what condition is it used to treat?
alpha2A adrenergic receptor agonist
ADHD
What are some of the side effects of psychostimulants as a treatment for ADHD?
Impaired growth (not normally long term)
Difficulty sleeping.
Anorexia
HR and BP abnormalities
How long does it take for Atomoxetine to take effect as a treatment for ADHD?
About 4-6 weeks.
What are some of the side effects of using Guanfacine as a treatment for ADHD?
Weight gain, tiredness, dizziness, hypotension.
List some of the different forms of dexamphetamine available.
Elvanse - long acting
Daytrana - transdermal patch
Dexedrine - fast acting 5mg tablets
How should health be monitored in children on psychostimulants?
HR and BP on every dose adjustment and every 6 months
Pre-treatment height and weight and every 6 months
Complete detailed history
What are some contraindications to using psychostimulants?
History of depression, anorexia, psychosis, suicidal tendencies, preexisting cardiovascular disorders.
What should be monitored in children who taken Atomoxetine?
BP, HR, height, weight, mood, LFTs.
What are some of the side effects of Atomoxetine?
Reduced sleep, reduced apatite, suicidal ideation.
How does clonidine and guanfacine work in the treatment of ADHD?
Inhibit noradrenaline at the synapse.
How long does it take clonidine and guanfacine to have a therapeutic effect?
4-6 weeks
Name some of the non-pharmacological treatments of ADHD.
Pyschoeducation
Behaviour therapy
Cognitive behavioural therapy (CBT)
Parent education programmes
What dietary changes can be made to treat children with ADHD?
Reducing sugar, additives, caffeine, food colourings.
Supplement diet with omega-3 and omega-6 fatty acids,