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ICOM - Mental Health > Rogers- ADHD > Flashcards

Rogers- ADHD Flashcards

1
Q

ADHD is characterized by developmentally inappropriate levels of the core symptoms of ,

, impulsivity, and inattention that adversely affect behavioral, emotional, cognitive, academic, occupational, and social functions

A

hyperactivity

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2
Q

What are some coexistent issues with ADHD?

A

sleep disorders,

anxiety,

conduct disorders

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3
Q

What are some concurrent childhood onset neurodevelopment disorders associated with ADHD?

A

language disability,

learning disability,

autism spectrum disorder,

tic disorders

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4
Q

What are some psychiatric comorbities associated with ADHD?

A

mood disorders,

depressive disorders,

anxiety disorders

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5
Q

Affects 5% to % of school-aged children, more commonly in males/females

A

9

males

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6
Q

As concerning a diagnosis of ADHD

At least several inattentive or hyperactive-impulsive symptoms occur before age years

A

12

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7
Q

Prevalence of disease is up to 5% to 9% of children, 2% to 6% of , and 2% of

A

school-aged

adolescents

adults

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8
Q

What is the ratio male to female for ADHD?

A

3:1 to 4:1

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9
Q

At what age should a parent see symptoms of ADHD?

A

see symptoms by age 4

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10
Q

to fold higher in children of parents with attention-deficit/hyperactivity disorder and/or siblings with attention-deficit/hyperactivity disorder

A

2 to 8

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11
Q

Up to % of first-degree relatives of children with attention-deficit/hyperactivity disorder are affected

A

33

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12
Q

What is the definitive genetic inheritance of ADHD?

A

non-Mendelian multifactorial

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13
Q

Though non-Mendelian multifactorial is the definitive inheritance of ADHD, some may have what other kind of genetic inheritance?

A

autosomal dominant for some

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14
Q

Some/Multiple genes contribute to the attentiondeficit/hyperactivity disorder phenotype

A

multiple

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15
Q

What are 2 canditate genes associated in the development of ADHD?

A

dopamine transporter gene (DAT1)

dopamine 4 receptor gene (DRD4)

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16
Q

Psychosocial family stressors can also contribute to or exacerbate the symptoms of ADHD

• These include poverty, exposure to violence, and undernutrition or malnutrition

injury also increases the risk of ADHD

A

Brain

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17
Q

Describe the abnormal levels of neurotransmitters in those with ADHD?

A

abnormal catecholamine metabolism, particularly dysregulation of dopamine and norepinephrine

  • Reduced dopamine activity in the prefrontal-striatalthalamocortical and cerebellar circuits
  • Abnormally low serotonin activity; serotonin is a modulator for dopamine
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18
Q

There is reduced activity in the prefrontal-striatalthalamocortical and cerebellar circuits

A

dopamine

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19
Q

Abnormally low serotonin activity; serotonin is a for dopamine

A

modulator

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20
Q

Howmany of the DSM-5 ADHD criteria must be met for diagnosis of ADHD?

A
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21
Q

What is the pervasivness criteria that must be met for ADHD diagnosis?

A

example:

at home and at school

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22
Q

Symptoms must persist for at least months in 2 or more settings and must be present before age 12 years

A

6

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23
Q

What are some diagnostic screeners for ADHD? And what kind of evidence is documented?

A

Rating scales

Connor’s Rating Scale, Vanderbilt ADHD Diagnostic Rating Scale, ADHD Rating Scale 5, Swanson, Nolan, and Pelham Checklist (SNAP), and the ADD-H: Comprehensive Teacher Rating Scale (ACTeRS)

subjective evidence

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24
Q

Teachers, caregivers, and observers who provide supportive information to complete standardized behavior rating scales should have regular contact with individual for a minimum of months

A

4

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25
Q

How to distinguish ADHD from central nervous system disease?

A

Central nervous system disease in patients whose clinical presentation includes more than subtle neurologic soft signs (eg, hypertension, papilledema, ataxia, neurologic deficits)

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26
Q

How to distinguish hyperthyroidism from ADHD?

A

Hyperthyroidism in patients with clinical signs concerning for elevated thyroid hormone levels (eg, weight loss, hypertension, resting tachycardia, goiter, exophthalmos, weakness, diaphoresis); exclude diagnosis with T₄ and TSH assay

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27
Q

High levels in patients with risk factors for lead toxicity (eg, inhabitant of substandard housing, exposure to old paint, housing in close proximity to a highway) can also lead to can lead to symptoms similar to ADHD

A

lead

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28
Q

ADHD is a diagnosis of inclusion/exclusion

A

exclusion

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29
Q

People with genetic syndromes (Down’s) can also have signs and symptoms similar to ADHD

A

congenital

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30
Q

Sudden/gradual manifestation development without previous history should prompt serious consideration for other conditions

A

sudden

For example: head trauma, physical or sexual abuse, neurodegenerative disorder, central nervous system tumor, substance use, mood or anxiety disorders, depression, major psychological stress in family or school

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31
Q

sleep disorders in patients with ADHD like symptoms (eg, snoring, pauses in breathing while asleep, daytime sleepiness) and risk factors (eg, obesity, adenotonsillar hypertrophy) for primary sleep disorders

A

Primary

children who don’t sleep well can appear to be hyperactive and lose concentration

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32
Q

untreated use disorder needs to be addressed before to fully addressing manifestations that may be related to attention-deficit/hyperactivity disorder

A

substance

(especially in adolescents)

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33
Q

List of psychosocial factors on differential diagnosis of ADHD

A
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34
Q

List if Diagnoses associated with ADHD behaviors

A
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35
Q

List of medical and neurologic condtions on differential diagnoses of ADHD

A
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36
Q

Review the chart of age-specific issues that could affect those with ADHD

A
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37
Q

Review the chart of ADHD associated behaviors

A
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38
Q

Predominantly inattentive type

  1. Only criteria for are present
  2. More common in
  3. Often includes impairment
A

inattention

females

cognitive

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39
Q

Predominantly hyperactive/impulsive type

  1. Only criteria for are present
  2. More common in
A

hyperactivity/impulsivity

males

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40
Q

Combined type

  1. Criteria for both and hyperactivity/impulsivity
  2. More common in
A

inattention

males

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41
Q

Symptoms interfere with life should include quality of social, academic, or occupational functioning

A

reduced

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42
Q

Broad clinical exists, rendering variable clinical presentations of disease

A

heterogeneity

43
Q

Hyperactivity/impulsivity symptoms usually appear by age years and peak by age years

A

4

7 or 8

44
Q

Prominent symptoms are motor and disruptive

A

restlessness

behavior

45
Q

Inattention symptoms usually appear by age years

A

8 or 9

46
Q

Adolescents and adults

•Typically exhibit; hyperactivity is less pronounced

A

inattention

47
Q

older adolescents and adults

•Older patients report more restlessness or inability to settle down rather than motor hyperactivity

A

inner

48
Q

•Disorder continues into adulthood in up to % of affected children

A

40

49
Q

Symptom manifestations can be gender dependent/independent

A

dependent

50
Q

Girls are more likely to have more issues with and they experience fewer issues with hyperactivity and behavioral disturbances

A

attention

51
Q

High prevalence of comorbid psychiatric disorders contribute to clinical of presentation

A

heterogeneity

52
Q

Presents with and inability to maintain attention during mundane and repetitive tasks, however, can hyperfocus on things they love

A

distraction

53
Q

Review the DSM-5 criteria for inattention

must have 6 and 9

A
  1. Lack of attention to detail
  2. Difficulty sustaining attention
  3. Difficulty with listening skills
  4. Difficulty with task completion
  5. Difficulty with organizational skills
  6. Difficulty with tasks requiring sustained attention
  7. Frequently loses belongings
  8. Easily distracted
  9. Forgetful
54
Q

What is expressed as restlessness, excess motor activity, fidgeting with hands and feet, or excessive talking?

A

hyperactivity

55
Q

What is expressed as tendency to act without thinking about consequences and social interference (eg, interrupting conversation or games during play)

A

impulsivity

56
Q

Review DSM-5 criteria for Hyperactivity and Impulsivity

must have 6 out of 9

A
  1. Fidgeting and squirming
  2. Stands when sitting is expected
  3. Runs around inappropriately
  4. Difficulty with quiet play
  5. Inability to relax and remain still
  6. Excessive talking
  7. Blurts out answers
  8. Difficulty waiting for turn
  9. Interrupts
57
Q

Review comorbid neuropsychiatric Disorders with ADHD

A

Oppositional defiant disorder (up to 60% of patients)

Mood disorder (up to 50% of patients)

Anxiety disorder (eg, generalized anxiety disorder, separation anxiety, panic disorder; up to 33% of patients

Developmental language or learning disability (eg, dyslexia or dyspraxia; up to 30% of patients)

Conduct disorder (up to 26% of patients)

Autism spectrum disorder (up to 20% of patients)

Depressive disorders (up to 18% of patients)

Tics or tic disorders (eg, Tourette syndrome; up to 7% of patients

58
Q

What are the top 3 comorbid neuropsychiatric disorders and at what % do they show up in those diagnosed with ADHD?

A

Oppositional defiant disorder (up to 60% of patients)

Mood disorder (up to 50% of patients)

Anxiety disorder (eg, generalized anxiety disorder, separation anxiety, panic disorder; up to 33% of patients

59
Q

More common features of ADHD other than criteria

A

Emotional lability (38% to 75% of children)

  • Clumsiness is very common
  • Sleep disorders or sleep problems
  • Frequent accidental injuries
60
Q

• Chronic academic and/or social failure can lead to loss of motivation and learned

A

helplessness

61
Q

Increased likelihood to be a of child abuse

A

victim

62
Q

What are the 2 subtle neurocognitive deficits?

A
  • Memory impairment
  • Calculation impairment
63
Q

What are the 3 subtle neurologic soft motor findings?

A
  • Mild dysdiadochokinesia (eg, difficulty with finger to nose or rapid alternating movements)
  • Difficulty with certain tasks such as finger tapping, skipping, tracing a maze, or cutting paper
  • Mixed laterality (i.e. ambidexterity)
64
Q

Variable/similar structural and functional brain abnormalities are noted in children with attention-deficit/hyperactivity disorder

A

variable

65
Q

•Evidence of delayed cortical and of the frontal subcortical circuits exists

A

maturation

dysregulation

66
Q

What are the 5 Specific areas of the brain affected by deficits?

A

frontal lobes,

inferior parietal cortex,

basal ganglia,

corpus callosum, and

cerebellar vermis

67
Q

Which areas have widespread small-volume reduction in the brain?

A

prefrontal cortex,

caudate,

and cerebellum

68
Q

Children with ADHD have variable deficits in cognitive processing, attention, planning, and of processing responses

A

motor

speed

69
Q

What are the 4 treatment goals for those with ADHD?

A
  • Improve core symptoms of inattention and hyperactivity/impulsivity
  • Improve school performance and optimize functional performance
  • Remove behavioral obstacles
  • Monitor disorder and adjust treatment over time based on treatment goals
70
Q

What is the treatment of choice for most patients is?

A

pharmacotherapy

71
Q

Other than improving long-term outcomes, what 3 major short-term outcomes occur with treatment with medications?

A

short-term enhancement of

academic, social, and behavioral functioning

72
Q

Treatment with medications decreases the likelihood of emergence of depression, oppositional defiant disorder, anxiety disorders, and substance use disorders;

treatment reduces aggression and antisocial behavior

A

stimulant

73
Q

What is the first line treatment for preschool aged children (4-5ys old)

A

behavioral therapy

74
Q

What is second line treatment for preschool (4-5) aged children if behavior interventions do not provide significant improvement and there is moderate to severe continuing disturbance in the child’s function?

A

methylphenidate

75
Q

What is the first line treatment for elementary school-aged children (6-11 yrs old)?

A

Medications are first line

Stimulants are preferred - ritalin, methphenedate, dexamphetamine

76
Q

What are the second line medications for Elementary school–aged children (aged 6-11 years)?

A

Atomoxetine, guanfacine, and clonidine are second line

77
Q

Bipolar adults can have ADHD symptoms when younger and medications will not work

A

stimulant

78
Q

Which medicine is an adjunct for an agry ADHD kid that will help with the anger symptoms?

A

guanfacine (BP medication)

79
Q

What is the first line treatment for adolescents (12-18 yrs old)?

A

Medications are first line and consider behavior therapy; preferably both

80
Q

What are the baseline measurements that should be taken and why?

A

Height, weight, blood pressure, and resting pulse rate

sleep patterns, appetite

Used to monitor effect and effectiveness of medications

81
Q

What circumstance would indicate referral to a specialist before beginning stimulatnt medication?

A

Patient history, family history, or physical history exam suggestive of cardiac disease

82
Q

When is taking a baseline ECG indicated?

A

abnormal personal history concerning for cardiac disease,

family history of cardiac disease, and

abnormal physical examination findings

83
Q

No evidence exists that pharmacologic treatment in children or adolescents causes abnormal changes in , sudden cardiac death, acute myocardial infarction, or stroke

A

QT-interval

84
Q

Stimulant medications are presynaptic agonists

A

dopamine

85
Q

What are the 3 main groups of stimulants for treating ADHD?

A

methylphenidates

amphetamine salts

mixed preparation

86
Q

What are the 2 types of methylphenidates?

A

Methylphenidate (eg, Ritalin, Concerta, Metadate, Methylin, Daytrana)

Dexmethylphenidate (eg, Focalin)

87
Q

What are the 2 types of amphetamine salts?

A

Dextroamphetamine (eg, Dexedrine)

Dextroamphetamine prodrug lisdexamfetamine (eg, Vyvanse)

88
Q

What is in the mixed stimulant preparation for treatement of ADHD?

A

Amphetamine and dextroamphetamine (eg, Adderall)

89
Q

Short-acting methylphenidate preparation duration is up to hours

A

5

90
Q

-acting methylphenidate (eg, Ritalin SR, Metadate ER, Methylin ER in the form of SR tablets) duration of action is 6 to 8 hours

A

Intermediate

91
Q

-acting preparations (eg, Concerta osmotic release tablets, Ritalin LA beadfilled capsules, Metadate CD bead-filled capsules, Biphentin bead-filled capsules, Quillivant XR liquid, Daytrana transdermal patch) duration of action is up to 12 hours

A

Long

92
Q

Long-acting preparations include dextroamphetamine SR (ie, Dexedrine Spansule) and lisdexamphetimine (ie, Vyvanse); lisdexamphetimine duration of action is over 10 hours

A

amphetamine

93
Q

• Doses of stimulants are/are not weight-dependent; lower doses of stimulants may produce suboptimal effects when dosed and titrated on a mg/kg basis

A

are not

94
Q

Start dose at low/high end of dosing range; titrate dose up every days until effective dose is achieved with minimal or no adverse effects

A

low

95
Q

Most adverse effects are dose and diminish with a decrease in dose or wane with time

A

dependent

96
Q

What % of patients will have an optimal response on low dose, medium dose, high dose, and will be unresponsive/unpalatable side effects?

A

25%

97
Q

What is the biggest side effect for ADHD medications?

A

loss of appetite

98
Q

By about how much will someone’s BP and HR increase on ADHD medication?

A

Small increase of 5mm/hg of BP

Small increase of heart rate 10 bpm

99
Q

Review the most common adverse side effects?

A
100
Q

Review the less common adverse side effects:

A
101
Q

What are the 6 rare side effects of ADHD medications?

A

Rare:

priapism,

peripheral vasculopathy,

depression,

suicidal ideation, and

sudden unexpected death

102
Q

What are the 2 Adverse effects at high doses:

A

headache and abdominal pain

103
Q

Treatment of children with stimulant medications does/does not increase risk and may decrease the risk of developing a substance use disorder later in life

A

does not

104
Q
A

ICOM - Mental Health (24 decks)

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