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Drugs and Behavior > Stimulant Medication & ADHD > Flashcards

Stimulant Medication & ADHD Flashcards

1
Q

What is ADHD?

A

attention deficit hyperactivity disorder

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2
Q

ADHD as a real and measurable disorder

A

not just kids who can’t sit still
not due to video games or lack of discipline
both over diagnosed & under diagnosed

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3
Q

inattention

A

careless mistakes
difficulty focusing
forgetfulness/losing things
difficulty staying on task/following instructions
organization problems

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4
Q

hyperactivity/impulsivity

A

fidgeting/restlessness/trouble sitting still
trouble stopping themselves from x- calling out an answer, interrupting…
excessive talking/movement
acting without thinking
trouble waiting in line/for your turn
reduced inhibition to risk

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5
Q

3 presentations

A

primarily inattentive- “daydreamers”
primarily hyperactive- usually diagnosed young boys
combined type

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6
Q

diagnosis

A

at least 6 symptoms for at least 6 months
not age appropriate
symptoms impair normal functioning
cannot be the result of other problems

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7
Q

some statistics

A

the most commonly diagnosed neurodevelopmental disorder

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8
Q

predominant rates of ADHD

A

ages 3-17
6-16%

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9
Q

among those diagnosed with ADHD

A

~38-81% are taking a stimulant medication
**medication is usually not recommended for children younger than 6
behavioral interventions (for the individual & the family) should accompany medication

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10
Q

Why do we need to treat?

A

people with ADHD make up a large proportion of the population
can also be highly functional members of society (strengths)

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11
Q

people with ADHD are more likely to have problems with

A

accidents & injuries
job loss & divorce
higher risk of addiction/substance use disorders
emotional regulation
sense of time/timing
excessive risk taking behavior poop

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12
Q

comorbidity

A

any mental, emotional, or behavioral disorder
behavior or conduct disorder
anxiety
depression
autism spectrum disorder
tourette syndrome

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13
Q

current treatment model

A

multimodal treatment

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14
Q

multimodal treatment

A

medication helps to manage symptoms
behavioral therapy help manage- day to day tasks, skills & strategies to minimize impairment, social skills training

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15
Q

ADHD in the brain

A

there are measurable and distinct differences between the brains of those with ADHD & “neurotypical” people

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16
Q

chemical differences of ADHD in the brain

A

lower levels of dopamine & norepinephrine

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17
Q

distinct structural differences of ADHD in the brain

A

prefrontal cortex
basal ganglia
cerebellum

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18
Q

prefrontal cortex

A

inhibition, self-regulation, planning

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19
Q

basal ganglia

A

learning ideas & motivated responding

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20
Q

cerebellum

A

timing, coordination

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21
Q

network between prefrontal cortex and cerebellum

A

regulates other systems- network of networks

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22
Q

structural differences

A

prefrontal lobe function
PFC is critical to working memory

23
Q

prefrontal lobe function

A

matures at a slower pace in ADHD
7.5 years in neurotypical=10.5 in ADHD
MRI shows decreased prefrontal-limbic blood flow
pattern of disrupted activity and connectivity

24
Q

PFC is critical to working memory

A

manipulating information in your mind
regulating attention, organization, planning
self-monitor & changing behavior

25
structural deficits ADHD
delayed brain growth abnormalities in basal ganglia
26
overall delayed brain growth relative to neurotypical
smaller right prefrontal cortex & cerebellum
27
abnormalities in basal ganglia related to reward and learning
BG-> high density of dopamine receptors smaller caudate & globus pallidus
28
the frontostriatal circuit
the ventral and dorsal anterior cingulate also includes portions of the BG
29
the ventral and dorsal anterior cingulate
control affective & cognitive components of executive control
30
in ADHD there are abnormalities in the frontostriatal circuits
these extend to the amygdala and cerebellum
31
PFC, BG & cerebellum are closely connected
cognition & learning
32
in ADHD
reduced connectivity between cerebellum & PFC cerebellum dysfunction likely associated w/ difficulty with predicting events & timing fronto-cerebellar circuit abnormalities might represent a distinct subtype of ADHD
33
ADHD & dopamine
several symptoms of ADHD are linked with dopamine & norepinephrine in PFC & BG reward & pleasure the power of "maybe"
34
delayed reinforcement of gradient
reinforcement is most effective when it is immediate delays=much slower learning
35
in the brains of someone with ADHD
immediate reinforcement= VERY rewarding delayed reinforcement= VERY weak problematically in our society- we reward those who can delay gratification
36
neurotransmitter imbalance
psycho stimulants upregulate dopamine & norepinephrine activity
37
psychostimulants
firstline treatment for ADHD inhibit dopamine reuptake methylphenidate (ritalin) & amphetamine (adderall)
38
upregulate dopamine & norepinephrine activity
increase prefrontal activity & down regulate some* BG activity optimal response curve
39
ritalin
quick- reaches peak ~2hrs after administration increase norepinephrine & dopamine in CNS- blocks reuptake
40
adderall
longer effects- peak 3-7 hrs after taking increase norepinephrine & dopamine in CNS- blocks reuptake, inhibits auto receptors, increase NT release, increase # of post synaptic receptors
41
cocaine/methamphetamine
typically taken in increasing doses over time used recreationally via injection, intranasally, inhalation
42
ADHD medications
typically taken in measured & precise doses *(which are monitored & updated as needed) use is instrumental and specific (1 tablet in the AM and after lunch) via transdermal patch, oral administration, extended release
43
strong base of evidence in treating symptoms
increased academic achievement decreased absenteeism at school reduced risk of emergency administration t the hospital for injury/trauma lower risk of depression and anxiety decreased substance abuse measurable and significant benefits in children, adolescence & adults
44
kindergarten teacher
Mrs. Samera
45
adverse effects of stimulant medication
decreased appetite sleep disturbances stomach aches drowsiness increased emotionality increased blood pressure & pulse
46
sleep disturbances
ADHD already prone to circadian disregulation, can be helped with careful dosing schedule
47
decreased appetite
slower physical growth in children
48
risk-benefit analysis
children & adolescence are monitored carefully while on medication
49
monitored for
height & weight compared to peers blood pressure & heart rate monitored regularly prescreen children for other risk factors prior to medication treatment interruptions/medication holidays
50
cardiovascular problems in kids
no significant association between these drugs and cardiovascular events this has been evaluated independently in several different populations & events
51
a review of 1,200,438 people with ADHD (ages 6-24)
found no increased risk of serious cardiovascular events
52
FDA conducted a review of sudden death in patients using ADHD medication
14 pediatric & 4 adult cases of sudden death none were solely or directly related to use of ADHD medication 6 deaths were due to structural cardiovascular abnormalities
53
there is a significantly reduced risk of SUD when ppl w/ ADHD are given proper medical treatment
reduction in risk taking behavior & inhibition problems
54
reduction in self-regulating behaviors
ADHD, depression, anxiety

Drugs and Behavior (9 decks)

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