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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
Q

structural deficits ADHD

A

delayed brain growth
abnormalities in basal ganglia

26
Q

overall delayed brain growth relative to neurotypical

A

smaller right prefrontal cortex & cerebellum

27
Q

abnormalities in basal ganglia related to reward and learning

A

BG-> high density of dopamine receptors
smaller caudate & globus pallidus

28
Q

the frontostriatal circuit

A

the ventral and dorsal anterior cingulate
also includes portions of the BG

29
Q

the ventral and dorsal anterior cingulate

A

control affective & cognitive components of executive control

30
Q

in ADHD there are abnormalities in the frontostriatal circuits

A

these extend to the amygdala and cerebellum

31
Q

PFC, BG & cerebellum are closely connected

A

cognition & learning

32
Q

in ADHD

A

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
Q

ADHD & dopamine

A

several symptoms of ADHD are linked with dopamine & norepinephrine in PFC & BG
reward & pleasure
the power of “maybe”

34
Q

delayed reinforcement of gradient

A

reinforcement is most effective when it is immediate
delays=much slower learning

35
Q

in the brains of someone with ADHD

A

immediate reinforcement= VERY rewarding
delayed reinforcement= VERY weak
problematically in our society- we reward those who can delay gratification

36
Q

neurotransmitter imbalance

A

psycho stimulants
upregulate dopamine & norepinephrine activity

37
Q

psychostimulants

A

firstline treatment for ADHD
inhibit dopamine reuptake
methylphenidate (ritalin) & amphetamine (adderall)

38
Q

upregulate dopamine & norepinephrine activity

A

increase prefrontal activity & down regulate some* BG activity
optimal response curve

39
Q

ritalin

A

quick- reaches peak ~2hrs after administration
increase norepinephrine & dopamine in CNS- blocks reuptake

40
Q

adderall

A

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
Q

cocaine/methamphetamine

A

typically taken in increasing doses over time
used recreationally
via injection, intranasally, inhalation

42
Q

ADHD medications

A

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
Q

strong base of evidence in treating symptoms

A

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
Q

kindergarten teacher

A

Mrs. Samera

45
Q

adverse effects of stimulant medication

A

decreased appetite
sleep disturbances
stomach aches
drowsiness
increased emotionality
increased blood pressure & pulse

46
Q

sleep disturbances

A

ADHD already prone to circadian disregulation, can be helped with careful dosing schedule

47
Q

decreased appetite

A

slower physical growth in children

48
Q

risk-benefit analysis

A

children & adolescence are monitored carefully while on medication

49
Q

monitored for

A

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
Q

cardiovascular problems in kids

A

no significant association between these drugs and cardiovascular events
this has been evaluated independently in several different populations & events

51
Q

a review of 1,200,438 people with ADHD (ages 6-24)

A

found no increased risk of serious cardiovascular events

52
Q

FDA conducted a review of sudden death in patients using ADHD medication

A

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
Q

there is a significantly reduced risk of SUD when ppl w/ ADHD are given proper medical treatment

A

reduction in risk taking behavior & inhibition problems

54
Q

reduction in self-regulating behaviors

A

ADHD, depression, anxiety

Drugs and Behavior (9 decks)

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