Week 1 - ADHD Flashcards
What is the male to female ratio of hyperkinetic disorders?
3-4:1
What are the core features of ADHD?
Inattention and lack of persistence in activities requiring concentration.
Excessive activity
Impulsivity.
What are the clinical features of ADHD?
Apparent before the child is age 7 years.
Excessive for the child’s age and development.
Pervasive i.e. evident in more than 1 environment e.g. at home and in school.
Symptoms may worsen in the afternoon.
Which genes are related to susceptibility of ADHD?
DRD4 SLC6A3/DAT1 DRD5 SLC6A4/5HTT HTR1B
What are the changes in the brain in people with ADHD?
Smaller brain volume - frontal and parietal cortex.
Smaller basal ganglia.
Right dorso-lateral prefrontal lobe reduced.
Smaller cerebellar vermis.
Attentional systems involve - anterior fronto-striatal networks
Posterior parieto-cerebellar circuits.
Which executive difficulties are associated with ADHD?
Organisation Planning Working memory Attention Response inhibition Impulse control.
Which comorbid disorders are associated with ADHD?
Sleep disorders Behavioural difficulties Specific learning disabilities Development co-ordination disorders Social communication difficulties Anxiety symptoms Tic disorders Mood difficulties Increased psychosocial factors.
What does assessment for ADHD include?
Direct observations in >1 setting. Psychoeducational assessment. Structured questionnaires. Identifying co-morbid (mental) health problem Developmental history Develop a formulation
What kind of information should be asked of parents?
Current behaviours Ability to sustain interest Eating and sleep habits What is the impact? Responses to interactions with others Parental management strategies Structured questionnaires
Which additional assessments should be taken when diagnosing ADHD?
Hearing and vision screening checks.
If appropriate to previous health problems, e.g. cardiac or epilepsy.
Screening for neurlogical signs and physical anomalies.
Baseline height and weight
Baseline blood pressure and heart sounds.
What is the non-pharmacological management of ADHD?
Provide a calm environment.
Avoid too many distracting stimuli when you want the child to concentrate.
Initially, avoid situations that require quiet, still behaviour for long periods.
Maintain structure and supervision longer than you think should be necessary.
What kind of information should be given at behaviour training programmes?
Encourage consistency in managing less desirable behaviour.
Do not personalise the behaviour problems.
Positively reinforce appropriate and acceptable behaviour.
Assist parents tob e firm and in control without being coercive.
Provide feedback using direct observation of interactions between child and parents.
What are the main pointers for behavioural management?
Do not give instructions without first gaining the child’s attention
Give clear direct instructions
Ask the child to repeat the instructions back to ensure they have heard & understood them
Improve concentration skills with activities the child already enjoys
Try and plan ahead for problem situations
What is meant by pharmacokinetics?
What your body does to the drug.
What is meant by pharmacodynamics?
What the drug does to your body.
What is meant by bioavailability?
Fraction of the administerd dose of drug that reaches the systemic circulation. expressed as letter F. Affected by many factors.
What is meant by clearance?
Volume of plasma cleared of drug per unit time.
What is meant by half-life?
Time required for serum plasma concentration to decrease by half.
What is the volume of distribution?
The volume in which the amount of drug would need to be uniformly distributed to produce observed blood concentration.
How many half lives to reach steady state?
4-5
What is meant by linear pharmacokinetics?
Concentration that results from a dose is proportional to the dose. Rate of elimination is proportional to the concentration.
What is meant by non-linear pharmacokinetics?
Concentration that results is not proportional to dose.
Rate of elimination is constant regardless of amount of drug present.
Dosage increases can saturate binding sites and result in non-proportional increase in drug levels.
Name 4 types of drug receptor.
Enzyme linked - multiple actions
Ion channel linked - speedy
G protein linked - amplifier
Nuclear (gene) linked - long lasting
What does affinity measure?
Propensity of a drug to bind to receptor; the attractiveness of drug and receptor.
What is meant by efficacy?
Ability of a bound drug to change the receptor in a way that produces an effect; some drugs possess affinity but NOT efficacy.
What is a full agonist?
An agonist with maximal efficacy.
What is a partial agonist?
An agonist with less than maximal efficacy.
What do antagonists do?
Antagonists interact with the receptor but do not change the receptor they have affinity but no efficacy..
What is a competitive antagonist?
Competes with agonist for receptor. Surmountable with increasing agonist concentration displaces agonist dose response curve to the right reduces the apparent affinity of the agonist.
What is functioning incorrectly in ADHD?
Low tonic firing of dopamine and noradrenaline neurons.
What is the first line medication of ADHD?
Psychostimulants e.g. methylphenidate and dexamphetamine.
What is the 2nd line treatment of ADHD?
Atomoextine
What is the purpose of 3rd line treatment of ADHD?
To augment therapy.
What does dexamfetamine do?
Facilitates release of dopamine from presynaptic cytoplasmic storage vesicles in synapse and blocks dopamine transporter protein (inhibits reuptake).
What does methylphenidate do?
Acts on dopamine transporter and has little effect on synaptic release.
In what percentage of cases are stimulants active?
75%
What effect do stimulants have on symptoms?
Improved attention span
Decreased hyperactivity and impulsivity.
Decreased aggression.
What is the usual dosing for methylphenidate?
MPH IR 5mg tablets (3-4 times a day).
Rapid on set of action.
What is the usual dosing of dexamfetamine?
Dexedrine 5mg (TDD max 20-40mg).
What are the side effects of psychostimulants?
Potential for growth retardation. Anorexia. BP and HR irregularities. Insomnia/sleep difficulties. Mood changes Abdominal pain Headaches.
What kind of physical health monitoring needs to be done for patients on stimulants?
Baseline HR and BP. Repeat at every dose adjustment and every 6 months.
Pre-treatment height and weight on growth chart and every 6 months.
Complete medical history.
What does atomoxetine do in the brain?
Noradrenaline reuptake inhibitor.
Enhances noradrenaline transmission in the prefrontal cortex area.
What are the side effects of atomoxetine?
Nausea Excessive tiredness Insomnia Abdominal pain Constipation Headaches Mood swings Hepatic impairment Increased heart rate Suicidal ideation
Give 2 examples of second line adrenergics?
Clonidine
Guanfacine
