104b - ADHD Flashcards
Which areas of the brian are affected by ADHD?
- Prefrontal cortex
- Executive function and planning
- Striatum
- Reward, reinforcement
- Motivation for behavior and activities
- Some cerebellum
- Overall brain volume
What is the mechanism of action of atomoxetine in the treatment of ADHD?
In which patients is it indicated?
Selective norepinephrine reuptake inhibitor
Works as an antidepressant to treat ADHD + anxiety
**Black box warning: increased suicidal thoughts in teenagers**
What comorbididities should we be aware of in children with ADHD? (4)
- Behavior or conduct problem
- Anxiety
- Depresssion and othe rmood disorders
- Autism spectrum disorder
- Learning and/or speech disorders
- Tourette syndrome
- Substance use disorder
- Obesity
What environemtal exposures contribute to risk of ADHD?
- Smoking, alcohol, drugs during pregnancy
- Lead exposure
- Brain injury
- Premature delivery + low birth weight
What causes ADHD?
Strong genetic component
(multiple genes + gene-environment interaction)
Environmental risk factors
- Smoking, alcohol, drugs during pregnancy
- Lead exposure
- Brain injury
- Premature delivery + low birth weight
- May confound with other factors
What is the role of therapy in the treatment of ADHD?
Therapy alone is less affective than medication alone
However, combination treatment may be good for other areas of functioning
- Anxiety
- Academic performance
- Parent-child relationships
- Social skills
What is the mechanism of action of stimulant medications in the treatment of ADHD?
Stimulants = methyphenydate, amphetamine
- Stimulate portions of the brain that are underactive
- Increase available dopamine and norepinephrine by blocking reuptake, facilitating release into the synapse
Amphetamine specifically gets into the presynaptic neuron and increases vesicle release
What is the most effective treatment for ADHD?
Medical management
Stimulants are first line
(Atomoxetine, alpha-2 blockers 2nd line)
What is the mechanism of action for guanfacine in the treatmnet fo ADHD?
What are the indications and side effects?
Alpha-2 agonist; reduces CNS activation
Helps with sympathetic overdrive, reduction of fight/flight response
Can be used in conjunction of stimulants
May cause sedation, drowsiness, depression, low BP, dizziness, fainting
What is the DSM-5 criteria for ADHD?
Persistent patern of inattention and/or hyperactivity-impulsivity that interferes with function or development, persisting for at least 6 months
- Requires 6+ symptoms in either category
- (Or 6+ in each category for mixed)
- In at least 2 settings
In how many settings do ADHD symptoms ahve to occur in order to diagnose ADHD?
At least 2
What are the contrindications to stimulants for the treatment of ADHD?
Significant cardiac history
Before what age must ADHD symptoms present to meet criteria for formal diagnosis?
Before age 12
What are the side effects of stimulants to watch out for in the treatment of ADHD?
- Decreased appetite
- Insomnia
- Headache
- Nausea
- Less common
- Irritability
- Lability
- Tics
- Heart racing
- Emotional blunting
- Hallucinations
What is the prevalence of ADHD?
3-11% of school-aged children
M>F
F more likely to have the inattentive type
