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medications and behavior > Chapter 6 Test (ADHD) > Flashcards

Chapter 6 Test (ADHD) Flashcards

1
Q

Alpha activity

A

Defined as EEG activity between 8 and 12 Hz characteristic of a relaxed or meditative state

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2
Q

Attention-deficit/hyperactivity disorder

A

A disorder characterized by difficulties in attention to tasks, excessive motor activity, and impulsivity. Often diagnosed in early childhood but may persist in adulthood

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3
Q

Attentional gate

A

The inhibitory influence of the thalamic reticular nucleus to regulate sensory information along the thalamocortical pathway

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4
Q

Attention regulation

A

The process whereby cortical input to the thalamus filters and allows attention to specific sensory information.

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5
Q

Autistic psychopath

A

Used to describe what is now know as Asperger’s disorder

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6
Q

Who first used the term Autistic psychopath?

A

Hdans Asperger

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7
Q

Autistic spectrum disorder

A

These include autistic disorder, Asperger’s disorder, and Rett’s disorder

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8
Q

Beta activity

A

Desychronized EEG activity ranging between 13 and 30 Hz. typically of the normal arousal state

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9
Q

Corpus callosum

A

A band of approximately 200 million interconnecting myelinated axons that unite left and right cortical areas as well as interhemispheric regions

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10
Q

Cortical underconnectivity

A

Deficits in white matter that make up the cortical circuits that integrate inter and interhemispheric connections.

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11
Q

Dopamine deficit theory

A

Depressed dopamine activity in the caudate nucleus and frontal cortices may contribute to cortical hypoarousal in ADHD

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12
Q

Dopamine transporter (DAT)

A

Proteins on the presynaptic membrane that selectively transport extracellular dopamine back into the terminal button.

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13
Q

What is responsible for dopamine reuptake?

A

Dopamine transporter (DAT)

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14
Q

Early infantile autism

A

Used to describe what is now known as autism

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15
Q

Who was the first to use the term Early Infantile Autism and when

A

Leo Kramer in 1943

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16
Q

Hypoarousal

A

A decrease in cortical arousal characterized by an increase in slow wave alpha and theta activity observed with an electroencephalograph (EEG)

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17
Q

Infantile Schizophrenia

A

A term used under the original classification scheme proposed to characterize autism

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18
Q

Who proposed infantile Schizophrenia?

A

Eugen Bleuler

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19
Q

Locus coeruleus

A

A nucleus of noradrenergic cell bodies located in the pons near the fourth ventricle

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20
Q

Neuregulin

A

A protein that signals Schwann cells for axon myelination

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21
Q

Reticular activating system

A

A system of neurons originating in the reticular formation of brainstem projecting to the thalamus and cortex.

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22
Q

What is Reticular activating system involved in?

A

In attention and cortical arousal

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23
Q

Reuptake transporters

A

Proteins on the presynaptic membrane that transfer neurotransmitter substances in the synaptic gap back into the terminal button.

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24
Q

Sensory thalamus

A

Regions of the thalamus that receive sensory information and project it to the cortex via the thalamocortical pathway

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25
Q

Thalamic reticular nucleus

A

Outer cortex of the thalamus that regulates the sensory thalamus and activity along the thalamocortical pathway.

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26
Q

What does the thalamic reticular nucleus function as?

A

an attentional gate by allowing or inhibiting sensory input to the cortex

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27
Q

Theta activity

A

Cortical EEG activity in the range of 3.5 to 7.5 Hz often observed during the early stages of sleep

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28
Q

Tuberomammillary nucleus

A

A nucleus of histaminergic cell bodies located in the ventral surface of the hypothalamus.

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29
Q

What is the Tuberomammillary nucleus involved in?

A

Believed to be involved in cortical arousal

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30
Q

White matter

A

Large groups of fast-conducting myelinated axons that interconnect regions of the brain. Often compared to grey matter, which consists of unmyelinated neurons.

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31
Q

What does white matter consist of inside the brain?

A

Inside of the brain the white myelinating matter consists of a kind of glia cells called an oligodendrocyte.

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32
Q

What does white matter consist of outside the brain?

A

Outside of the brain, in the spinal cord, this myelinating glia is called a Schwann cell.

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33
Q

What is ADHD characterized by?

A

1) Pervasive inability to attend to tasks
2) Disruptive activity/ impulsivity
3) Excessive motor activity/impulsivity

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34
Q

What do children with ADHD struggle with?

A

1) attention
2) following instructions
3) completing tasks

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35
Q

What is the percent of children diagnosed with ADHD?

A

8%

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36
Q

What is the age children are normally diagnosed with ADHD?

A

4-17

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37
Q

How many children does attention disorders affect?

A

Over 4.5 million

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38
Q

Of those who are affected, how many are taking medication?

A

Over 2.5 million (a substantial proportion)

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39
Q

When are attention disorders typically first observed in children?

A

When they begin to develop independent locomotion

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40
Q

When does ADHD normally dissipate?

A

late adolescence or early adulthood.

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41
Q

In how many do symptoms of inattentiveness persist?

A

In as many as 50% into adulthood

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42
Q

What behavioral disorders does adult ADHD come with?

A

1) depression
2) anxiety
3) conduct disorder
4) drug abuse
5) antisocial behavior

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43
Q

What disorders may attention disorders co-occur with?

A

Autism and Asperger’s

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44
Q

How long must inattention or hyperactivity-impulsivity be present before diagnosis?

A

Six months

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45
Q

How many of the symptoms must be present and to what level?

A

Six of the symptoms and they must be disruptive and inappropriate for the child’s developmental level.

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46
Q

In ADHD, where is there a pattern of hyoarousal?

A

in the corical

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47
Q

In ADHD, where kind of activity is there a pattern of increase in?

A

Theta activity

48
Q

How is a higher theta/beta activity ration among ADHD kids found?

A

In EEG

49
Q

Where in particular is there consistent cortical hypoarousal?

A

frontal and cingulate cortices

50
Q

What does FMRI studies find in the thalamic sensory activity?

A

A decrease in thalamic sensory activity

51
Q

What does a decrease in thalamic sensory activity suggest?

A

Abnormalities in reticular activating system

52
Q

What may contribute to cortical hypoarousal and an irregular EEG pattern?

A

A decrease in cholinergic input to the sensory thalamus and to the thalamic reticular nucleus.

53
Q

What underlies attentional regulation?

A

Corticothalamic projections from the frontal cortex back to the TRN

54
Q

What inhibits the stimuli that would normally arouse the cortex via the thalamacortical pathway?

A

thalamic reticular nucleus

55
Q

What happens during normal wakefulness?

A

The cholinergic input to the TRN disinhibits the attentional gate allowing for cortical arousal?

56
Q

What happens to the attention gate in ADHD?

A

It is closed and the cortex remains under aroused

57
Q

Children with ADHD may express delayed or accelerated cortical maturation.

A

Delayed cortical maturation

58
Q

T/F
There is a study showing similar developmental patterns between children with ADHD and those without but there is a significant different in cortical thickness in remaining cerebral areas.

A

True

59
Q

Where are the deficits most pronounced in ADHD patiens?

A

Prefrontal regions of ADHD

60
Q

What is presently unknown about ADHD

A

If delayed cortical maturation is a result of cortical hypoarousal or the cause of it.

61
Q

What do stimulant drugs do to normalize cortical activity?

A

They increase beta activity and decreasing slower wave alpha and theta activity in frontal cortices

62
Q

There is a —— expression of the dopamine transporter in ADHD patiens

A

increased

63
Q

What have studies using radioactive ligands for dopamine receptors find?

A

increased DAT numbers in ADHD patientns

64
Q

Where is there an increase number of DAT

A

Caudate nucleus

65
Q

Where are the differences between those with ADHD and those without not found?

A

The putamen

66
Q

What plays a key role in regulating dopamine activity throughout the brain by determining synaptic dopamine availability?

A

The dopamine transporter (DAT)

67
Q

What does increase in DAT in the caudate nucleus and frontal cortices diminish?

A

dopamine availability and receptor activity in ADHD.

68
Q

What is one of the most widely used assessment scales for measuring treatment outcomes for ADHD?

A

Connor’s Global Index (GCI) scale.

69
Q

What is used to assess changes in ADHD specifically and based on the DSM-5?

A

A subscale of the Global Index (CGI-ADHD)

70
Q

What is a more objective assessment for ADHD treatments?

A

fMRI or EEG

71
Q

What were the results of the 1999 National Institute of Mental Health’s 14 month study of ADHD treatment options?

A

They found that…
1) treatments using stimulant meds were far superior to intensive behavioral treatment or community-based treatment alone
2) Children treated with meds (alone or with combination of therapy) showed greater academic performance and social skills than those in non-medicated comparison group

72
Q

Drug abuse risk decreases or increases in stimulant-treated patients

A

Decreases

73
Q

When were amphetamines used for treatment of ADHD?

A

1930s

74
Q

What are Amphetamines used for ADHD

A

1) Dexadrine (dextro-amphetamine)
2) Adderall (dextro/levo-amphetamine)
3) Vyvanse (lisdexamfetamine)

75
Q

What is the most recently approved amphetamine for ADHD?

A

Vyvanse (lisdexamfetamine)

76
Q

What are the two stimulant drugs that are almost indistinguishable in effects from amphetamines

A

1) Ritalin (methylphenidate)
2) Focalin (dexmethylphenidate)

77
Q

What methylphenidate is only available as a skin patch?

A

Daytrana

78
Q

Methylphenidate and other amphetamine compounds account for how much off the prescription medication for ADHD?

A

90%

79
Q

How do methamphetamines and amphetamines increase synaptic concentration of both norepinephrine and dopamine?

A

1) They block reuptake transporters for NE and increase NE released into synapse
2) Bind to vesicular transporter and cause DA release from storage into the cytoplasm of terminal button
3) Increase amount of DA released rom synaptic vesicles during neuronal signaling

80
Q

How does Da contribute to cortical arousal in ADHD?

A

through the mesocortical pathway originating in the nucleus accumbens

81
Q

How does NE activity contribute to cortical arousal?

A

By reticular activating system originating in the locus coeruleus

82
Q

What are side effects of amphetamines?

A

1) Insomnia
2) nervousness
3) Irritability
4) weight loss
5) Dizziness

83
Q

What side effects of amphetamines are related to the noradrenergic activity?

A

1) Hypertension
2) tachycardia
3) cardiac arrhythmias

84
Q

What happens when one has an excessive or overdose of amphetamines?

A

psychotic states
seizures
cardiac failure

85
Q

Is Ritalin (methylphenidate) associated with an increase in cancer or stunted growth?

A

No,

86
Q

What is the most widely prescribed drug for ADHD?

A

Ritalin (methylphenidate)

87
Q

Are Strattera (atomexetine) and Provigil (modafinil) stimulants or non-stimulants?

A

Non-stimulants

88
Q

How does Strattera (atomexetine) and Provigil (modafinil) resemble amphetamines?

A

Both
1) block reuptake transporters for NE and DA
2) promote wakefulness and increase in activity

89
Q

What does Provigil (modafinil) specifically do?

A

1) increases NE and DA activity in the brainstem and forebrain areas that regulate sleep and promote wakefulness
2) activates hypothalamic centers that regulate sleep-wake cycles by inducing orexin release

90
Q

What is orexin?

A

An excitatory neuromodulator that regulates the activity of catecholamine brainstme nuclei involved in arousal.

91
Q

What does modafinil (Provigil) promote?

A

alertness by increasing histamine release in the tuberomammilllary nucleus of they hypothalamus

92
Q

What does histamine activity in the hypothalamus do?

A

1) regulates sleep
2) regulates wakefulness by activating hypothalamic nuclei involved in arousal

93
Q

Increasing histamine = what
Decreasing histamine = what

A

Increasing contributes to wakefulness
Blockade causes drowsiness and sedation

94
Q

What drug is approved for narcolepsy and excessive sleepiness associated with sleep apnea and shift-work sleep disruptions

A

modafinil (Provigil)

95
Q

What drug is as effective as methylphenidate in reducing ADHD symptom and has fewer side effects

A

modafinil (Provigil)

96
Q

What is drug is the catecholamine agonist that selectively blocks reuptake transporters for NE and may increase DA activity in frontal cortex indirectly

A

Strattera (atomoxetine)

97
Q

what was Strattera (atomoxetine) originally developed for?

A

antidepressants

98
Q

What is Strattera (atomoxetine)’s most notable side effects?

A

1) gastrointestinal discomfort
2) decreased apetite
3) Insomnia
4) agitation
5) increased heart rate
6) hypertension

99
Q

How many children does the autistic disorder effect?

A

90 to 110 in every 10,000

100
Q

What is the rate that autism occurs in men vs women?

A

four times more frequently in males than in females

101
Q

When was Autism first named?

A

1943

102
Q

By whom was autism first named?

A

Leo Kramer

103
Q

Who often sees the first signs of autism

A

parents

104
Q

What must be present for Autism?

A

1) deficits in social communication and social interaction as manifested by
2) Restricted repetitive patterns of behavior, activities, or interests

105
Q

What is the most consistent pathological correlation for autism

A

Cortical underconnectivity and deficits in both functioning and volume of anterior cingulate cortex

106
Q

What does the theory of cortical underconnectivity propose?

A

That autism is a result of deficits in white matter that makes up the cortical circuits that integrate interhemispheric connections

107
Q

What was found in fMRI for autism?

A

1) less activity in left inferior frontal gyrus (Broca’s)
2) more activity in left posterior superior temporal gyrus (Wernicke’s)

108
Q

Where was the delay during the comprehension tasks when compared to non autistic control subjects?

A

In the cortical activation

109
Q

Does deficits in the development of myelination throughout the corpus callosum and the cortex underlie autistic disorder.

A

Yes

110
Q

Where is there a reduction of corpus callosum size i autistics?

A

The anterior (genu) and posterior (splenium) regions

111
Q

What does the protein neuregulin signal?

A

Schwann cells to myelinate

112
Q

Is underconnectivity linked to a deficit in the protein neuregulin?

A

Yes

113
Q

What is myelination critical for?

A

Normal signaling within the brain

114
Q

What does myelination a major determinant of?

A

signal velocity

115
Q

Is autism a consequence of abnormal synaptic activity or neuronal communication?

A

No

116
Q

What is autism normally co-occuring with?

A

1) depression
2) anxiety
3) hyperactivity
4) seizures
5) sever behavioral agitaiton

117
Q

How are co-occuring conditions of Autism managed?

A

With medications approved for other disorders (therefore they are off label)

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