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7. Child and adolescent psychiatry > ADHD > Flashcards

ADHD Flashcards

(56 cards)

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1
Q

Cardinal features of ADHD

A

Hyperactivity
Impulsivity
Inattention

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2
Q

Age at which symptoms should be present for a diagnosis of ADHD in DSM V

A

12

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2
Q

Age at which symptoms should be present for a diagnosis of ADHD in DSM V

A

12

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3
Q

Change for DSM V regarding ADHD and ASD in combination

A

Comorbid diagnosis now allowed

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4
Q

Questionnaire used to get information for teachers to investigate ADHD symptoms

A

Connor’s questionnaire

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5
Q

Number of settings symptoms must be present in for a diagnosis of ADHD

A

2 or more

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6
Q

Length of time ADHD symptoms should persist before a diagnosis

A

6 months

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7
Q

Prevalence of ADHD in UK school aged children by DSM IV criteria

A

3-4%

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8
Q

Prevalence of ADHD in school aged children by ICD 10 criteria

A

1-2%

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9
Q

Rate of ADHD in boys compared to girls

A

3:1

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10
Q

Increased risk of ADHD with an affected sibling

A

2-3x higher

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11
Q

Heritability of ADHD

A

80%

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12
Q

Concordance of ADHD in monozygotic twins

A

79%

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13
Q

Concordance of ADHD in dizygotic twins

A

32%

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14
Q

Genes associated with ADHD

A

Dopamine transporter gene (DAT1)
Dopamine D4 receptor gene
SNAP-25

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15
Q

Functional imaging findings in children with ADHD

A

Lower cerebral blood flow to frontal areas
In teenage girls - globally lower glucose metabolism

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16
Q

Neurotransmitters involved in ADHD

A

Dopamine and noradrenaline dysregulation in the prefrontal cortex

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17
Q

Potential environmental factors involved in ADHD

A

Obstetric complications
Low birth weight
Prematurity
Prenatal exposure to alcohol, nicotine, and benzodiazepines
Poor attachment
Early deprivation
Living in an institution

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18
Q

Percentage of children with ADHD who have comorbid conduct disorder

A

14%

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19
Q

Percentage of children with ADHD who have comorbid oppositional defiant disorder

A

40%

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20
Q

Percentage of children with ADHD who have comorbid anxiety disorder

A

34%

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21
Q

Percentage of children with ADHD who have comorbid tics

A

11%

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22
Q

Percentage of children with ADHD who have comorbid mood disorder

23
Q

Percentage of children with ADHD who meet diagnostic criteria in adulthood

24
Percentage of children with ADHD who develop substance misuse problems as adults
15-20%
25
Mechanism of action of stimulant treatments of ADHD
Release noradrenaline, dopamine and serotonin Increase extracellular dopamine which inhibits impulses
26
Reason for withdrawal of pimoline for ADHD treatment
Abnormal LFTs Occasionally liver failure
27
Most rapid stimulant ADHD treatment
Methylphenidate
28
Daily dose range of methylphenidate
5-60mg daily
29
Mechanism of action of atomoxetine
Noradrenaline reuptake inhibitor Increases noradrenaline in the synaptic cleft
30
Monitoring required for methylphenidate and atomoxetine
Height Weight BP HR 3 monthly then 6 monthly For atomoxetine - LFT monitoring recommended
31
Relationship between ADHD medications and tics
Methylphenidate can cause tics; atomoxetine does not
32
Adverse effects of methylphenidate
Decreased appetite and weight loss Growth slowing for first 2 years Sleep disturbance Cramps Headaches BP and pulse increase Emotional blunting Tics Depression Hallucinations
33
Adverse effects of atomoxetine
Decreased appetite and weight loss Mild growth slowing GI symptoms Fatigue Dizziness
34
Medications which may improve ADHD symptoms other than stimulants or atomoxetine
TCA Alpha 2 agonists Antipsychotics
35
Benefits of using TCAs for ADHD
Treats comorbid depression and anxiety May be useful for stimulant non-responders
36
Monitoring required for TCA treatment of ADHD
ECG
37
Adverse effects of TCAs used to treat ADHD
Sedation Changes in BP (up or down) Dizziness Dry mouth Heart block
38
Benefits of alpha 2 agonists to treat ADHD
Treat comorbid tic disorder or aggression Useful for those who are over-aroused Can be useful for stimulant non-responders
39
Adverse effects of alpha 2 agonists used to treat ADHD
Delayed response Sedation Postural hypotension Dry mouth Hallucinations Hypertensive rebound if doses missed
40
Male:female ratio of ADHD
4:1
41
Environmental risk factors for ADHD
Prematurity Maternal alcohol use during pregnancy Maternal smoking during pregnancy Head injury
42
First line medication for a child with ADHD and a congenital heart condition
Atomoxetine
43
Symptoms most likely to resolve first in childhood ADHD
Hyperactivity
44
Percentage of children with ADHD who have comorbid ASD
59%
45
Percentage of children with ADHD who have specific learning disorders
70%
46
Class of medication which can be used for ADHD with comorbid depression/anxiety
TCA
47
Length of time a trial of methylphenidate or lisdexamphetamine should last
6 weeks
48
Percentage of children who have ADHD
5-7%
49
Percentage of adults who have ADHD
2.5-3.5%
50
ADHD medication which should be avoided if there is hepatic impairment
Atomoxetine
51
Medication suggested for ADHD with comorbid tics
Alpha 2 adrenergic agonist e.g. clonidine
52
First line medication for adult ADHD
Methylphenidate
53
Neural pathway implicated in ADHD
Frontostriatal
54
First line treatment for ADHD if there are substance misuse concerns
Atomoxetine
55
Second line treatment for ADHD if there are substance misuse concerns and atomoxetine is not suitable
Modified release methylphenidate e.g. Medikinet XL

7. Child and adolescent psychiatry (9 decks)

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