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ADHD Flashcards

(40 cards)

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1
Q

3 main symptoms of adhd

A

inatentiveness, (impulsivity, hyperactivity) - usually cluster together

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2
Q

Diagnostic Tests

A

ICD-11 international classifiaction of mental and behavioural disorders 11th
DSM-V (broadly used) diagnostic and statistical manual of mental disorders 5th edition

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3
Q

Innatention

A

significant difficulty in sustaining attention to tasks that do not provide high level of stimulation or frequent rewards, easily distracted and problems woth organisation

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4
Q

Hyperactivity

A

excessive motor activity and difficulty remaining still, most evident in structured situations that require behavioural self control

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5
Q

impulsivity

A

tendency to act in response to immediate stimuli without deliberation or consideration of the risks and consequences

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6
Q

Why can’t ADHD be considered a catergorical diagnosis

A
  • symptoms can overlap with other related disorders
    -in children - mood,conduct, learning disorders, motor control,anxiety disorders
    -in adults - personality disorders bipolar, OCD, substance misuse
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7
Q

Diagnostic criteria ICD-11

A

Inattention, impulsivity, overactivity must all be present from early age, persist in ore than one setting, and impair social function, learning, and normal development

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8
Q

inattentive symptoms

A
  • fails to have attention to details
    -difficulty keeping attention during tasks
    -does not seem to listen when speaking to them
    -no follow through on tasks
    -often loses things and is forgetful
    -easily distracted
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9
Q

Hyperactivity symptoms

A

-fidgets/squirms
-cant sit still
runs/climbs in innapropriate situations
-difficulty playing quietly
-often “on the go”

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10
Q

impulsivity symptoms

A

-blurts out answers before question is finished
-difficulty awaiting turn
- interupts or intrudes

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11
Q

what % of children are diagnosed with ADHD

A

Very common to see in practise, 6% of all children are diagnosed with ADHD and is 30-50% of all child mental health cases

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12
Q

People with _____ are more likely to have ADHD

A
  • born preterm
    -children in care
    -those with conduct disorders, ODD, Mood disorders
    -close family with ADHD
    -epilepsy
    -neurodevelopment disorders eg autism
  • adukts with mental health conditions
    -substance misuse
    -people who have been involved in crime/ gone to prison
    -brain injuries
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13
Q

why is ADHD underrecognised in girls?

A

usually misdiagnosed with other mental health disorders

girls less likely to be referred

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14
Q

What type of condition is ADHD

A

chronic

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15
Q

Initial managemnt of ADHD

A

extensive and comprehensive mental helath assessment by a specialist clinician
AND
full assessemnt by educational and/or clinical psychologist

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16
Q

onset of ADHD

A

-usually before 3 years old
- atleast 6 months of aladaptive level
-clinically severe in atleast 2 different settings

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17
Q

1st line treatment - Non pharmaceutical intervention

Study These Flashcards
A

-education and advice
-parent training / family centered therapy
- Behavioural interventions (school/preschool)

18
Q

Why is it hard to have medications for syndromal control rather than just managing symptoms?

Study These Flashcards
A

-experiemental studies are difficult both ethically and practically

19
Q

why are most drugs used off -license

Study These Flashcards
A

pharma’kinetics pharma’dynamics extrapolated from adults only
- must openly disucss with parents/carers
-must obtain INFORMED consent

20
Q

Why are adult drugs not hazardous towards children

Study These Flashcards
A
  • decreases bioavailability as children have greater metabolism
  • greater distrubution as relatively larger extracellular fluid
    -can cross BBB rapidly
21
Q

how should medication dosages be prescribed

Study These Flashcards
A

mg/kg to reflect adult/child differences

22
Q

ideal properties of ADHD medication

Study These Flashcards
A
  • long duration of action
  • not addictive
  • easy administration
  • no affect on appetite
  • rapid onset of action
    -effective in treating symptoms
  • dissipates rapidly as to not induce insomnia
23
Q

what criteria does the patient need to meet to be able to initiate medication?

Study These Flashcards
A
  • they continue to meet criteria for ADHD and need treatment
    -presence of co-existing health and social circumstances
    -current educational and or employment circumstances
    -risk assessment for substance abuse
    -care needs

plus baseline physicals test (see monitoring requirements)

24
Q

1st line treatment for children aged 5 and over

Study These Flashcards
A

Methylphenidate (not licensed in children under 6) if after 6 week trial does not show desired benefit you can switch

25
methylphenidate MoA
inhibits uptake of monamines into presynaptic neurone, thereby increasing dopamine hit at presynaptic receptor sites
26
methylphenidate dosing regime
5-10mg OD/BD, increase weekly by 5-10mg until reach 60mg, if no response after 1 month decrement dose and stop concerta XL 18,36mg tablets stimulants usually withdrawn during or after puberty
27
methylphenidate adverse affects
insomnia, decreases appetite, euphoria,depression/anxiety, in rare cases : psychosis, hepatic dysfunction
28
2nd line treatment
lisdexamfetamine - >=6yrs dexamfetamine - >=3yrs
29
(lis)dexamfetamine MoA
amfetamines are non-catecholamine sympathomimetic amines (mimics sympathetic nervous system) with CNS stimulant acitivity thought to block the reuptake of norepinephrine and dopamine into presynaptic neurones and increase release of monaines into extra-neuronal space.
30
lidexamfetamine dosing
-individualised according to therapeutoc needs and response to patient - initially start on 30mg OM some start on 20mg OM - can increase 10-20mg weekly -should take the lowest most effective dose max 70mg per day
31
dexamfetamine dosing
start at lowest possible dose - 5mg OD/BD -increase by 5mg weekly only if necessary -tolerability and efficacy should be observed max dose is 20mg in some speicialist circumstances upto 40mg should be taken when most needed (eg combat school/social behavioural needs) usually AM and lunchtime as later in the day can cause sleep disturbance
32
atomoxetine MoA and dosing
highly slective inhibitor of the pre synaptic noradrenaline transporter, minimal effect on sertonogernic or doperminergic transporters 0.5mg/kg children <70kg - after 7 days 1.2mg/kg children >70kg - 40mg and after 7 days 80mg maintenance dose adults - 40mg 7 days then 80-120mg maintenance
33
guanfacine MoA
selective alpha2A-adrenergic receptor agonist non stimulant - modulates pfc and bg signalling through direct modification of synaptic noradrenline transmission at alpha 2 adrenergic receptors antihypertensive - reduces sympathetic nerve impulses from vasomoter centre to the heart and blood vessels = lower vasucular resistance, blood pressure, heart rate
34
guanfacine dosing
dose titration and monitoring is neccassary - patients shoul be advised about this particularly at initiation of treatment somolence and sedation are clinically significant or persistant decrease dose or discontinue side affects : syncope, hypotension, bradychardia, somolence, sedation sustained orthostatic hypotension or fainting episodes reduce/switch medication
35
monitoring of ADHD drugs
- monitor effectiveness of medication and side affects -patient should monitor their own side affects -use rating scales MADRS YMRS -regular reviews regardless of on medication or not -height and weight -heart monitoring (comparisons to normal range) before and after each dose change and every 6 months if tachychardic, arrythmias or systolic BP >95th percentile measured on 2 occasions - reduce dose and refer to paed hypertension specialist - sleep- use sleep diary -sexual dysfunctunction (switch to amoxetine) -epilepsy (stop review gradual re-intro) -worsening behavior
36
how often should height and weight be monitored
height every 6 months weight every 3 months (<=10yrs) every 6 months (>10yrs) should be plotted on a growth chart
37
what should you do if patient develops Tics from stimulants
switch to guanfacine ,amoxetine or clomidine
38
other medications that can be used
TCAs (imipramine) Clomidine Rispiredone buprioprion modafinel
39
what %of parents with ADHD have children with it
40-60
40
what % of children with ADHD have a parent with it
25%

spectrum disorders (2 decks)

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