Flashcards in ADHD Deck (18):
ADHD is called what? Different types; other features different in DSM V vs. DSM IV?
1. ADHD combined 2. ADHD inattentive 3. ADHD hyperactive/impulsive;
Think before age of TWELVE, has to occur in multiple settings (home, school, football field, restaurant), and must cause SOCIAL DISABILITY
For ADHD inattentive, what is needed for diagnosis and what are symptoms?
6 INATTENTION symptoms for 6 months: FAT LOT DMF
1. Poor attention to detail leads to MISTAKES
2. Cannot sustain ATTENTION
3. Does not LISTEN
4. Does not FOLLOW THROUGH
5. Does not ORGANIZE
6. Avoids TASKS
7. Loses THINGS
8. Is DISTRACTED
9. Is FORGETFUL
For ADHD hyperactive/impulsive, what is needed for diagnosis and what are symptoms?
6 hyperactive/impulsive symptoms: FLLR WIth TB
2. LEAVES seat
4. Too LOUD (not quiet)
5. TALKS a lot
6. BLURTS out answers
7. Cannot WAIT turn
Course of ADHD?
1. Usually apparent at young age where age appropriate norms for paying attention and delaying gratification are not met
2. Milder and more inattentive causes might not be noticed until LATER IN LIFE when demands are GREATER!!
3. Inattentiveness tends to persist greater than hyperactivity/impulsivity
Genetics of ADHD?
70-80% heritable, greater than schizo; chromosome-related;
MANY GENES associated with ADHD and think DAT, DA receptors, dopa decarboxylase genes and NET or NE receptor genes defective
As we go up the U-shaped curve in ADHD, what do you see near the bottom on the x-axis and then at the top? What is the x-axis?
1. MDD, negative symptom schizo
Transmitter/receptor complexes and neuronal firing
For ADHD, what will neuroimaging show?
Hypoactivity of the anterior cingulates (other areas have to compensate for this)
Regarding ADHD, and it being a neurodevelopmental disorder, the brain
might be developing two years slower without appropriate pruning in the teenage years
Key NT's involved in ADHD?
Decreased tonic NE and DA firing in PFC
Environmental factors (ie not genetic) contributing to ADHD?
1. Cig/alcohol use in pregnant woman
2. Lead poisoning
3. Head injuries
4. Maybe learned behavior (look at what's going around the house with your parents and if they're hyperactive/impulsive
5. Reaction to stress and anxiety?
DD and associated conditions with ADHD?
2. Learning disability (less cingulate activity)
3. Substance use disorder
4. Personality disorder
5. Bipolar disorder
Most common disorder associated with ADHD?
Regarding meds for ADHD, what mech do they use and the SE's?
1. Stimulants (promote DA and NE, risk of addiction, paranoia potentially, stunted growth and weight loss)
2. Non-stimulants (atomoxetine, guanfacine ER and clonidine ER are LESS EFFECTIVE, but carry no addiction risk since they don't deal with dopamine, can be sedating often, and alpha-2 agonists can lower BP)
How do you manage ADHD besides drugs?
Psychotherapy (think COGNITIVE BEHAVIORAL therapy for ADHD, the leading treatment for ADHD that's actually a therapy)
What do you start with for preschoolers regarding treatment for ADHD?
Behavioral therapy FIRST!! (then go up to amphetamines for kids 4-5, and then try methylphenidate later at 7-8)
For ADHD children and adolescents, what do you start with and why? What about adults?
Start with slow-release MPH and then amphetamines because there's less risk of addiction, and later can give immediate release stimulants followed by non-stimulants (you want to save the kid's life FIRST! Do that with amphetamines);
Adults start with non-stimulants because you're worried more about addiction, and only later would you give slow-release stimulants and immediate release stimulants!!
For ADHD, what receptors do you have on the pyramidal neurons in the cortex? What does this mean for treating ADHD?
Dopamine 1 and NE alpha 2 receptors; AD and NE can help allow noise to dissiate and increase signal strength to the neuron, respectively;
OR just give clonidine/guanfacine