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Pathophysiology > ADHD > Flashcards

Flashcards in ADHD Deck (30):
1

Describe ADHD

-inattention
-distractibility
-impulsivity
-hyperactivity

2

What is the minimum time requirement that one must show these symptoms for before being diagnosed with ADHD ??

6 months

3

Is a quick initiation of medication a good or bad idea when referring to ADHD patients?

BAD

4

What is associated with ADHD?

-more injuries
-lower grades
-lower driving record
-increased drug abuse
-more antisocial
-decreased job performance and status

5

What comorbidities are common with ADHD?

-tourette's disorder
-learning disability
-oppositional or conduct disorder
-anxiety
-depression
-enuresis (involuntary urination)

6

What two types of symptoms exist in ADHD?

1. inattentive
2. hyperactive

7

Describe the inattentive symptoms

-distractibility
-forgetfulness
-poor organization
-impersistence
-mistake-prone
-work avoidance

8

Describe the hyperactive symptoms

-fidgetiness
-intrusiveness
-restlessness
-noisiness
-talkativeness
-inappropriate activity

9

What are percentages of remission for this disease (percent of how many people will get rid of these symptoms)

from ages 12-20: 20% will remit, 60% will partially remit

10

What symptoms go away first?

The hyperactive symptoms go away first. The inattentive symptoms usually follow, but not always.

11

How many kids have ADHD? (according to US stats)

8%

12

How many adults have ADHD? (according to US stats)

3-5%

13

Describe the etiology (origination) of this disease

-genetics
-right sided hypofrontality
-locus ceruleus "underperforms"
-fall birthdays (this is questionable)
-worsened by stressors
-more evident in routinized setting (School)

14

Describe the neuropathology and neuroimaging involved with this disease.

-small increase in cerebrum growth (10%) at 1-3 yrs
-reduced numbers of cerebellar purkinje neurons (30%)
-reduced cell size and increased cell density in the limbic areas of the brain
-modified genes/proteins impairing the balance of excitatory vs. inhibitory synaptic singling in local and extended circuits

15

What is the risk associated with first degree relatives?

4-8X

16

What increases a person's risk of developing ADHD?

-FAS (fetal alcohol syndrome)
-lead poisoning
-infantile meningits
-obstetric adversity
-maternal smoking
-adverse or absent parent-child relationship

17

What are triggers associated with ADHD?

-artificial colors, flavours, or additives
-refined sugar, sodas, caffeine
-food allergy or intolerance
-increased use in advanced technology (more video games, movies, screen time)
-essential fatty acid deficiency
-iron and zinc deficiency

18

Describe the "multimodal" approach to treating ADHD

-avoid triggers if known
-chiropractic approach
-when meds are needed use a combination treatment (drugs without support = low success rate)
-behavioral - parent, family, classroom, (structures, checklists, attainable goals)

19

List some treatment goals for patients with ADHD

-make sure they are realistic, achievable, and measurable
-may include relationship factors, academic performance, rule following
-clarity, immediacy, predictability, consistency, responsibility - VITAL

20

What is arousal dysregulation ?

-insufficient alertness alternating with overarousal

21

What are the main neurochemical targets associated with ADHD drug treatment?

-noradrenergic tracts
-dopaminergic tracts
**these are both underperforming in patients with ADHD

Stimulants which augment both of these systems are considered 1st line treatment!!

22

regulated arousal = ?

improved perfomance

23

increased control = ?

reduced hyperactivity and/or aggression

24

What are possible psychostimulants that could be used in ADHD?

-methylphenidate (ritalin, adderall, biphentin)
-amphetamines

25

How do psychostimulants help patients with ADHD?

-all block norepinephrine and dopamine reuptake
-the increases NE/DA activity in locus ceruleus improves attention, ability to focus or select
-amphetamines also promote DA and NE release from presynaptic neutrons
** by blocking reuptake we increase the activity of the neurotransmission

26

What are some adverse effects associated with stimulants?

-decrease appetite
-increase BP, anxiety, irritability, difficulty falling asleep, stomach complaints, headache
-MAY WORSEN TICS ? - what are TICs...(ex. tourette's disease)
-can flatten personality or elevate risk of sudden cardiac death

27

Describe an alternative such as atomoxetine.

-enhances the activity of norepinephrine by inhibiting the reuptake from the synapse, with minimal direct effect on Dopamine
-slower onset
-no abuse potential
-expensive

28

Describe the alternative bupropion.

-weak DA(dopamine) and NE reuptake inhibitor
-primarily used as an antidepressant or an aid in smoking cessation
-augments DA and NE, has shown value for some persons with ADHD
-less appetite effects than with stimulants
-no abuse potential!!

29

What are important points involving dose adjustment?

-doses may need to be changed with growth, with symptoms or which changing adverse effects

30

What are drug holidays? Are they good or bad in ADHD patients?

-drug holidays are when patients stop their medication for a certain period of time.
-they are good for ADHD patients and highly recommended to reassess treatment and allow for growth rebound