Flashcards in ADHD Deck (30):
What is the minimum time requirement that one must show these symptoms for before being diagnosed with ADHD ??
Is a quick initiation of medication a good or bad idea when referring to ADHD patients?
What is associated with ADHD?
-lower driving record
-increased drug abuse
-decreased job performance and status
What comorbidities are common with ADHD?
-oppositional or conduct disorder
-enuresis (involuntary urination)
What two types of symptoms exist in ADHD?
Describe the inattentive symptoms
Describe the hyperactive symptoms
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
What symptoms go away first?
The hyperactive symptoms go away first. The inattentive symptoms usually follow, but not always.
How many kids have ADHD? (according to US stats)
How many adults have ADHD? (according to US stats)
Describe the etiology (origination) of this disease
-right sided hypofrontality
-locus ceruleus "underperforms"
-fall birthdays (this is questionable)
-worsened by stressors
-more evident in routinized setting (School)
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
What is the risk associated with first degree relatives?
What increases a person's risk of developing ADHD?
-FAS (fetal alcohol syndrome)
-adverse or absent parent-child relationship
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
Describe the "multimodal" approach to treating ADHD
-avoid triggers if known
-when meds are needed use a combination treatment (drugs without support = low success rate)
-behavioral - parent, family, classroom, (structures, checklists, attainable goals)
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
What is arousal dysregulation ?
-insufficient alertness alternating with overarousal
What are the main neurochemical targets associated with ADHD drug treatment?
**these are both underperforming in patients with ADHD
Stimulants which augment both of these systems are considered 1st line treatment!!
regulated arousal = ?
increased control = ?
reduced hyperactivity and/or aggression
What are possible psychostimulants that could be used in ADHD?
-methylphenidate (ritalin, adderall, biphentin)
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
What are some adverse effects associated with stimulants?
-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
Describe an alternative such as atomoxetine.
-enhances the activity of norepinephrine by inhibiting the reuptake from the synapse, with minimal direct effect on Dopamine
-no abuse potential
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!!
What are important points involving dose adjustment?
-doses may need to be changed with growth, with symptoms or which changing adverse effects