Attention Deficit Hyperactivity – ADHD Flashcards
What is ADHD and who does it affect specifically?
Heterogenous behavioural syndrome- inattention and hyperactive impulses symptoms are seen – 6% of children meeting criteria.ADHD accounts for 30-50% of mental health referrals.
What are the causes of ADHD?
Not clear, there is a genetic link that a parent with ADHD will have a child with ADHD – increase prevelance in groups with: Pre- mature births,epilepsy,brain injury,mood disorders.
What are the characteristics and symptoms of ADHD?
Hyperactive,impulsive and in attention
Explain features of inattention?
Fails to give close attention to detail or makes careless mistakes in school work,has difficulty keeping attention,does not listen when spoken to directly,does not follow through on instructions
Explain features of impulsivity?
Bursts out answer before question completed,difficulty waiting turn
Explain features of hyperactivity?
Fidgets with hands. Whilst symptoms tend to cluster together, some are more hyperactive and impulsive wheras others are innatentive.
What are the list of different conditions that can come along side adhd and what are they in an order of priority and which ones are prioritised?
- Most imaping condition needs to be treated first.
-depression – if a patient ahs moderate to severe depression you would treat that first, be vigilant of risk of suicide. Akathisia with SSRIs,SNRIs with mild depression treat ADHD first and mood may improve.
-Bipolar – treatment of ADHD can be offered when bipolar becomes stabilised - Anxiety – some patiensts may show worsening anxiety – some may improve Psychotic disorder -Treatment of ADHD may trigger phsychotic relapse in pre- diagnosed patients. Stable pts in remission may benefit from adhd treatment
What are the different methods of ADHD diagnosis?
DSM-V, used to diagnose adhd where there is a triad of symptoms: inattention,impulsivity,hyperactive behaviour that are pervasive(all aspects of life effected),of early onset,unexplained by other disorders and resulting in impairment and disability
ICD-10 uses a narrow more restrictive diagnostic categories which looks at people with more severe symptoms and mpairment.
- The American academy of paediatric APP – diagnosis is based on very specific symptoms which must be resent in more than one for at least 6 months.
- Conner rating scale also used
- - ADHD under represented in girls
What are the symptoms of ADHD?
They can overlap with other conditions and adhd wuldnt be considered a categorical diagnosis so ,care in differential diagnosis needed. It has a common co-existence with othe mood and behavioural issues. In adults : bipolar,ocd and substance misuse.
What are the non pharmaceutical interventions for the treatment of ADHD:
Psychoeducational measures (such as education and advise), this should be the basis of any treatment offered. Parent and family behavioural theapy often effective in randomised clinical trials.behaviousal interventions at school or pre- school- are effective in reducing hyperactive behaviours and promoting social adjustments.
What are the pharmaceutical interventions for the treatment of ADHD?
used to control symptoms rather than condition itself. Treatment selected based on efficacy,tolerability,acceptability- ideal meds should have a rapid onset of action and long duration of action but quick to dissipitate – prevent insomnia.They should not cause addiction,rebound affect or casue apetite issue.
Before tarting med:review to confirm that they continue to meet the criteria of an ADHD patient and defo have it. Mental health and social circumstnces review – including presence of mental health issues,neurodevelopmental issues,current education and employment status,risk assessment of substance misue.
Explain the treatment pathway for ADHD:
Methylphenidate – 5-10 mg daily increased to max of 60mg daily
Lisdexomfenidate 30mg OM increased to the max of 70mg daily. If after 6 week trial no improvement thennnnnn, Dexamphetamine – 5mg Daily increased to max of 20 mg daily , if resposnding but can tolerate drug profile – Guanfacine 1mg daily increased to 0.05-0.12 mg/kg daily.Atomoxetine can be used if they still can not tolerate methyl phenidate or lisdexampphetamine,having considered alternative formulation and preparation of it and adequate dosing. Dosing should be started low and slow – initial dose should be low and any changes to the dose should be done in small increments ,Coomon prescribing errors see failure to increase the doses slowly until no further symptoms or ADRs are noted or when ADRs are manageable and initiating with an intial dose that is too high.
What is the monitoring in place?
Efficacy of treatment: Conners rating scale – sensitive(able to detect change),reliable.Growth – height and weight measured every 6 months in yound people and children. Weight should be measured every 3 months in children older than 10 .Cardivasuclar monitoring – monitoring heart rate and bp to understand and compare with normal ranges before and after -if a person taking ADHD meds ahs a substantial tachycardia,arrythmias – reduce dose
Physchostimulatnts are what?
methylphenidate,lisdexamfetamine and dexamphetamine.Stimulants are more effective for treating hyper activity that inattention.They have an antagonistic effect on the norepinephrine and dopamine reuptake inhibitor NDRI there by increasing the presence of these neurotransmitters in extra- neural space and prolonging their action.Stimulants raise brain functioning activity level to within a normal range,Stimualnts also activate brain inhibitory and self -organising mechanisms which helps focus attention and manage impulse therefore allowing a person to have greater control over his or her behaviour.
Side effects- Apetite suppression, weight change,irritability anxiety,sadness,headaches,bad sleep,dysphoria,bp changes,hypertension is most likely.
Non stimulants
Atooxetien and guanfacine. Atomoxetine – known to be potent and selective inhibitor of norepinephrine transport NET, which prevents cellular reuptake of norepinephrine throughout brain = improves adhd symptoms. Atomoxetine may cause sexual dysfunction.
Guanfacine – alpha 2 a reception agonist which modulates signalling in pre- frontal cortex and basal ganglia – through modification of direct synaptic nerve impulses,Because guanfacine is non selective,it reduces synaptic impusles from vasomotor to the heart centre,blood vessles causing decrease in peripheral restainceand heart rate.It may also prolong the QT interval Guanfacine isnst indicated in adult ADHD – SE- dyspepsia, dizziness, drowsiness
