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Pathophysiology - Midterm > Lecture 6: ADHD & Schizophrenia > Flashcards

Lecture 6: ADHD & Schizophrenia Flashcards

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1
Q

What is needed for a diagnosis of ADHD?

A

A thorough assessment by a highly skilled practitioner with a global approach

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2
Q

What are common comorbidities with ADHD?

A

Tourette’s disorder, learning disability, oppositional disorder, anxiety, depression, and enuresis (bed wetting)

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3
Q

What are inattentive symptoms of ADHD?

A

Distractibility, forgetfulness, poor organization, impersistence, mistake-prone, and work avoidance

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4
Q

What are hyperactive symptoms of ADHD?

A

Fidgetiness, intrusiveness, restlessness, noisiness, talkativeness, and inappropriate activity

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5
Q

True or false: ADHD symptoms are generally mixed between the inattentive and hyperactive categories.

A

True

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6
Q

What is the general age of onset for ADHD?

A

12

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7
Q

What type of symptoms first and what type occur last in ADHD?

A

Hyperkinesis first; inattention last and least to remit

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8
Q

What are risk factors for ADHD persistence?

A

Positive family history and comorbid disorders

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9
Q

How many children with ADHD go on to manifest symptoms in adulthood?

A

About 50%

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10
Q

What type of ADHD symptoms are typically found in adults?

A

Distractibility and inattention

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11
Q

What are 4 causes of ADHD?

A

1) Genetics
2) Right-sided “hypofrontality”
3) Locus ceruleus underperforming
4) Worsened by stressors

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12
Q

In what setting is ADHD more obvious?

A

Routinized settings (ex: school)

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13
Q

What are 4 changes in the neuropathology of a patient with ADHD?

A

1) Small increase in cerebrum growth at age 1-3
2) Decreased number of cerebellar Purkinje neurons
3) Decreased cell size and increased cell density in limbic areas
4) Modified genes impairing balance of excitatory and inhibitory synaptic signalling

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14
Q

How likely is someone to have ADHD if they have a first-degree relative with it?

A

4-8x greater

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15
Q

What factors increase the risk of having ADHD?

A

FAS, lead poisoning, infantile meningitis, obstetric adversity, maternal smoking, and adverse or absent parent-child relationship

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16
Q

What are 4 triggers for ADHD?

A

1) Artificial colours, flavours, and additives
2) Refined sugar, sodas, and caffeine
3) Food allergy
4) Essential fatty acid or iron and zinc deficiency

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17
Q

What are suggested treatments for ADHD?

A

1) Parent, family, and classroom “contingency” rewards and privileges
2) Avoiding triggers (if known)
3) Chiropractor
4) Combining meds with support

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18
Q

What are the goals of ADHD treatment?

A
  • Collaborative support system between family and school
  • Realistic, achievable goals
  • Clarity, immediacy, predictability, consistency, and responsibility
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19
Q

What are common deficits found in ADHD?

A
  • Inability to control behaviour
  • Inability to resist distractions
  • Inability to develop an awareness of space and time
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20
Q

What is considered first-line treatment for ADHD?

A

Stimulants which augment dopaminergic and noradrenergic tracts

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21
Q

What can improval of “gating” ability do for patients with ADHD?

A

Increase behaviour control, executive function, and regulate arousal

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22
Q

In regards to ADHD treatment, what is desired instead of increasing physical stimulation?

A

Ability to select restraint and to mentally focus

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23
Q

What does regulated arousal mean in ADHD?

A

Increased performance

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24
Q

What does increased control mean in ADHD?

A

Decreased hyperactivity and/or aggression

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25
What are 2 examples of psychostimulants?
Methylphenidate and amphetamines
26
What are examples of methylphenidate and what is the difference between them?
- Ritalin, biphentin, and Adderall | - All have different release pharmacokinetics
27
What do methylphenidate and amphetamines do?
Block norepinephrine and dopamine reuptake
28
What does increased norepinephrine and dopamine activity in locus ceruleus lead to?
Improved attention and ability to focus
29
What is a function of amphetamines but not methylphenidate?
Promotes dopamine and norepinephrine release from presynaptic neurons
30
What are 4 side effects of stimulants?
1) Decrease appetite 2) Increase BP, anxiety, irritability, difficulty falling asleep, or headaches 3) Worsen tics 4) Rarely may "flatten" personality or increase risk of sudden cardiac death
31
What is the function of atomoxetine?
Enhances activity of norepinephrine by inhibiting reuptake from synapse
32
What is 1 advantage and 1 disadvantage to atomoxetine?
- No abuse potential | - More costly
33
What is bupropion?
A weak dopamine and NE reuptake inhibitor
34
What is bupropion primarily used for?
As an antidepressant or an aid to smoking cessation
35
What are 2 advantages to bupropion?
- Less appetite effects than stimulants | - No abuse potential
36
What can cause the need for dose adjustments?
Growth, symptoms, or adverse effects
37
What can have a major impact on good and bad outcomes of medications for ADHD?
When and what form is taken
38
What is not a good idea when using stimulants for ADHD?
Forced substitution of medications
39
What is recommended for ADHD treatment?
Drug holidays to reassess treatment and allow for frowth rebound
40
What is neurosis (in general terms)?
A characteristic
41
What is psychosis (in general terms)?
A mental state or symptom (a "now" descriptor)
42
What is schizophrenia (in general terms)?
A diagnosis of a complex and usually chronic illness
43
What is the primary goal of schizophrenia treatment?
Ensure safety
44
What are secondary goals of schizophrenia treatment?
- Decrease agitation, hostility, anxiety, tension, and aggression - Normalize sleeping and eating pattern - Convey empathy and caring
45
True or false: eliminating hallucinations and delusions is a reasonable expectation for treatment
False, it may not be realistic or possible
46
True or false: schizophrenia is NOT the same as split or multiple personality
True
47
What are the symptom clusters of schizophrenia?
Positive, negative, and cognitive
48
What are the main areas affected by schizophrenia?
Thought, behaviour, mood, perception, cognition, and impairing function
49
What is the typical age of onset for schizophrenia in males?
19-25
50
What is the typical age of onset for schizophrenia in females?
24-32
51
What are the known causes of schizophrenia?
- Genetic influence - Abnormality on CNS scans (brain asymmetry, abnormal neuronal pruning) - Neurotransmitter imbalance (dopamine)
52
When is the suicide risk for schizophrenia the highest?
The first 5 years of diagnosis
53
Schizophrenia has a wide range of _____
Symptoms and functional status
54
What is schizophrenia functional impairment primarily related to?
Prolonged impact of negative and cognitive symptoms
55
What does the degree of functional impairment from schizophrenia correlate with?
Time and severity of poorly-controlled symptoms
56
What are 8 "positive" symptoms of schizophrenia?
Hallucinations; ideas of reference; agitation; hostility; bizarre actions/statements; distractible; paranoia; suicidal
57
What is the most common symptom of schizophrenia?
Hallucinations
58
True or false: hallucinations are only experienced in one sense, visual
False, hallucinations may be experienced in more than 1 sense, such as auditory, visual, tactile, or olfactory
59
What is most commonly experienced with hallucinations?
Voices
60
What are delusions?
False, often fixed beliefs which persist despite "proof" of falseness or illogic
61
What are 4 symptoms of a thought disorder?
Disorganized; garbled speech; thought blocking or "removal"; made-up words
62
Are positive or negative symptoms of schizophrenia more devastating?
Negative
63
What are 10 "negative" symptoms of schizophrenia?
Immobile facial expression; monotonous voice; anhedonia; diminished ability to initiate and sustain planned activity; speaking infrequently; poor judgement and hygiene; withdrawn; socially isolated; impaired concentration; suicidal
64
What is cognitive impairment in schizophrenia related to?
Acute symptoms and prolonged neurotransmission imbalance
65
What is chlorpromazine?
Sedating phenothiazine
66
What does chlorpromazine help with?
Acute psychosis
67
What type of drugs FIRST showed antipsychotic potential?
Dopamine antagonists
68
What is the target of first generation antipsychotics?
Blockade of dopamine, specifically the D2 receptor
69
What will blocking dopamine in the nigrostriatal portion of the brain cause?
Movement disorder
70
What will blocking dopamine in the mesolimbic portion of the brain cause?
Psychosis relief
71
What will blocking dopamine in the mesocortical portion of the brain cause?
Psychosis relief and restlessness
72
What will blocking dopamine in the tuberoinfundibular portion of the brain cause?
Increased prolactin
73
What will blocking dopamine in the frontotemporal portion of the brain cause?
Cognitive impairment
74
What is the target of second generation antipsychotics and what does this do?
- Serotonin, specifically the 5HT2A receptor | - Decreases movement disorders that are a risk with antipsychotics
75
What is the most favourable antipsychotic?
One that has affinity for both serotonin and dopamine receptors
76
What medications can work quickly on positive symptoms of schizophrenia?
Antipsychotics and benzodiazepines
77
What is a pharmacist's role in schizophrenia management?
- Help patient give meds a chance to help - Reinforce value of adherence - Ease fears - Manage side effects - Reduce stigma

Pathophysiology - Midterm (11 decks)

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