ADHD

Question 1

ADHD is called what? Different types; other features different in DSM V vs. DSM IV?

Answer 1

Neurodevelopmental disorder;
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

Question 2

For ADHD inattentive, what is needed for diagnosis and what are symptoms?

Answer 2

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

Question 3

For ADHD hyperactive/impulsive, what is needed for diagnosis and what are symptoms?

Answer 3

6 hyperactive/impulsive symptoms: FLLR WIth TB

1. FIDGETS
2. LEAVES seat
3. RUNS/climbs
4. Too LOUD (not quiet)
5. TALKS a lot
6. BLURTS out answers
7. Cannot WAIT turn
8. INTERRUPTS

Question 4

Course of ADHD?

Answer 4

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

Question 5

Genetics of ADHD?

Answer 5

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

Question 6

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?

Answer 6

1. MDD, negative symptom schizo
2. ADHD
3. NORMAL
4. Hypervigilant
5. Psychosis;
   Transmitter/receptor complexes and neuronal firing

Question 7

For ADHD, what will neuroimaging show?

Answer 7

Hypoactivity of the anterior cingulates (other areas have to compensate for this)

Question 8

Regarding ADHD, and it being a neurodevelopmental disorder, the brain

Answer 8

might be developing two years slower without appropriate pruning in the teenage years

Question 9

Key NT’s involved in ADHD?

Answer 9

Decreased tonic NE and DA firing in PFC

Question 10

Environmental factors (ie not genetic) contributing to ADHD?

Answer 10

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?

Question 11

DD and associated conditions with ADHD?

Answer 11

Penis BALS

1. Autism
2. Learning disability (less cingulate activity)
3. Substance use disorder
4. Personality disorder
5. Bipolar disorder

Question 12

Most common disorder associated with ADHD?

Answer 12

Anxiety

Question 13

Regarding meds for ADHD, what mech do they use and the SE’s?

Answer 13

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)

Question 14

How do you manage ADHD besides drugs?

Answer 14

Psychotherapy (think COGNITIVE BEHAVIORAL therapy for ADHD, the leading treatment for ADHD that’s actually a therapy)

Question 15

What do you start with for preschoolers regarding treatment for ADHD?

Answer 15

Behavioral therapy FIRST!! (then go up to amphetamines for kids 4-5, and then try methylphenidate later at 7-8)

Question 16

For ADHD children and adolescents, what do you start with and why? What about adults?

Answer 16

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!!

Question 17

For ADHD, what receptors do you have on the pyramidal neurons in the cortex? What does this mean for treating ADHD?

Answer 17

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

Question 18

Prognosis for ADHD?

Answer 18

Can range really…