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Psychiatry > ADHD > Flashcards

ADHD Flashcards

1
Q

Triad of ADHD?

A

Inattention
Hyperactivity
Impulsivity

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2
Q

What is the impact of childhood ADHD?

A

Significant parenting difficulties
Increased levels of home stress and high expressed emotions
Emotional dysregulation leading to difficulties in peer relationships and reckless/ dangerous behaviour
Poor problem solving leading to developmentally inappropriate decision making
Significant barrier to learning and potentially exclusion from education
Higher likelihood of antisocial behaviour

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3
Q

What is the impact of adult ADHD?

A

Increase in frequency of psychiatric comorbid
Higher levels of criminality and antisocial behaviour
Higher level of substance misuse

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4
Q

What causes ADHD?

A 
Perinatal precipitants
Genetic predisposition 
Psychosocial adversity 
Neuroanatomical brain changes
Cognitive and behavioural features
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5
Q

Genetic link in ADHD?

A 
Increased risk (around 60%) among offspring of adults 
15% increased risk of ADHD in siblings
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6
Q

What genes tend to be implicated in ADHD?

A

Those encoding for dopamine and serotonin transporters

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7
Q

What perinatal factors increase the risk of ADHD in children?

A 
Links to tobacco and alcohol sue during pregnancy with higher likelihood of ADHD 
Foetal alcohol syndrome 
Prematurity 
Perinatal hypoxia 
Short/ long labour,
Foetal distress
Low forceps delivery 
Preeclampsia 
Viral infection
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8
Q

What psychosocial adversity factors are implicated in the progression of ADHD?

A 
Inconsistent parenting 
Martial discord 
Low social class
Large family size 
Paternal criminality 
Maternal mental disorder 
Maltreatment
Emotional trauma
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9
Q

What is required for a diagnosis of ADHD?

A

Developmentally inappropriate behaviour
Impairing function
Pervasive across settings (home, school, work)
Longstanding from age 5`

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10
Q

Main functions of frontal lobe

A 
Reasoning
Planning
Impulse control
Judgement
Initiation of actions
Social/ sexual behaviour 
Long term memory
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11
Q

Which areas of the brain are underactive in ADHD?

A

Frontal lobe

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12
Q

What is the neurochemistry of ADHD?

A

Excessive dopamine removal (higher concentration of dopamine transporter; re-uptake inhibitors)
Reduction in NA and serotonin

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13
Q

What will NA mediate in ADHD?

A 
Attention when acting as stress hormone
Exertion 
Perseverance
Recall memory
Intuition
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14
Q

What will serotonin mediate in ADHD?

A 
Mood
Social behaviour
Sleep 
Learning memory 
Satisfaction 
Pleasure/ pain 
Relaxation
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15
Q

Assessment of children with ADHD?

A

Driven by parents/ school
Ideally a school observation
Screening questionnaires and structured diagnostic questionnaires are helpful
Background information regarding risk factors, including developmental hx and family history
Exploration of early history and attachment style

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16
Q

Assessment of adults with ADHD

A

Driven by patient
Historical concerns are presented and should be elicited by parents/ siblings/ relatives
Specific adult screening tools
Cognitive difficulties and ability to function need to be evaluated
Co-morbid common

17
Q

Diagnostic criteria in children for ADHD

A

6 or more symptoms of inattentiveness and/or 6 or more symptoms of hyperactivity and impulsiveness
Present before age of 5 (or before 3)
Reported by parents, school and seen in clinic
Symptoms reduce functionality

18
Q

Diagnostic criteria for adults with ADHD

A

5 or more symptoms of inattentiveness and/or 5 or more hyperactivity and impulsiveness
Historical concerns since early age

19
Q

In what areas of life can adult ADHD affect?

A

Underachieving at work or education
Driving dangerously
Difficulty making/ keeping friends
Difficult relationships with partners

20
Q

Psychosocial interventional treatments for mild/ moderate and severe ADHD in children

A

Parent training
Social skills training
Sleep and diet; elimination and supplementation
Behavioural classroom management strategies
Specific educational interventions

21
Q

Pharmacological management for ADHD

A

1st line: methylphenidate, dexamfetamine, lisdexamfetamine
2nd line: SNRI (atomoxetine)
3rd line: Alpha agonist (clonidine, guanfacine)
4th line: ADs (impiramine), antipsychotics (risperidone)

22
Q

Mode of action of methylphenidate (stimulants)?

A

Increase dopamine by blocking its transporter

23
Q

Mode of action of dexamphetamine?

A

Increases dopamine

Increased extracellular NA and 5-HT

24
Q

Mode of action of SNRI in ADHD?

A

Increased NA

25
Q

Role of dopamine in ADHD

A 
Alertness
Working memory
Motivation 
Clarity 
Attention 
Balanced mood
26
Q

NNT for stimulants in ADHD

A

4

27
Q

What monitoring needs to be done for children on stimulants for ADHD?

A

Monitor growth and HR

28
Q

What is the mode of action of methyphenidate?

A

Dopamine/ NA reuptake inhibitor (NDRI)

1st line for ADHD

29
Q

What is the mode of action of atomoxetime?

A

NA reuptake inhibitor (NRI)

2nd line for ADHD

Psychiatry (35 decks)

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