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23 Cards in this Set
- Front
- Back
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What are the four classifications of ADHD?
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ADHD Combined type
ADHD Predominantly Inattentive type ADHD Predominatly hyperactive-impulsive type ADHD NOS |
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What are the DSM IV criteria for inattention?
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(1) inattention: six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities (b) often has difficulty sustaining attention in tasks or play activities (c) often does not seem to listen when spoken to directly (d) often does not follow through on instructions and fails to finish school work, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) (e) often has difficulty organizing tasks and activities (f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) (g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) (h) is often easily distracted by extraneous stimuli (i) is often forgetful in daily activities |
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What are the DSM IV criteria for impulsivity-hyperactivity?
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six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Hyperactivity (a) often fidgets with hands or feet or squirms in seat (b) often leaves seat in classroom or in other situations in which remaining seated is expected (c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) (d) often has difficulty playing or engaging in leisure activities quietly (e) is often "on the go" or often acts as if "driven by a motor" (f) often talks excessively Impulsivity (g) often blurts out answers before questions have been completed (h) often has difficulty awaiting turn (i) often interrupts or intrudes on others (e.g., butts into conversations or games) |
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At what age does DSM IV state symptoms of ADHD must be present before?
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Age 7
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How many settings must symptoms of ADHD be present in for a diagnosis?
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Two or more
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What is the prevalence of ADHD?
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3-4%
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What symptom of ADHD is most common in adults?
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inattention hyperactivity/impulsivity decrease with age
Also of note comorbidity increases with age |
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Name 4 syndromes associated with ADHD
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Fragile X
PKU G6PD autistic spectrum |
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What environmental factors have been correlated with ADHD?
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encephalitis, lead exposure, TBI, poor maternal health, maternal drug us, FAS, maternal smoking, perinatal hypoxia, pre-eclampsia, malnutrion
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Name 4 areas of the brain that are involved in ADHD
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Prefrontal cortex
Temporal cortex Parietal cortex Cerebellum anterior cingulate basal ganglia |
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What two neurotransmitters are correlated with state of arousal?
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Dopamine and Norepinephrine
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What are the most common comorbid disorders with ADHD and their prevelance rates?
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25% Learning disabilities
25% anxiety 50% ODD/CD 9-40% Depressive D/O |
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Describe the mechanism of action for psychostimulants used in the treatment of ADHD.
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block dopamine and norepinephrine reuptake transporters and release dopamine from presynaptic storage vesicles
Also weakly stimulate the release of stored norepinephrine |
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What is the difference in potency between methylphenidate and amphetamines and what is the max daily dose for each?
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Amphetamine approximately twice as potent as methylphenidate
amphetamine 60mg/day methylphendiate 100mg/day |
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What are the most common side effects from stimulants?
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appetite supression, headache, GI upset, mood changes, tics, insomina
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When is an EKG needed prior to starting a stimulant?
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when there is a positive patient or family cardiac history or exam findings that trigger a referral to cardiology
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What is the mechanism of action of atomoxetine?
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blocks NE reuptake transporter
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Describe appropriate dosing schedule of atomoxetine.
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<70 kg patient: 0.5 mg/kg/day divided q am & afternoon for 4 days;
then consolidate to 1.0 mg/kg/day q d for 4 days; then give 1.2 mg/kg/day q daily >70 kg patient: 18 mg capsule q am & afternoon for 4 days; then consolidate to 1.2 - 1.8 mg/kg/day Recommended maximum = 100 mg/day |
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What are the common side effects from atomoxetine?
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Abdominal distress, appetite suppression, cough, dizziness, growth deceleration, headache, hepatotoxicity (rare), hypertension, insomnia, irritability, moodiness, lethargy, nausea, suicidality (rare), tachycardia, vomiting, weight loss
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How do alpha 2 adrenergic agonists help with ADHD symptoms?
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inhibit arousal by NE and thus lead to a calming effect.
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What are the common side effects of alpha 2 agonists?
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appetite increase, behavioral activation, bradycardia, constipation, depression, dizziness, dry mouth and eyes, fatigue, headache, hypotension, irritability, rash, rebound hypertension, rebound tachycardia, sedation, stomachache
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What are the major differences between clonidine and guanfacine?
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Guanfacine has more a 2A selectivity, a longer half-life, less sedation, hypotension, bradycardia than clonidine
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Describe the dosing schedule for alpha 2 agonists.
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Start clonidine 0.05 mg qhs X 3 days, then 0.05 mg TID
Titrate clonidine 0.05 mg weekly; maximum = 0.4 mg/day Start guanfacine 0.5 mg qhs X 3 days, then 0.5 mg q 12 hr Titrate guanfacine 0.5 mg weekly; maximum = 4 mg/day Start guanfacine XR 1 mg q am, titrate weekly in 1 mg steps |
