Kfkg Mh

Front 1

Diagnostic criteria for ADHD

Back 1

A persistent pattern of inattention and/or hyperactivity/impulsivity that interfers w/ functioning or development

Front 2

What are important differentials to consider fro ADHD?

Back 2

• Oppositional defiant disorder (r they defiant?) or intermittent explosive
  
• Speech/language/learning problems - do they simply not understand what
  
• Tics? Sleep apnea?
• Autism spectrum disorder
• Anxiety
• Reactive attachment disorder (early/infant toddler years - pt w/o stable relationships)
• **not exhaustive****

Front 3

What can minimize signs of ADHD?

Back 3

1. Parent giving frequent positive reinforcement or child is well-supervised and corrected before problem
2. New setting - so stimulated more...
3. Child is interested in subject
4. Electronics - pt's get hyper focused on them
5. Office visit (one-on-one interaction often doesn't reveal behavior)

Front 4

environmental risk factor for ADHD

Back 4

Low birth weight

Mom smoked

Toxins in environment - lead

Front 5

Males or females more or less frequently dx'ed

Back 5

Males : Females

2:1

Front 6

T/F Family member w/ ADHD increases risk

Back 6

True

Front 7

According to DSMV, ADHD symptoms can now be present up until this age?

Back 7

Age of symptom onset can be present up to age 12 (use to be younger - 7yo -but missed adolescent girls especially)

Front 8

For each category of ADHD, how many sx are necessary in each category and for how long ?

*how is criteria different for adolescents?

Back 8

6 or more of SX present for at least 6 months and not consistent w/ developmental level

and negatively impacts social/academic/occupation

** adolescents only need 5 sx

Front 9

What combinations of ADHD are there? Does it always have to be inattention AND hyperactivity/ impulsivity?

Back 9

ADHD can have combinations for

-Combined inattention & hyperactivity/impulse

-Predominant inattention

-Predominant hyperactivity/impuls

Front 10

What percentage of patients w/ ADHD have ODD?

Back 10

• ODD occurs in half of patients w/ combined aDHD
  
• 1/4 of patients w/ hyperactive type
  

Front 11

If treat patient with ADHD and don't get better, what should you consider?

Back 11

1. Maybe they have learning disability

Front 12

If patient has ODD and ADHD and symptoms of ODD are not improving w/ ADHD medication, what should you consider?

Back 12

Consider increasing medication

Front 13

1st line pharm for anxiety

Back 13

SSRI and SNRI

Front 14

What is combined approach to treating anxiety?

Back 14

1. Pharm

2. CBT

3. Recognize and stop self-medication w/ alcohol/drugs

Front 15

Most common side effects of SSRIs

Back 15

GI side effects: Nausea, diarrhea (last couple days)

Sexual dysfunction

Weight gain - in general

(Rakel - chp 46)

Front 16

rPotential DDX for depression

Back 16

Anemia

Thyroid

Vit B12

Sleep apnea

Cancer

HIV

(Rakel - chp 46)

Front 17

Difference between bipolar I vs bipolar II

Back 17

Bipolar I = mania

Bipolar II = hypomania and depression

(Rakel - chp 46)

Front 18

Anti-depressant induced mania or hypomania indicates what disease?

Back 18

Bipolar

(Rakel - chp 46)

Front 19

How often should anti-depressant meds be adjusted?

Back 19

Every 2-4 weeks or until max dose/ intolerable symptoms develop

(Rakel - chp 46)

Front 20

How long should anti-depressant therapy be continued?

Back 20

6-9 months d/t risk of relapse if d/c'ed prematurely

(Rakel - chp 46)

Front 21

If patient fails anti-depressant therapy w/ one agent, what are potential next steps?

Back 21

1. Switch to different drug in same class or switch classes

2. Add adjuvant drug w/ no anti-depressant activity (lithium, T3, atypical anti-psychotic)

3. Add second anti-depressant

(Rakel - chp 46)

Front 22

Patients experience more withdrawal symptoms with this version of venlafaxine?

Back 22

More withdrawal symptoms with immediate-release venlafaxine

(Rakel - chp 46)

Front 23

Withdrawal syndrome symptoms associated with drugs w/ short half lives like venlafaxine and paroxetine

Back 23

flu-like symptoms

electric shocks in back of head

dizziness

(Rakel - chp 46)