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52 Cards in this Set

  • Front
  • Back
how is ADHD characterized?
neurobehavioral disorder with inattention, hyperactivity, and impulsivity
how do the symptoms of ADHD present
cause great impairment in affected patients
present before age 7
manifest in multipel settings like school/home
cause significant impairment
how many % of kids have ADHD?
75-80%

60% have sx and impairments as adults
what is 314.01 combined type of ADHD
6 sx of inattention and 6 sx of hyperactivity-impulsivity for 6 months
what is 314.00 predominantly inattentive type
at least 6 sx of inattention but fewer than 6 sx of hyperactivity-impulsivity for 6 months
what is 314. 01 predominantly hyperactive-impulsive type
at least 6 sx of hyperactivity-impulsitivyt but fewer than 6 sx of inattention for 6 motnhs
name the criteria for inattentive type of ADHD. 6 or more manifestations of:
difficulty sustaining attention
fails to finish tasks
loses things
forgetful
easily distrated
avoids tasks requiring sustained attnetion
seems to not listen

proposed DSM5 4 ore more if >16 yo
what are the sx of inattention in kids? adults?
kids- difficulty sustaining attention
easily distracted and forgetful
doesn't follow through
can't organize
loses things
doesn't listen


adults- difficulty sustaining attention
easily distracted
poor concentration
manages time poorly
mispalces thigns
difficulty finding things
what are the criteria for hypyeractive impulsive type
impulsivity- blurts out answers before question is finished, difficulty wasting time, interrupts or intrudes on others

hyperactivity- fidgets, unable to stay seated, inappropriate running/climbing, difficulty engaging in leisurely activities quietly , talks excessively
symptom cluster for impulsivity in kids and adults?
kid- blurts out answers, can't wait his turn, intrudes/interrupts

adults- drives too fast, impulsively changes, irritable or quick to get angry
sx cluster for hyperactivity in kids? adults?
kids- squirms, fidgets, runs, climbs, can't play/work quietly, on the go

adults- inner restlessness, fidgets when seated, self selects active jobs, talks excessively
what are the impacts of untreated ADHD on adults
interpersonal problems
deficits in occupational functioning
academic underachievement
increased accident rates
how does adhd affect MVA
pts with ADHD tend to have more severe accidents than controls
what are some difficulties in making accurate ADHD dx?
testing objective but not specific
dx dependent on social and educational circumstances
sx overlapw tih other psych illnesses
subjectivity of diagnostic criteria
bipolar disorder vs ADHD?
more likely in bipolar disorder : gradiosity, elevated mood, daredevil acts, uninhibited people seeking, silliness/laughing
what is the path behind ADHD
related to difference in functioning in prefrontal cortex, basal ganglia
how does catecholimingeric CNS pathways affect ADHD
NE and DA are modulators of attention and psychomotor activity

disruption causes cognitive, behavioral, and learning related changes paralleling that in ADHD
what levels of dopamine are a/w ADHD
it has been shown that increased release of dopamine with stimulation occurs in adults with ADHD

thought that ADHD has low baseline dopaminergic tone
why are neuroimaging techniques not valid tools for ADHD diagnosis
lacks specificity and sensitivity
is ADHD familial?
90% concordance in monozygotic twins
heritability of 0.75
a/w dopamine transporter gene DAT-1
and D4 receptor gene DRD4
thyroid receptor-beta gene
how do you do an ADHD eval/assessment
standard h&p
screening neuro exam
hx from parents/caregivers
inattention, hyperactivity, impulsivity, age of onset, multiple settings, duration of sx, degree of functional impairment

info from school. classroom behavior, learning and attendance, examples of school work, teacher eval, report card
what kind of associated conditions of ADHD do you assess for
impaired vision/hearing
learning/speech/language disorders
seizures, tics, migraines
medical illnesses, malnutrition
sleepdisorders
medication/lead toxicity/pica
anxiety, realistic fears, depression
identify target behaviors and colelct previous treatment data
target behavior --> response

medication --> dosage, duration, SE, adverse events
what should you check in periodic follow up visits of ADHD pts?
target behavior outcome
academic progress
adverse effects of meds
response to meds does not validate a dx of ADHD
what are some non pharmacologic treatments you can use
coaching- problem solving skills

cognitive/behavioral - correct negative belief systems

conflict resolution/anger management/interpersonal skills

behavioral interventions- reinforcement with rewards priviledges

time out, access to positive reinforcement removed contingent on performance of unwanted/problem behavior

response cost
token economy system

decrease workload to match ability
coordinate between school and home, set time limits for work completions
what are the stimulant treatments for ADHD
similar to dopamine and NE structurally

inhibits DA and NE transporter proteins, inhibits MAO

d-enantiomers of methylphenidate and amphetamine are MC
amphetamines and methylphenidate have what characteristics
safe medically
good tolerability
robust response
equal response rates
what do stimulants improve (sx wise)
inattention
impulsivity
hyperactiivty
noncompliance
impulsive aggression
social interaction
academic productivity and accuracy
what are some SE of stimulants
insomnia
HA
stomach ache
irritability
decreased appetite
what are CI and cautions for stimulants?
CI in cardiac abnormalities

be careful if you have HTN, glaucoma, tics, bipolar disorder, aggression, suicidality, seizure disorder, psychosis
what can you do to alleviate insomnia with stimulants
avoid evening meds
what can you do to alleviate stomach ache/headache
decrease dose, switch to another stimulant or agent
if you have irritability with stimulants what can you do
decrease dose
try longer acting agent
assess for other disorders
what can you do if you have growth suppression with stimulants
weight- give meds with meals, snacks, consider drug holidays

height- deficits found in prepuberty children, catch up gaines in height even with continued stimulant treatment. no direct studies have proven much
what should you do if you have tics
switch stimulant
decrease dose
adjust treatment of tics
try nonstimulant meds
what are teh D-enantiomer stimulants
methylphenidate: focalin
amphetamine: dexedrine
what are the racemic compounds
MPD: ritalin, metadate
amphd: adderall

amphetamine aspartate, amphetamine sulfate, dextroamphetamine saccharate, dextroamphetaine sulfate
which drugs are FDA approved for adults
atomoxetine (strattera)
dexmethylphenidate XR - focaline
mixed amphetamine salts XR- adderall xr
methylphenidate HCL (concerta)
lisdexamphetamine (vyvanse)
what meds are NOT approved for adults
short acting mixed amphetamine salts - adderall
short acting methylphenidate - methylin, ritalin, focalin
dextroamphetamine - dexedrine, dexdrine,
methylphenidate transdermal system

nonstimulants- gaunfacine
extended release clonidine
what is IR methylphenidate
takes effect 30 min after admin
peaks 1.5-2 hours after ingestion
benefit gonea fter 4 hours
generally t.id dosing

no more than 60 mg / day
SR stimulants
gelatin capsule with 2 types of spherical beads

one with solid methylphenidate HCL the other with polymer coating acting as a rate controlling membrane

biphasic peak effect
lasts 9 hours

metadate peaks at 1.5 and 6 hrs
ritalin LA peaks at 1.5 and 4.5 hrs
focalin peaks at 1-4 hours and 4-7 hrs
how does concerta work
osmotic release oral system
outer coating of IR methylphenidate over insoluble shell that water permeates at a controlled rate
as water goes in, internal compartments are forced out at a controlled rate
may have a smoother effect
peak at 6.7 and effective for 12 hours
this is a gelatin capsule with 2 types of spherical beads one with dextroamphetamine (solid) or mixed amphetamien salts, the other with polymer coating that acts as a rate controlling membrane
SR stimulant: amphetamine

dexedrine spansule (dextroamphetamine) peaks at 8 hours typically effective for 9

adderal XR mixed amphetamine salts - peak effect at 5-6 hours effective fr 9-12
this is converted in blood to l-lysin and d-amphetamine
lisdexamfetamine

dosage 10-70 mg/day

peak plasma 4.5-6 horus after oral ingetsion
may have less potential for abuse and drug tampering
what are some non stimulant meds for ADHD
atomoxetine
modafinil
TCA's
bupropion
alpha adrenergic agents
describe atomoxetine
nonstimulant
NE reuptake inhibitor
significant increase of dopamine noted in prefrontal cortex

dosed q.d
peak [ ] x1-2 hours after dosing

suicide warning
name some antidepressants
imipramine and deipramine (TCA's)
block reuptake of noreepinephrine
serious potential cardiac effects

bupropioni (wellbutrin) more favoral risk to benefit ratio than TCA's

long duration of action, potential benefit on mood and anxiety
name the 2 alpha adrenergic agents
clonidine
guanfacine

binds alpha adrenergic receptors micmics noradrenergic neurotransmission

can lead to sedation or diminished neurotransmission
efficacy and safety not well studied
you with ADHD have a 2-3 greater risk of substance use disorder. it is earlier with what activity and what dz
earlier with cigarette smoking

risk is higher with bipolar disorder
adults with ADHD have a prolonged course of SUD. what drug is mc abused
marijuana
T or F, SSRI can effectively treat depression and anxiety and ADHD
false. can't treat adhd

stimulants on the other hand can treat adhd but not anxiety and mood disorders
what should you consider for depression and anxiety
buspirone and benzodiazepines