ADHD

Question 1

ADHD

Answer 1

A neurodevelopmental disorder characterized by difficulties with attention, hyperactivity, and impulsivity.

Question 2

Symptoms

Answer 2

Hyperactivity
Impulsivity
Inattention

Question 3

What age to symptoms commonly present?

Answer 3

• 3-7 yrs
• May not be noticed until after 7yrs

Question 4

Non-drug treatment

Answer 4

1. Lifestyle - diet + exercise
2. Parent training/ education programmes
3. Environmental modifications
4. CBT

Question 5

When would you recommend drug treatment in children?

Answer 5

• ONLY for SCHOOL-children (5 years and above)
• They should have moderate-severe symptoms
• And had not responded sufficiently to non-drug treatment

Question 6

What do you do if the child in under 5?

Answer 6

• If under 5 years old then
  ONLY under the advice of a specialist

Question 7

Which drugs are used for treatment of ADHD in children?

Answer 7

1. Methylphenidate
   - e.g. Medikinet, Concerta XL,
   Equasym XL, Tranquilyn
2. Atomoxetine
3. Dexamfetamine
4. (Lisdexamfetamine is a prodrug of Dexamfetamine)
   - Elvanse

Question 8

Methylphenidate

Answer 8

Medikinet, Concerta XL,
Equasym XL, Tranquilyn, Xagittin XL

Question 9

Lisdexamfetamine

Answer 9

Elvanse

Question 11

Which drug treatment is first-line for
children?

Answer 11

1. Methylphenidate
   If after 6 weeks trial of maximum tolerated dose and still experiencing symptoms switch to 2nd line

Question 12

Treatment in children 5+

Answer 12

1. Methyphenidate
2. Lisdexamfetamine/ Dexamfetamine
3. Atomoxetine/Guanfacine

Question 13

Lisdexamfetamine vs dexamfetamine

Answer 13

• Lisdexamfetamine = longer duration of action = larger SE profile
• If pt can’t cope with this switch to dexamfetamine

Question 14

When would
Atomoxetine or
Guanfacine be used in a child?

Answer 14

If they couldn’t tolerate
Methylphenidate and Lisdexamfetamine or
Dexamfetamine

Question 15

Which release pattern of drug treatments may be preferable for a child?

Answer 15

• MR
• Same applies for adults
• Reduces the need to take doses in school (or work) due to slow release pattern

Question 16

When would immediate release preparations be preffered in ADHD?

Answer 16

• During initial dose titration
• When more flexible dosing regimens are required
• Can also be used in combination with MR preps at certain times of day to extend duration of action

Question 17

Treatment in adults

Answer 17

1. Methyphenidate or lisdexamfetamine/ dexamfetamine
   * 6 week trial of one of them - if it doesn’t work try the other
2. Atomoxetine
3. Refer to specialist ADHD service

Question 18

What other drug treatments can be used for treating
ADHD in adults?

Answer 18

• Guanfacine (unlicensed - NOTE: ONLY LICENSED FOR USE IN CHILDREN)
• Bupropion (Zyban)
  (Unlicensed)
• Modafinil (Unlicensed)
• TCA antidepressants
  (Unlicensed)
• Venlafaxine (Unlicensed)

Question 19

When would CBT be considered in adults?

Answer 19

• If the patient is stabilised on drug treatment but still has functional impairment associated with the disorder
  OR
• There has been no response to drug treatment
  unlike most mental health disorders, CBT is done after trying drug treatment

Question 20

Do ADHD drugs cause weight GAIN or weight LOSS

Answer 20

weight loss