ADHD

Question 1

ADHD definition eg criteria

Answer 1

ADHD = inattention +/- impulsivity/hyperactivity
Started before 12
Occurs in more than two settings
At least 6 months symptoms
Interfere or reduce functioning
Do not occur in psychotic disorder or another MH issue

Question 2

Inattention symptoms

Answer 2

Failing to give close attention to detail or making careless mistakes in schoolwork, work, or other activities.
Difficulty in maintaining concentration when performing tasks or play activities.
Appearing not to listen to what is being said, as if the mind is elsewhere, without any obvious distraction.
Failing to follow through on instructions or finish a task (not because of oppositional behaviour or failure to understand).
Difficulty in organizing tasks and activities.
Reluctance, dislike, or avoidance of tasks that require sustained mental effort.
Losing items necessary for tasks or activities such as pencils, mobile phones, or wallets.
Easy distraction by extraneous stimuli.
Forgetfulness with regard to daily activities.

Question 3

Hyperactivity symptoms

Answer 3

Fidgeting with or tapping hands or feet, or squirming when seated.
Leaving the seat where remaining seated is expected, such as in a classroom.
Running about or climbing in situations where inappropriate. In adolescents or adults, this may be limited to a feeling of restlessness.
An inability to play or engage in leisure activities quietly.
Being ‘on the go’ or acting as if ‘driven by a motor’. Others may experience the person to be restless or difficult to keep up with.
Talking excessively.
Blurting out an answer before a question has been completed.
Difficulty waiting his or her turn.
Interrupting or intruding on others.

Question 4

Differential diagnosis ADHD

Answer 4

anxiety/depression
Autism
Oppositional defiant disorder
Conduct disorder
Tourette’s
Learning disorders
Substance misuse
Bipolar

Disinhibited social engagement disorder (DSED) and reactive attachment disorder (RAD) - trauma and stress related.
Foetal alcohol syndrome
Absence seizures

Question 5

Social and educational impact of ADHD Ina. Child how assess

Answer 5

self-care (for example, eating, or hygiene),
travelling independently, making and keeping friends,
achieving in school,
forming positive relationships with other family members,
developing a positive self-image, avoiding criminal activity,
avoiding substance misuse, maintaining emotional states free of excessive anxiety and unhappiness, understanding and avoiding common hazards.
Difficulty driving
Difficulty w ADLs dangerous

Question 8

How to manage ADHD in child primary care

Answer 8

If having adverse affect:
Watch and wait for 10 weeks encouraging self help and behaviour management
Refer parents and carers to ADHD based support group
Refer to CAMHs

Question 9

When refer child to CAMHS with ADHD

Answer 9

Sever symptoms
Can’t do period of watch and wait

Behavioural and/or attention problems persist with at least moderate impairment following a period of watchful waiting or a parent support programme.

Question 10

Adult ADHD symptoms

Answer 10

occupational or educational underachievement, dangerous driving, gambling, and difficulties in carrying out daily activities (such as shopping and organizing household tasks), in making and keeping friends, in intimate relationships (for example, excessive disagreement), and with childcare.

Question 11

When refer adults for ADHD diagnosis

Answer 11

No prev diagnosis -> specialist ADHD MH service

Prev diagnosis -> general psychiatry

Question 12

How often monitor weight, height and BP after start medication for ADHD

Answer 12

-WEIGHT - every 3 months if < 10 years old
- 3 and 6 months after treatment started, then every 6 months after if >10
HEIGHT - every 6 months children
BP - before and after each dose change. Routinely every 6 months

Question 13

Advice on driving with amfetamines

Answer 13

drowsy, dizzy, unable to concentrate or make decisions, or if they have blurred or double vision.

It’s an offence to drive over certain conc of amfetmaines irrelevant of effect in you

Question 14

Preschool age children management ADHD

Answer 14

parent training programme
Tertiary care may consider drugs if severe

Question 15

School age children ADHD management

Answer 15

1 - education and group based support parents and patient. Liase w school/uni
Individual offered if needs can’t be met in group.
Environmental modifications
2 - methylphenidate if above doesn’t improve
3 - lisdexamfetamine, dexamfetamine, and atomoxetine as alternatives
4 - melatonin for 6-17 yr olds if insomniac
5 - add CBT if meds not entirely affective

Question 15

Adult ADHD treatment

Answer 15

1 - environemtnal adaptations
2- Lisdexamfetamine or methylphenidate
3 - dexamfetamine or atomoxetine alternatives
4 - if still impaired with mediation -> non pharmaceutical support eg structured supportive psychological intervention focused on ADHD, regular follow-up either in person or by phone, and/or elements of a full course of CBT.

Question 16

Common adverse effects methylphenidate drug

Answer 16

GI - N+V, abdo pain, dyspepsia, Diarrhoea, DECREASED APPETITIE
CVS - tachycardia, palpitation, arrhythmias, and changes in blood pressure.
CNS - insomnia, nervousness, asthenia, depression, irritability, aggression, headache, drowsiness, dizziness, dysphemia, and movement disorders. Can impair connotative function and therefore driving
Dermatological - pruritus and rash.
Other adverse effects, including reduced weight gain, cough, nasopharyngitis, tics (very rarely Tourette syndrome), fever, arthralgia, alopecia, and growth restriction.

Question 17

Less common adverse effects methylphenidate drug

Answer 17

common adverse effects include constipation, dyspnoea, dysphemia, abnormal dreams, confusion, suicidal ideation, urinary frequency, haematuria, muscle cramps, epistaxis, and contusion.
Rarely, angina, sweating, and visual disturbances have been reported.
Very rarely, the following have been reported hepatic dysfunction, myocardial infarction, cerebral arteritis, psychosis, seizures, neuroleptic malignant syndrome, tolerance and dependence, blood disorders including leucopenia and thrombocytopenia, angle-closure glaucoma, exfoliative dermatitis, and erythema multiforme, supraventricular tachycardia, bradycardia, and convulsions.

Question 18

Amfetamines side effects drug

Answer 18

Metabolic - decreased appetite and weight
Psychiatric - insomnia, anxiety, agression, lability, mood swings, depression
CNS - dizzy, dyskinesia, hyperactivity, confusion, ittitability, headache
CVS - HPTN, tachycardia, PROLONGED QTC, cardiomyopathy, MI
Sexual dysfinction
Mydiraisis, angle closure galucome
Elevated plasma Corticosteroid levels
Vascular disorders - epistaxis

Question 19

amfetamine drug interactions

Answer 19

Moclobemide, Rasigiline - hypertensive crisis
MAOIs - serotonin syndreome - WITHIN 14 DAYS. Also SSRIs and SNRIs
Atomoxetine - psychosis and moevemnt disorders
Haloperidol - inhibt effects
TCAs - CVS
HIV protease inhibtiors