ADHD

Question 1

part of brain most involved in ADHD

Answer 1

prefrontal cortex

Question 2

when does the prefrontal cortex finish myelination

Answer 2

25

Question 3

Genetics and ADHD

Answer 3

• Genetic imbalance in dopamine and noradrenergic systems

- Strong genetic influence

Question 4

Environment and ADHD

Answer 4

• Increased risk with prenatal smoking exposure
• Prematurity, Brain injury, fetal alcohol, lead
• Dietary factors do not play a role in majority of children

Question 5

when must symptoms of ADHD be present

Answer 5

by 12 years of age

Question 6

how many symptoms must be present to have ADHD

Answer 6

6/9

Question 7

criteria symptoms for inattentive ADHD

Answer 7

• careless mistakes
• Difficulty sustaining attention
• Does not seem to listen
• Does not follow through on tasks
• Not organized
• Avoids sustained mental effort
• Loses things
• Is easily distracted
• forgetful

Question 8

criteria symtpoms for hyperactive/impulsivity ADHD

Answer 8

• Fidgets or squirms
• Inappropriately leaves seat
• inappropriately runs or climbs
• Has difficulty playing quietly
• is “on the go”
• Talks excessively
• Blurts out answers
• Has Difficultly waiting his or her turn
• Interrupts or intrudes on others

Question 9

time frame for ADHD

Answer 9

present for over 6 months

Question 10

Comorbidities with ADHD?

Answer 10

• Learning disorder (10-30%)
• Opposition defiant disorder/Conduct disorder
• Anxiety or mood disorder
• Tourette’s and tic disorders
• coordination problems
• substance abuse
• sleep problems
• Triad of psychiatry
• PANDA’s

Question 11

What is the triad of psychiatry

Answer 11

• ADHD
• Tourette’s syndrome
• OCD

Question 12

What is PANDA’s

Answer 12

post infectious state that looks like Triad of psychiatry

Question 13

Primary MOA of stimulants

Answer 13

• block reuptake pump

- increases dopamine and NE

Question 14

What action does amphetamine have that other stimulants don’t

Answer 14

-cause presynaptic release into synapse

Question 15

Common side effects of stimulants

Answer 15

• Decreased appetite - give with or after meals
• Difficulty falling asleep
• Tics
• upset stomach . .give with food
• Headaches

Question 16

Less common side effects of stimulants

Answer 16

• Moodiness or irritability
• Overly quiet “Zombie effect”
• Weight loss
• small decrease in height velocity
• Rebound symptoms as med wears off
• Mild increase in heart rate and BP
• Rare risk of mania or hallucinations
• Priapism . .trazadone

Question 17

FDA concern about stimlulant use

Answer 17

• don’t use if heart disease, arrhythmia, or FH of arrhythmia
• EEG not needed if carciac hx is negative

Question 18

MOA of Atomoxetine (straterra)

Answer 18

-selective NE reuptake inhibitor

Question 19

Atomoxetine is useful in ADHD with what

Answer 19

anxiety or depression

Question 20

Side effects of Atomoxetine

Answer 20

• Somnolence: can give in evening or divide dose
• Anorexia, GI upset, weight loss - give with food , divide dose
• Dizziness
• Rare risk of liver disease
• Increased risk of suicidal ideation

Question 21

What are the alpha 2 agonists used to treat ADHD

Answer 21

Clonidine and Guanfacine

Question 22

describe Clonidine and Guanfacine and how they work

Answer 22

• useful for sleep, tics, aggression, hyperarousal
• not as effective for inattention
• Used as adjunctive
• Work on POST SYNAPTIC ALPHA 2 receptor as agonist

Question 23

Side effects of The alpha 2 agonists

Answer 23

• Sedation (especially with clonidine)
• Dry mouth
• depression
• low BP
• headache

Question 24

Withdrawal symptoms of the alpha 2 agonists if suddenly stopped

Answer 24

• high pulse
• BP
• headache
• agitation

Question 25

Treatment of ADHD with anxiety

Answer 25

- responds to stimulants - May need to add SSRI - another option is atomexetine

Question 26

Treatment of ADHD and tics

Answer 26

- Stimulants and clonidine | - Atomoxetine

Question 27

Treatment of ADHD and aggression

Answer 27

-Stimulant and clonidine/guanfacine