ADHD

Question 1

Impact of adult ADHD?

Answer 1

1. increase freq of psychiatric COMORBIDITY
2. HIGHER levels of CRIMINALITY
3. higher levels of SUBSTANCE abuse
4. impairment in OCCUPATIONAL fxn (easily accomodated)

Question 2

what causes AHDH?

Answer 2

• perinatal percipitants
• psychosocial adversity
• genetic predisposition

> all 3 leads to neuroanatomical BRAIN changes > cognitive and behavioural fts of ADHD

Question 3

What are perinatal factors that cause ADHD?

Answer 3

• use of TOBACCO and ALCOHOL during pregnancy
• —-ADHD-like kids with fetal alcohol syndrome
• ADHD a/w signif. premature baby and perinatal HYPOXIA
• others: fetal distress, forceps delivery, eclampsia, unusally short or long labour
• exposure to a vital infection

Question 4

What is meant by psychosocial ?adversity?

Answer 4

links to PARENTING styles

—-marital discord, low social class, large family size, paternal criminality, emotional trauma

Question 5

Which area of the brain is LEAST active in ADHD?

Answer 5

• Prefrontal region of the are

- resp. for EXECUTIVE functioning (making decisions, initiation of actions), inability to self-manage time…

Question 6

What is the neurochemistry behind ADHD?

Answer 6

-appears to be an —excessively EFFICIENT dopamine-removal system

Question 7

What is the 3 characteristic signs of ADHD?

Answer 7

TRIAD of:

• INATTENTION
• HYPERACTIVITY
• IMPULSIVITY

Question 8

What is essential for the diagnosis of ADHD in adults?

Answer 8

• should have a MODERATE effect on diff. areas on their life —-UNDERACHIEVING at work/school
• dangerous driving
• hard to make and keep friends
• diffic. relationships

Question 9

What are psychosocial interventions?

Answer 9

• parent training
• social skills training
• SLEEP AND DIET (reduce gluten, reduce SUGAR)
• behvavioural classroom

Question 10

What is the first line rx for moderate to severe pharmacological rx?

Answer 10

-1st line (STIMULANTS): METHYLPHENIDATE, DEXAMFETAMINE, LISDEXAMFETAMINE

Question 11

How does ADHD affect daily functioning?

Answer 11

• impairs self-regulation
• impairs executive functioning/ emotional regulation
• pervasive ACROSS various settings (school, home)
• LONGSTANDING since 5y,o

Question 12

How does ADHD differ in adults?

Answer 12

• more INATTENTIVE symptoms

- less obvious HYPERACTIVITY and impulsivity

Question 13

What is the impact of childhood ADHD?

Answer 13

• hard to parent
• INCREASED home stress/emotions
• difficulties in PEER relationships
• inappr. decision making
• exclusion from EDUCATION
• antisocial behaviour

Question 14

When left untreated, what occurs with ADHD patients?

Answer 14

• 3-5 fold INCR. in divorce risk
• 60% become suspended from school
• 50% in MVA

Question 15

What theory lies in the fact that ADHD symptoms die down with age?

Answer 15

• the maturation of the brain> THICKENING of the cortex allows the brain to COMPENSATE for cognitive deficits

Question 16

How likely is the offspring of an ADHD pt gonna get ADHD?

Answer 16

• 60%

Question 17

Sibling risk of ADHD?

Answer 17

15%

Question 18

What genes are involved in ADHD?

Answer 18

• dopamine and serotonin

Question 19

What forms of psychosocial adversities predisposes one to ADHD?

Answer 19

• severe MARITAL discord
• low SOCIAL class
• Large family size
• paternal criminality
• maternal mental d.o
• emotional trauma and maltreatment

Question 20

Briefly state the causal factors and compounding factors of ADHD.

Answer 20

Genetic risk is an IMPORTANT precursor; which is COMPOUNDED by ONE or MORE psychosocial risk factors

Question 21

Which part of the brain is UNDERACTIVE in ADHD?

Answer 21

• frontal lobe

needed for EXECUTIVE functioning- reasoning/planning/judgement/social and sexual behavior/ long term memory

Question 22

Wit anxiety, which parts of the brain is underactive?

Answer 22

• A LARGE majority of the brain is underactive

- why you can’t think straight when you suffer from anxiety…

Question 23

What occurs in ADHD neuro-chemically?

Answer 23

• excessively efficient REMOVAL of dopamine (d.t HIGH conc. of DOPAMINE TRANSPORTER)—-therefore LESS dopamine a/w with adhd (REWARD system is not as active—-UNLESS MULTIPLE ACTIVITIES is done at once)

Question 24

ADHD involves the reduction of dopamine and 2 other NTs…what are they?

Answer 24

1. serotonin (influences MOOD, SOCIAL behaviour, SLEEP and MEMORY)
2. Norepinephrine (affects ATTENTION when acting as a STRESS hormone)

Question 25

What should be presented for the diagnosis of ADHD in children?

Answer 25

- 6 or more symptoms of INATTENTIVENESS - 6 or more symptoms of HYPERACTIVITY/IMPULSIVITY - present since 5 y.o - reported by parents, clinic, school - ---affects DAILY functioning

Question 26

How diff. is the diagnostic criteria in adults?

Answer 26

- 5 or more symptoms of inattentiveness and/or 5 or more of impulsiveness

Question 27

What are the following lines of therapy for ADHD ?

Answer 27

- 2nd line: SNRI (atomoxetine) - 3rd line: Alpha agonist - 4 th line: antidepressants, antipsychotics

Question 28

What particular family of drugs help BOOST concentration ?

Answer 28

Stimulants - dexamphetamine and methylphenidate > reduce short term memory; helps FOCUS on the task at hand - reduces impulsive behaviours

Question 29

How does increasing NE levels help in ADHD?

Answer 29

...NONSTIMULANTs (SNRI/Alpha-agonists) reduce sympathetic stimulation; increases NE - rids HESITATION, DOUBT, Obsession

Question 30

Diminished serotonin levels exacerbates what conditions?

Answer 30

- anxiety - confusion - restlessness

Question 31

Diminished dopamine is said to add to....

Answer 31

- foggyness - compulsion - hyperactivity