Psychiatry : ADHD

tell me about aetiology of ADHD ?

- Genetic factors - Two catecholamine neurotransmitters - dopamine and noradrenaline- play a key role in ADHD. - Environmental factors: low birth weight, smoking during pregnancy, childhood abuse/neglect, neurotoxin/alcohol exposure.

Differential diagnosis of ADHD ?

-Bipolar disorder - Developmental variations - Learning disability - Seizure disorder -Autism spectrum disorders ==Emotional/behavioral disorders Depression or mood disorder Anxiety disorder Obsessive compulsive disorder Conduct disorder Child abuse or neglect Sleep disorder Iron deficiency anemia Lead poisoning Endocrine disorders Substance abuse Food allergy

types of ADHD ?

-predominantly inattentive -predominantly hyperactive (impulsive) -mixed

can cause dizziness , weight loss , mood swings , liver injury ( very rarely)?

Atomoxetine

what is ADHD ?

Attention deficit/Hyperactivity disorder: • ADHD is characterized by persistent inattention, hyperactivity, and impulsivity inconsistent with the patient's developmental stage.

can cause : bradycardia , arrhythmia , hypertension , withdrawal hypotension ?

Clonidine

The single most important test to perform is ?

IQ test

tell me about Stimulants MOA and side effect ? examples ?

MOA:↑ neurotransmitters (dopamine) • e.g. methylphenidate compounds, dextroamphetamine AE: weight loss, emothional irritability, infections, insomnia (not to be taken at bedtime).tic Common side effects of methylphenidate include loss of appetite and weight, irritability, oversensitivity and crying spells, headaches, and abdominal pain. Insomnia may occur, particularly when this agent is dispensed late in the day. Tics, while a less frequent complication of stimulant treatment, can cause significant impairment. (Whether this is the drug causing tics or the unmasking of a previous tic predisposition is unclear.)

tell me Nonpharmacological treatments of ADHD ?

Parent and school psychoeducation · Behavioural parent training. · Behavioural classroom management. · Educational intervention: · The child should be in the first row in the class. · Not beside window (reduce distractions) · Split the tasks of the class activities. · Allow the child to take break between tasks. Let him or her to move before the break ends (walking or wipe the board). Behavioral psychotherapy: teach the child · Time management. Organizational skills (e.g. structured · routine and giving rewards when they are following the routine) · Decrease distractions

tell me about COURSE/PROGNOSIS of ADHD ?

Stable through adolescence ■■ Many continue to have symptoms as adults (inattentive > hyperactive) ■■ High incidence of comorbid oppositional defiant disorder, conduct disorder (CD), and specific learning disorder

can cause insomnia , anorexia , weight loss , dizziness , irritability and abuse potential.

Stimulants

first line treatments for ADHD ?

methylphenidate

Females present more often with inattentive symptoms of ADHD ......is that true ?

yes

for ADHD : Multimodal treatment plan: medications are the most effective treatment for decreasing core symptoms, but should be used in conjunction with educational and behavioral interventions.........is that true ?

yes

tell me about atomoxetine ? MOA ? side effect ? AEs ?

· MOA: norepinephrine reuptake inhibitor. · Second line. · AEs: tachycardia, high blood pressure

tell me Pharmacological treatments of ADHD ?

■■ First-line: Stimulants—methylphenidate compounds, dextroamphetamine, and mixed amphetamine salts ■■ Second-line choice: atomoxetine, a norepinephrine reuptake inhibitor ■■ Alpha-2 agonists (e.g., clonidine, guanfacine) can be used instead of or as adjunctive therapy to stimulants

tell me DSM criteria for ADHD ?

■■ Two symptom domains: inattentiveness and hyperactivity/impulsivity ■■ At least six inattentive symptoms ■■ Fails to give close attention to details or makes careless mistakes. ■■ Has difficulty sustaining attention. ■■ Does not appear to listen. ■■ Struggles to follow through on instructions. ■■ Has difficulty with organization. ■■ Avoids or dislikes tasks requiring a lot of thinking. ■■ Loses things. ■■ Is easily distracted. ■■ Is forgetful in daily activities. and/or ■■ At least six hyperactivity/impulsivity symptoms ■■ Fidgets with hands or feet or squirms in chair. ■■ Has difficulty remaining seated. ■■ Runs about or climbs excessively in childhood; extreme restlessness in adults. ■■ Difficulty engaging in activities quietly. ■■ Acts as if driven by a motor; may be an internal sensation in adults. ■■ Talks excessively. ■■ Blurts out answers before questions have been completed. ■■ Difficulty waiting or taking turns. ■■ Interrupts or intrudes upon others. ■■ Symptoms >6 months and present in two or more settings (e.g., home, school, work) ■■ Symptoms interfere with or reduce quality of social/academic/occupational functioning ■■ Onset prior to age 12, but can be diagnosed retrospectively in adulthood ■■ Symptoms not due to another mental disorder