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ADHD clinical

34 important questions on ADHD clinical

What can cognitive enhancement with stimulants do for certain individuals according to a previous lecture?

- Improve certain neurocognitive tasks
- Effect most pronounced in "bad stoppers"

What are the additional criteria for diagnosing ADHD according to DSM-5?

- Symptoms of hyperactivity-impulsivity or inattention before age 12
- Symptoms present in two or more areas
- Clear evidence of significant impairment in social, school, or occupational functioning

What are some characteristics of hyperactivity in individuals with attention deficit hyperactivity disorder (ADHD)?

- Constant inner sense of restlessness
- Choosing jobs that require working long hours, high levels of activity, or multiple tasks- Avoiding jobs that require low level activity
- Social tension resulting from constant activity

What are some characteristics of impulsivity in individuals with attention deficit hyperactivity disorder (ADHD)?

- Easily frustrated
- Changing relationships or jobs frequently
- Difficulties with driving, traffic accidents
- Easily losing temper
- Hasty decisions
- Low tolerance for stress
- Interrupting conversations
- Speaking out without thinking

What are some characteristics of inattention in individuals with attention deficit hyperactivity disorder (ADHD)?

- Poor time management skills
- Avoiding tasks demanding attention
- Putting off tasks and activities
- Excessive multitasking leading to tasks being incomplete
- Problems with starting or completing tasks, or failure to switch to a different task
- Needing to adapt a lifestyle to fit the benefits and the negatives of having a short attention span

What are the methods used for diagnosing ADHD?

- No biomarkers available
- Detailed interview on symptoms and course with patient, relatives, school teachers/reports

What performance-based measures can support the diagnosis of ADHD, although they are not part of the diagnostic criteria?

- Wisconsin Card Sorting Test
- Stroop Test
- Verbal Fluency
- Continuous Performance Test (Qb Test)

What is the reported prevalence of ADHD in the Netherlands and worldwide according to DSM-criteria?

- Netherlands: ~3%
- Worldwide: ~5%
- Male:female ratio is 2-3:1
- Symptoms often persist into adulthood

What is the estimated contribution of genetic factors to ADHD?

- Estimated at 70-80%
- Involves multiple genes of small effect
- No major genes have been identified

What different network activities have been observed in the right hemisphere of individuals with ADHD using functional MRI?

• Inhibition network (inferior frontal cortex, supplementary motor area and anterior cingulate
cortex)
• Attention network (dorsolateral prefrontal and parietal cortex, cerebellum)

What are some treatments with evidence for a positive effect on cognitive function?

- Cognitive training
- Behavioral training
- Omega-3 fatty acids
- Reduction of food additives

Which treatment is considered the most effective, according to the provided information?

Medication is by far the most effective.

What is the mechanism of action for Alpha-2 receptor activation according to the text?

Alpha-2 receptor activation leads to dopamine release.

What are the characteristics of stimulants such as methylphenidate and dexamphetamine?

- Short-acting and long-acting variants (3-12 hrs)
- Immediate action, follows blood concentration
- Can be used daily or intermittently
- Effect: increased attention, reduced hyperactivity
- Side-effects: loss of appetite, headache, rapid heartbeat, increased blood pressure, difficulty sleeping
- Possibly addictive: controlled substances

When would atomoxetine and bupropion be considered as second best options?

- When stimulants are ineffective or not tolerated
- Daily use

What is mentioned about the long-term use of amphetamines for ADHD?

- Recreational high doses may cause brain changes
- No evidence of long-term effects from therapeutic doses
- ADHD symptoms change over life-span; try to reduce medication during follow-up

What happens in case of a polymorphism associated with reduced DBH expression?

- DBH is an enzyme that converts dopamine to noradrenaline
Een polymorfisme dat geassocieerd is met verminderde DBH-expressie zou leiden tot een verminderde omzetting van dopamine naar noradrenaline.

What according to Labbate is the effect of stimulant treatment in ADHD in relation to substance use disorder?

- Longitudinal treatment can reduce substance abuse risk
- Greater protection in adolescence than adulthood

What according to Labbate is the value of behavioral therapy for ADHD?

- Medication management alone superior to behavioral treatment
- Modest benefit of adding intensive behavioral treatment to medications alone

Which neurochemical mechanism underlies the stimulating effect of stimulants on the sympathetic nervous system?

Psychostimulants such as amphetamines and methylphenidate primarily act by increasing the release of dopamine and norepinephrine and by inhibiting their reuptake. This mechanism leads to higher levels of dopamine and norepinephrine in the synaptic cleft, resulting in the stimulation of sympathetic activity. Overdose with psychostimulants results in a syndrome of marked sympathetic hyperactivity (i.e., hypertension, tachycardia, hyperthermia) often accompanied by toxic psychosis or delirium.

What is the likely reason for the appetite-suppressant properties of stimulants?

- The hypothalamic effects of stimulants are likely responsible for their appetite-suppressant properties.

Why should one be cautious when using stimulants in individuals with high blood pressure and excessively high and variable heart rate?

- Due to the risk of arrhythmias.

What are the two determinants for choosing the dosage in children and adults, respectively?

- Immediate-release versus extended-delivery preparations and body weight.

What does the statement “amphetamine is more potent than methylphenidate” mean? Does that affect efficacy?

- Amphetamine binds more or is more effective in the brain
- It needs lower doses
It refers to the relative pharmacological potency of amphetamine compared to MPH. This means that amphetamine has greater pharmacological effectiveness in activating certain neurochemical pathways compared to MPH. However, the fact that amphetamine is more potent does not necessarily mean that it is more effective in treating ADHD. Efficacy is a complex issue that depends not only on the potency of the drug but also on other factors such as side effects, individual response, and other treatment variables.

Why can a high dosage of amphetamine result in a dry mouth?

- High blood pressure puts body in action mode

Why would sudden withdrawal after chronic amphetamine use result easily in hypersomnia and hyperphagia?

Although there are no physical withdrawal symptoms, patients who have used high doses of psychostimulants for prolonged periods may experience a marked central syndrome, including fatigue, hypersomnia, hyperphagia, and severe depression in the short term. This can occur due to the neurochemical adaptations that occur in the brain with prolonged drug exposure. Chronic amphetamine use alters the balance of neurotransmitters in the brain, particularly dopamine and norepinephrine, which are involved in regulating sleep-wake cycles and and appetite.

Why are possibly fatal consequences of an amphetamine or methylphenidate overdose treated with adrenergic receptor blockade?

Overdose with amphetamines or MPH results in marked sympathetic hyperactivity, including hypertension, tachycardia, and hyperthermia. Adrenergic receptor blockade is used to counteract these effects.

Which neurotransmitter levels in the frontal cortex are elevated under atomoxetine?

- Atomoxetine increases norepinephrine and DA in prefrontal cortex

Can you think of a reason why atomoxetine would have less of a sympathetic effect compared to methylphenidate?

In vitro, ex vivo, and in vivo studies have shown that atomoxetine is a selective antagonist of the presynaptic norepinephrine transporter, with little or no affinity for other noradrenergic receptors or other neurotransmitter transporters or receptors (except for a weak affinity for the 5-HT transporter). This selective action may result in less overall sympathetic stimulation compared to MPH, which has a broader effect on increasing neurotransmitter levels, including dopamine, across various brain regions.

What is the difference between methylphenidate and atomoxetine with respect to the time it takes to achieve the desired effect?

Methylphenidate works immediately, while atomoxetine will take weeks to have the desired dose and effect.

According to Labbate, what is the odds ratio for the association between atomoxetine and suicidal ideation?

The odds ratio for the association between atomoxetine and suicidal ideation is approximately 3.14.
Formula: OR = (a/c)/(b/d)

Is the odds ratio for the association between atomoxetine and suicidal ideation statistically significant?

The 95% confidence interval for the odds ratio is:
Lower bound: 0.37
Upper bound: 26.95
The p-value from the chi-square test is approximately 0.495. Since the CI includes 1 and p-value > 0.05, the high odds ratio is not statistically significant.

For which disorder are choline-esterase inhibitors mostly being used?

Choline-esterase inhibitors are mostly used for people with ADHD with tic-disorders or several behavior problems.

What is the most likely main biochemical target of methylphenidate in relation to dopamine?

- Dopamine Transporter (DAT)
- Methylphenidate blocks DAT
- Leads to increased dopamine levels in synaptic cleft

The question on the page originate from the summary of the following study material:

Psychopharmocology

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