ADHD

ADHD

• a persistent pattern of inattention and hyperactivity- impulsivity with onset during the development period

• Degree of inattention and hyperactivity impulsivity is outside the limits of normal varioation expected for age and level of intellectua; functioning and significant interferes with academic occupational

ADHD neurobiology and basis of treatment

• both dopamine and noradrenaline are involved in the treatment response

• Other neurotransmitters throught to be involved include glutamate and serotonin poitentially some light on the memory and mood aspect of ADHD

• DA modulates rewards in the Ventura; striatum- ADHD patients need higher rewards and how hypo activating in reward circuits

• DA modulates working memory and inhibitory functions in fronto striata’s circuits- ADHD patients have impaired prefrontal cognitive function and show hypo activation in prefrontal circuits

• 2 firing modes tonic and phasic ADHD patients have a reduced tonic pool of DA and compensate with increased physical release

ADHA treatment target

• educate about the disorder and its management

• Support the individual

• Improve the core symptoms

• Address the associated impairments

• Treat the psychiatric co morbidity

• Monitor physical health

ADHD treatment domains

• medication

• Psychological;

• Individuals CBT, DBT mindfulness

• PSpychoeducation

ADHD pre medication

• confirm the diagnosis of ADHD

• Review of menta; health comorbidites

• Risk assessment of substance misuse and drug diversion

• Review physical health

  • Medical history

  • Height and weight

• blood pressure and pulse

• Weight

• Annual review

ADHD choice of medication

• lisdexamfetamine or methylphenidate

• Switch those who have not derived enough benefit to lisdexamfetamine or methylphenidate following a 6 week trial at an adequate dose

• Consider atomexetine guanfacine atypical antipsychotic

Noradrenaline

• efficacy of stimulation in ADHD

• Cognitive function

• Attentiveness

• Distractibility

• Hyperactivity

• Behavioural disruption

Dopamine

• adverse effect of stimulation

• Insomnia

• BP

• Nause

Mechanism of action

• pyschostimulants - DAT and NAT inhibitors

• Non stimulants:

  • Atomoxetine- NARI selective noradrenaline reuptake inhibitor

  • Clonidine and guanfacine

  • Bupropion

Methylphenidate

• M/R preparation. Should be prescribed

Contra indications

• CVD

• Hyperthyroidism

• Suicidal tendencies

Monitor

• growth restriction in children

• For psychiatric disorder

• Pulse

Lisdexamfetine and dexamfetamine

• CVD: moderate- severe hypertension

• Hyperthyroidism

Overdose

• wakefulness, excessive activity, paranoia, hallucinations

Monitor

• aggressive behaviour or hostility

• Pulse, BP psychiatric

• Weight and height in children