adhd

PHRM 110 - WEEK 13: ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD): OVERVIEW

  • ADHD is the most commonly diagnosed childhood behavioral disorder.

  • Prevalence:

    • The percentage of school-age children reported to have ADHD ranges between 5% and 12%.

    • ADHD is not limited to children; it affects adolescents and adults as well.

    • Up to 25% of children who have a parent, sibling, or other close family relative diagnosed with ADHD also exhibit symptoms of ADHD.

SYMPTOMS OF ADHD

  • Common symptoms include:

    • Hyperactivity and restlessness: Excessive movement and inability to relax.

    • Inability to sit still when required: Difficulty maintaining physical stillness during passive activities like classroom learning.

    • Impulsiveness: Acting on a whim without considering the consequences.

    • Inattention and distractibility: Difficulty in focusing on tasks and being easily distracted by extraneous stimuli.

    • Forgetfulness: Frequently losing items and forgetting to complete tasks.

    • Inability to complete tasks: Struggling to finish schoolwork, chores, or other obligations.

    • Symptoms interfere with various aspects of life, including:

    • School performance

    • Playground activities

    • Home responsibilities

    • Community interactions

    • Social relationships

ENVIRONMENTAL AND NUTRITIONAL RISK FACTORS FOR ADHD

  • Genetics: The strongest link to ADHD.

  • Environmental exposures include:

    • Cigarette smoke and alcohol during pregnancy: Teratogenic effects leading to developmental issues in offspring.

    • High levels of lead-based paint: Exposure to lead, especially in older homes.

    • Leaded gasoline: Still utilized in certain regions worldwide.

  • Dietary factors: Food additives and sugar may exacerbate ADHD symptoms.

    • Diet intervention: Some studies indicate that approximately 5% of children with ADHD show symptom improvement when on a diet restricting specific food additives.

TREATMENT OF ADHD

  • There is no cure for ADHD; instead, the focus is on controlling symptoms.

  • Two primary treatment modalities for ADHD:

    • Pharmacotherapy: Utilization of medications.

    • Behavioral therapy: Techniques to help manage behaviors associated with ADHD.

  • Drug treatments commonly employed include:

    • Amphetamines: Facilitate symptom control by altering neurotransmitter activity.

    • Nonamphetamine stimulants: Alternative medications with different mechanisms of action.

  • Substance action in ADHD patients differs from that in individuals without ADHD:

    • Amphetamines decrease hyperactivity and enhance focus.

AMPHETAMINES

  • Chemical Structure: Amphetamines are structurally similar to norepinephrine.

  • Mechanisms of Action:

    • Stimulate the release of norepinephrine.

    • Block monoamine oxidase (an enzyme that breaks down neurotransmitters).

    • Stimulate the release of dopamine, leading to significant central nervous system effects.

  • Effects of Increased Norepinephrine Activity:

    • Increases alertness and responsiveness.

    • Increases wakefulness.

    • Reduces fatigue awareness.

  • Common Amphetamine Examples:

    • Adderall

    • Vyvanse

    • Dexedrine

METHYLPHENIDATE

  • Mechanism of Action: Exact mechanism is not fully understood but involves:

    • Increased release of norepinephrine to maintain arousal and alertness.

    • Stimulates dopamine levels in brain regions responsible for concentration.

    • Enhances attention span, enabling better functioning in academic settings and reduces disruptive, impulsive behaviors.

  • Common Methylphenidate Examples:

    • Biphentin

    • Concerta

    • Foquest

    • Ritalin SR

ADVERSE EFFECTS OF ADHD MEDICATIONS

  • Common side effects associated with ADHD treatments include:

    • Decreased appetite

    • Nausea

    • Stomachache

    • Anxiety

    • Irritability

    • Insomnia

    • Increased heart rate and palpitations

    • Arrhythmia

    • Dizziness

    • Tremor

    • Amphetamine syndrome (drug-induced psychosis)

WARNING LABELS FOR ADHD MEDICATIONS

  • Important usage instructions include:

    • Take with food: To mitigate gastrointestinal side effects.

    • May be habit-forming: Indicates potential for dependency.

    • Swallow whole; do not crush or chew: Applicable to sustained-release and extended-release formulations.

    • Medications come in immediate release, sustained release, and extended release forms.

    • High abuse potential: Caution advised due to potential for misuse.

NONAMPHETAMINE STIMULANT: ATOMOXETINE

  • Type: Selective norepinephrine reuptake inhibitor.

  • Usage: Prescribed for ADHD, however, the exact reasons for effectiveness remain unclear.

  • Effects: Increased ability to focus and decrease in hyperactivity.

  • Common Adverse Effects (A/Es):

    • Headache

    • Insomnia

    • Cough

    • Decreased appetite

    • Upper abdominal pain

GUANFACINE (INTUNIV XR)

  • Function: Selective alpha-2A adrenergic receptor agonist.

  • Administration: Available in an extended-release formulation; important not to crush or chew for optimal efficacy.