Download Alterations in Mental Health Function

ADHD
Etiology
 8.4%
of children
 Boys>Girls
 Deficit of catecholamines _____ &
______________________


Decreased threshold for stimuli
(_________________)
Delay in self-regulation (________________,
______________________)
Clinical Manifestations
DSM V Criteria
 Inattentive
 Hyperactivity
for 6 months
 Impulsivity for 6 months
 Some symptoms present before age
___________
 Present in 2 or more settings
 Impairment in social, academic or
occupational functioning
 Not accounted by another Mental Illness
Diagnosis
 Family
history
 Birth history
 G&D milestones
 Sleeping & eating patterns
 School performance
 Social & environmental conditions
 PE-R/O neurological cause
Social Implications
 Parents
 Children
Co-morbidities
Therapy
 Environmental
 Behavior
 Diet
 Medications
Medications-Stimulants





Increase synaptic levels of dopamine &
norepinephrine
2-4 weeks to titrate dose for effect
Long-acting
Short-acting
Chewable forms


Reduces interrupting, fidgeting, (hyperactive sx)
Improves task completion & home relationships
Medications - Stimulants








Adderall® (intermediateacting)
Adderall XR® (long-acting)
Concerta® (long-acting)
Daytrana® (long-acting
patch)
Dexedrine® (short-acting)
Dexedrine® Spansule®
(intermediate-acting)
Focalin® (short-acting)
Focalin XR® (long-acting)







Metadate CD® (longacting)
Metadate® ER
(intermediate-acting)
Methylin™ ER
(intermediate-acting)
Ritalin® (short-acting)
Ritalin LA® (long-acting)
Ritalin SR® (intermediateacting)
Vyvanse® (long-acting)
Medications-Stimulants
 Adverse









Effects
_________________
_________________
Headaches
Abdominal discomfort
___________________
Irritability
___________________
Social withdrawal
Lowers seizure threshold
Medications-Nonstimulants
 Norepinephrine
reuptake inhibitor




 Anti-depressants

atomoxetine
(Strattera) - 1-2 X a
day
Less potential of
substance abuse
Risk for ______________
Biggest side effect –
_____________________


Ideal for ADHD + depression
not as effective as
stimulants or Strattera at
improving attention span
and concentration.
Tricyclic antidepressants:
Pamelor™ (nortriptyline),
Tofranil® (imipramine), and
Norpramin® (desipramine)

Wellbutrin, Effexor,
Monoamine oxidase
inhibitors (MAOIs)
Alpha Adrenergic Agonists
 Extended-release
meds
- guanfacine (Intuniv)
- clonidine (Kapvay)
*used if no response to stimulants
*used as adjunct for partial response to
stimulants
Future substance abuse
 According
to the National Institute of Drug
Abuse, the answer is no.
 "The studies conducted so far have found
no differences in later substance use for
children with ADHD who received
treatment and those that did not. This
suggests treatment with ADHD medication
appears not to affect (either negatively or
positively) an individual’s risk for
developing a substance use disorder."
(National Institute of Drug Abuse, 2014).
Follow-up
 How
often should we follow-up and why?
 https://youtu.be/z2hLa5kDRCA