ADHD

  • Evidence suggests a genetic link
  • Altered neurotransmitters in the CNS may cause decreased executive functioning
  • ADHD & School/Work:  poorer performance, more disruptive, more frequently lose/change jobs
  • ADHD & Life skills:  have fewer friends, more divorces/broken relationships, more teen pregnancies, more car accidents
  • Diagnosis:  6 or more symptoms of inattention or hyperactivity/impulsivity for at least 6 months, beginning before age 7, in 2 or more settings (school, work, home)
    • Must rule out other conditions as well
  • Medication management:  Baseline, Titration, Maintenance
  • Stimulants are effective 60-70% of the time in decreasing ADHD symptoms
    • Watch out for decreased appetite, decreased growth, insomnia & rebound symptoms, SUDDEN CARDIAC DEATH potential with stimulants
    • Don’t use w/ MAOIs or in patients with narrow angle glaucoma
  • Atomoxetine (strattera–SNRI) has also been used as 1st line
    • SE:  potentially serious liver damage; black box warning for suicide
  • Guanfacine (intuniv) & modafinil (provigil–C4 drug) have both also been used as 1st line agents
  • 2nd line agents used in patients who didn’t respond, have intolerable SE, significant comorbid disorders, high risk of abuse, profound mental retardation:  bupropion (wellbutrin), venlafaxine (effexor), clonidine (catapres), guanfacine (tenex)
  • Don’t mix two stimulants
  • Duration of therapy:  many ppl require therapy into adulthood, take weekend holidays, school performance, trust the parents

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