NR606 Final Exam

NR606 Final Exam (24/25 Correct Answers A+) Stimulant Medications: Methylphenidate - -Low risk of adverse effects -Available formulations: • Ritalin - available in immediate release (IR) and extended release (XR) available in beads that may be sprinkled on food for children who cannot swallow pills • Concerta biphasic - combined immediate and delayed release in one medication • Daytrana - patch applied in AM and removed after 9 hour Stimulant Medications: Dexmethylphenidate (Focalin) - -Available in IR and ER -More potent than Ritalin -High risk of adverse effects Stimulant Medications: Amphetamine (Adzenys) - -available in orally disintegrating ER formula for children who cannot swallow pills -Avoid prescribing when an MAOI has been used within 14 days Stimulant Medications: Dextroamphetamine (Adderall) - -Available in IR and extended-release formulations -Often dosed in morning (IR or XR) with an evening or evening prn (IR) dose if med effects diminish prior to end of school, study or the workday -Most abused & diverted prescription stimulant Stimulant Medications: Lisdexamfetamine (Vyvanse) - -Biologically inactive until metabolized by the body (Prodrug) -Less abuse & diversion potential than other stimulants -Higher-cost medication Non-stimulant medication: Atomoxetine (Strattera) - -Noradrenergic (NRI) -Initial drug of choice for adults with ADHD -no abuse potential -tolerated well when prescribed in BID dosing -appropriate choice for comorbid substance abuse -may augment the effects of antidepressants & antianxiety meds -can be dosed at bedtime if fatigue is noted -unlikely to worsen tics Non-stimulant medication: Clonidine - -α 2 agonist • May be taken as monotherapy or with stimulant medications -enhances precortical function for better mental focus -appetite neutral -may help with sleep disturbances, administer at bedtime -adverse effects: • sedation, brain fog -monitor of BP closely during initial titration, risk of hypotension -tapered to avoid rebound hypertension post discontinuation Non-stimulant medication: guanfacine - -α 2 agonist • May be taken as monotherapy or with stimulant medications -may also be used for children with tics, sleep disturbances, or aggression -tolerability & convenience enhanced by once-daily oral controlled-release formulation -adverse effects: • sedation, headache, decreased appetite -reduced side-effect profile comparable to clonidine -bedtime administration to avoid daytime sedation Non-stimulant medication: Bupropion (Wellbutrin) - -Norepinephrine Dopamine Reuptake Inhibitor -off-label use for ADHD in adults -appropriate for clients with concurrent depression or tobacco abuse Attention-deficit/hyperactivity disorder (ADHD) - -one of the most common neuropsychiatric disorders -approximately 9.4% of children in the U.S. -more frequently males than females, ratio 2:1 -symptom burden mild to severe -characterized by consistent pattern of inattention &/or hyperactivity & impulsivity that interferes with functioning & development • affect development of proper cognitive, behavioral, emotional, social, & academic function -hyperactivity and impulsivity ADHD subtype symptoms: excessive fidgeting or talking, feelings of restlessness and impatience, frequent interruption, and difficultly playing quietly -inattentive ADHD subtype symptoms: difficulty organizing tasks, maintaining a routine, and paying attention to detail • may not be distinguishable until eight or nine years of age -primarily disrupts neuronal connections within the frontal lobe & prefrontal cortex Without early identification and proper treatment, ADHD can cause disruptions in: - academic performance family stress difficulties in social relationships accidental injuries ADHD is associated with: - increased rates of depression & SUD Symptoms of ADHD - -Selective Attention • Lack of attention to detail • Careless mistakes • Not listening • Losing things • Diverting attention • Forgetfulness -Lack of Sustained Attention • Poor problem solving • Difficulty completing tasks • Disorganization • Difficulty sustaining mental effort -Impulsivity • Excessive talking • Blurting things out • Not waiting for one's turn • Interrupting -Hyperactivity • Fidgeting • Leaving one's seat • Running, climbing • Trouble playing quietly When is ADHD most often diagnosed - -preschool and elementary school • inattentive features become more prominent ADHD Lifespan Considerations: Symptoms Change with Age - -Young children with ADHD • often have developmental delays • may engage in behaviors less mature than peers -Teens with ADHD at risk for: • poor academic performance • problems with driving • difficulties with social situations • risky sexual behavior • substance abuse -75% of children with ADHD experience symptoms in adulthood -Adolescents & Adults with ADHD • may struggle with executive function, attention, working memory • problems with day-to-day functioning, performance at work, relationships ADHD is a deficiency of neurotransmitters, mainly _________ & _________ - dopamine and norepinephrine ADHD diagnostic criteria - -A pattern of at least six symptoms of inattention and/or hyperactivity-impulsivity that interfere with functioning or development. -Symptoms persist for six months or longer. -Symptoms interfere with social, academic, or occupational functioning. -Symptoms are present in two or more settings • for instance, home & school Kelsey is a 7-year-old first-grader who is the youngest of four children. During parent-teacher conferences, her teacher reported that she is polite, respectful, and gets along well with her peers. She has a hard time keeping her desk neat and she frequently misplaces her supplies and loses library books. She must often be told more than once to complete instructions. Her work is appropriate for her grade level, but she often makes careless mistakes on her assignments. She struggles with math and avoids doing arithmetic assignments. Her parents endorse that Kelsey's room is "sloppy" but do not notice any of the other concerns in the home environment. What is the most likely diagnosis for Kelsey? ADHD predominantly inattentive presentation ADHD predominantly hyperactive-impulsive ADHD combined presentation unlikely ADHD diagnosis - ADHD predominantly inattentive presentation Rationale: Kelsey meets diagnostic criteria for ADHD with a predominantly inattentive presentation. Inattentive symptoms include lack of attention to detail, making careless mistakes, difficulty listening and following instructions, frequent disorganization and misplacing items, distractibility, avoiding tasks that require sustained mental effort, and forgetfulness. Although Kelsey's parents identify only one symptom in the home setting, she exhibits multiple symptoms in the school setting. Logan is a 6-year-old kindergartener who has a newborn sister. His parents are concerned that Logan seems to be unable to occupy himself quietly when his sister is napping. Logan interrupts both his parents and other adults in the home who come to visit his sister. He gets impatient when his questions are ignored by adults. His parents endorse that the behaviors began about the same time as his mom's pregnancy was announced. Logan's teacher does not endorse the same behaviors at school; his teacher states he is quiet, reserved, and plays well with others. What is the most likely diagnosis for Logan? ADHD predominantly inattentive presentation ADHD predominantly hyperactive-impulsive presentation ADHD combined presentation unlikely ADHD diagnosis - unlikely ADHD diagnosis Rationale: Although Logan has some symptoms that are consistent with a diagnosis of ADHD, the symptom onset coincides with his mother's pregnancy. There are no concerns of symptoms at school; more information is needed to assign a diagnosis of ADHD. Xander is an 8-year-old second-grader who is the youngest of two children. His mother notes that he acts as if he has "non-stop energy." He pesters and interrupts his older sister to play when she is reading or doing homework, and he has little patience for completing his homework. Xander's mom endorses that his behavior has been consistent for the past few years. Xander's teacher notes that he fidgets during seat time, speaks out of turn in class, and runs or skips in the halls. What is the most likely diagnosis for Xander? ADHD predominantly inattentive presentation ADHD predominantly hyperactive-impulsive presentation ADHD combined presentation unlikely ADHD diagnosis - ADHD predominantly hyperactive-impulsive presentation Rationale: Xander meets diagnostic criteria for ADHD with a hyperactive-impulsive presentation, including fidgeting, "non-stop" energy, difficulty in engaging in quiet activities, speaking out of turn, excessive running, and interrupting others. The behaviors occur in school and at home and have been present consistently for several years. Belle is a 10-year-old fourth-grader who is the oldest of two children. During parent-teacher conferences, her teachers expressed concerns that she has difficulty listening and paying attention in class. She plays with her pencil and eraser constantly during lessons and, when she does pay attention, she blurts out answers to questions without waiting to be called upon. She talks to her peers during class and often interrupts the teacher to share with the class. Belle often forgets to bring her backpack or lunch to school and often leaves school without her jacket. Belle's mother notes that her daughter has always been talkative and energetic; she has difficulty keeping her things organized and must be reminded of daily chores, such as feeding her hamster. What is the most likely diagnosis for Belle? ADHD predominantly inattentive presentation ADHD predominantly hyperactive-impulsive presentation ADHD combined pres - ADHD combined presentation Rationale: Belle meets diagnostic criteria for ADHD combined presentation. She has several symptoms of hyperactive-impulsive presentation, including fidgeting, speaking out of turn, excessive talking, and interrupting. She also has symptoms of inattentive presentation, including difficulty listening, paying attention, forgetfulness, and difficulty with organization. Although her symptoms at school differ from those seen at home, she has symptoms in both environments. Rating scales for ADHD - -ADHD Rating Scales (ADHD-RS-IV and 5) -Swanson, Nolan and Pelham (SNAP) scale -Adult ADHD Self Report Scale (ASRS) -Vanderbilt scales -Conners' scales