Neurology/Psychiatry Exam #3 (ADHD/MS)

Delusions are not a characteristic of Autism Spectrum Disorders. Autism is a neurodevelopmental disorder characterized by impaired social interactions, impaired nonverbal/verbal communication, and repetitive behaviors. Delusions, on the other hand, are a symptom commonly associated with psychotic disorders such as schizophrenia, but not with autism.

Genetics are known to have a significant influence on the development of ADHD. Research has shown that ADHD tends to run in families, with a higher likelihood of the disorder occurring in individuals who have close relatives with ADHD. Twin studies have also provided evidence for a genetic component, as identical twins (who share 100% of their genes) are more likely to both have ADHD compared to fraternal twins (who share only 50% of their genes). This suggests that there is a hereditary factor involved in ADHD etiology, supporting the statement that genetics play a significant role in ADHD.

The statement suggests that combining cognitive behavior therapy (CBT) with selective serotonin reuptake inhibitors (SSRIs) is more effective in treating major depressive disorder in pediatric patients compared to using either treatment alone. This implies that the combination of therapy and medication provides better outcomes and symptom relief for pediatric patients with depression.

methlyprednisolone 500-1000mg IV, 3-5days

Risperidone is FDA approved as a pharmacologic option for Autism Spectrum Disorders. This medication is an atypical antipsychotic that helps in managing symptoms such as irritability, aggression, and self-injurious behavior in individuals with autism. It works by affecting certain chemicals in the brain that may be imbalanced in people with this disorder. Risperidone is commonly prescribed alongside behavioral therapy to provide comprehensive treatment for individuals with Autism Spectrum Disorders.

T-lymphocytes can be auto-reactive and cause damage to the myelin sheath and axon. They can also induce pro-inflammatory response, causing further damage

When treatment with stimulants, commonly used for ADHD, leads to an increase in tics, it is recommended to consider an alternative treatment option. Clonidine, also known as Catapres, is a medication that can be used to treat ADHD symptoms. It works by affecting certain chemicals in the brain and can help reduce impulsivity and hyperactivity. Therefore, it is true that treatment with clonidine can be considered when stimulants result in increased tics.

The given statement suggests that a majority (more than 70%) of ADHD cases are linked to genes. This means that genetics play a significant role in the development of ADHD. It implies that individuals with a family history of ADHD are more likely to have the condition themselves. This information aligns with previous research that has found a strong genetic component in ADHD.

Paroxetine is not expert recommended in the treatment of major depressive disorder in pediatric patients. This may be due to the fact that paroxetine has been associated with an increased risk of suicidal thoughts and behaviors in this population. Other SSRIs such as fluoxetine, citalopram, and sertraline are considered safer and more effective options for pediatric patients with major depressive disorder.

The statement suggests that the transdermal methylphenidate patch is equally effective as other forms of the medication. This implies that the patch can deliver the drug in a manner that is just as effective as oral or other administration methods. Therefore, the answer is true.

Never shake (Harlem or otherwise) before administration

Concerta is the correct answer because it is a methylphenidate medication that has an osmotic release system. This system allows for a gradual and controlled release of the medication over a 12-hour period, extending its effect throughout the day. Strattera, Vyvanse, and Daytrana are not methylphenidate medications and do not have an osmotic release system.

While more common in females, prognosis is better for females.

(Note: Double negative is used in this question so that quiz-takers know other options are indicators of unfavorable prognosis. Therefore, use of this double negative is perfectly cromulent).

While blood dyscrasias are not a common precaution, sudden cardiac event are a major potential risk.

The starting/titration dose of atomoxetine (Straterra) is 0.5 mg/kg/day. This means that for every kilogram of body weight, a starting dose of 0.5 mg of atomoxetine should be administered daily. This dose is commonly used to initiate treatment with atomoxetine and can be adjusted based on the individual's response and tolerability.

Similar side effect profiles

Amphetamine and methylphenidate are both stimulant medications that increase the levels of dopamine in the synaptic cleft. They work by blocking the reuptake of dopamine, allowing it to remain in the synapse for a longer period of time. This increased dopamine availability can lead to increased stimulation and improved focus in individuals with conditions such as attention deficit hyperactivity disorder (ADHD). Therefore, both amphetamine and methylphenidate can increase synaptic cleft levels of dopamine.

Shows significant reduction in disability progression, but is very expensive

“Metabolic disease” was not on the list provided on Slide 32 of Dr. Howrie’s notes. I’m a bad person for giving into “da man” and just went with a list.

Hyperactive/combined form = higher dose, Inattentive = lower dose

Bupropion is a mild DA and NE reuptake inhibitor

Ataxia refers to the loss of coordination of muscle movements, which is not commonly associated with the use of stimulants. Stimulants typically increase alertness, energy, and focus, but they can also have side effects such as anorexia (loss of appetite), headache, and mood changes. However, ataxia is not a commonly reported adverse effect of stimulant use.

MPD = inhibited monoamine transporter = increase dopamine & norepinephrine
Increased dopamine = increase signal-to-noise ratio = less distraction

According to the DSM-V, the diagnosis of ADHD in patients under 17 years old requires 6 symptoms, while the diagnosis of ADHD in patients over 17 years old requires 4 symptoms.

Often used in conjunction with interferon and glatiramer

The locus coeruleus NE neurons are involved in arousal and attention. Their suppression improves the therapeutic effect of these psycho stimulants.
(Note: decimus meridius = Maximus Decimus Meridius = main character from the movie “Gladiator”)

DA and NE, the are only “possibly involved”

Amphetamine’s MoA relies on modification of vesicle release of dopamine

Alpha-2-Adrenoceptor agonists such as clonidine and guanfacine are known to inhibit norepinephrine (NE) release in the locus coeruleus. The locus coeruleus is a region in the brainstem that plays a key role in regulating arousal and attention. By inhibiting NE release in this region, alpha-2-Adrenoceptor agonists can decrease sympathetic outflow and produce sedative and antihypertensive effects.

Used in the treatment of relapsing-remitting MS (RRMS)

3-6 weeks to have full effect (Half life - 5 hours, Wikipedia)
No potential for abuse
Only drug approved by the FDA for adult ADHD
May be taken once a day (effects lasts 24 hr with a carry over to the next day)

Focalin is Dexmethlyphendiate. Dose is lowered by 50%. Efficacy and tolerability is the same as methlyphenidate.

Howrie notes (slide 40) says guanfacine treatment onset

Reintroduced as a monotherapy (not adjunctive)